We have developed the Female Urinary Symptom Score (FUSS), a symptom questionnaire for the evaluation of urinary incontinence and lower urinary tract symptoms in women and their effect on quality of life. The FUSS is a modified version of the International Prostate Symptom Score adapted for use in women. It consists of a simple questionnaire of only eight questions, which patients can answer quickly on a numerical scale. We performed a validation study of the FUSS by comparing it with the King’s Health Questionnaire (KHQ), a well-validated but longer symptom questionnaire. We sent both questionnaires to 220 women between the ages of 45 and 65 years randomly selected from two general practices in the United Kingdom. Urinary symptom status was unknown; 149 (94%) of the FUSS questionnaires and 115 (73%) of the KHQs were completed correctly. Correlation was conducted on the scores of the 115 matched pairs and was high (r = 0.83). We sent another copy of the FUSS questionnaire to the same group of women after four weeks, and found that the test and re-test scores for FUSS were highly correlated (r = 0.88). We conclude that the FUSS is a simple, reliable and reproducible tool for the diagnosis of urinary symptoms in women. As it is brief, we believe that it will be useful in the primary care setting, enabling women to receive appropriate treatment and care as early as possible.

Urinary incontinence is a common and debilitating problem. Its prevalence increases with advancing age, and heavy reliance on containment products results in high costs for community services, yet evidence exists that effective treatments can be provided in primary care. This quasi-experimental study compared the knowledge, practice and perceptions of their role by community nurses before (Phase 1) and after (Phase 3) the introduction of evidence-based clinical guidelines for continence care. Local guidelines were developed from nationally published guidelines and introduced into two localities of a community NHS trust (the intervention group) with a supporting educational programme during Phase 2. An audit of patient notes showed statistically significant improvements in assessment details recorded by the intervention group, and in the numbers of patients for whom a treatment plan was identified at Phase 3. Data collected from questionnaires, interviews and focus groups showed that the majority of community nurses in both the intervention and control groups believed that their role should involve the assessment and first-line treatment/management of urinary incontinence. However, limitations in their knowledge of continence care and difficulties in enhancing that knowledge base were identified. Three themes relating to role perceptions emerged from interviews, namely assessment skills, patient capacity and role restrictions. The study raises questions about what may constitute realistic expectations of role development for community nurses. Greater development of multidisciplinary teamworking, including enhancement of the link nurse role to provide co-ordination in continence care, could be a way forward.