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Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, Kruger J, Yadav M, Dumoulin C. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J 2022; 33:2633-2667. [PMID: 35980443 PMCID: PMC9477909 DOI: 10.1007/s00192-022-05324-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. METHODS An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0-10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0-10). RESULTS After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. CONCLUSIONS There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, The Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
| | | | - Achla Batra
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ingeborg Hoff Brækken
- Kolbotn Physical Institute, Nordre Follo Municipality, Nordre Follo, Norway
- The Pelvic Floor Centre, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Yi Ling Chan
- Department of Obstetrics and Gynaecology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Cristine Homsi Jorge
- Department of Health Science Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Manisha Yadav
- Paropakar Maternity and women's hospital, Thapathali, Kathmandu, Nepal
| | - Chantale Dumoulin
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Qin Z, Dong Z, Tang H, Zhang S, Wang H, Bao M, Wei W, Shi R, Chen J, Xia B. A preliminary clinical report of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Front Surg 2022; 9:931691. [PMID: 35965861 PMCID: PMC9372293 DOI: 10.3389/fsurg.2022.931691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To study the efficacy and safety of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse. Design Patients were selected into this study on a voluntary basis to evaluate the short-term efficacy of this surgery by comparing the OP-Q scores before the operation, three months after the operation, and six months after the operation. Setting and Patients Evaluate the clinical efficacy and safety by a retrospective analysis of the clinical data of the 18 patients with POP-Q grade III–IV pelvic organ prolapse treated by the Department of Gynecology of Nanjing Medical University Affiliated Changzhou No.2 People's Hospital from April 2020 to November 2020, and their post-operation follow-ups. Interventions Patients with postoperative follow-ups found no obvious relapse without intervention measures. Measurements and Main Results The transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation was performed successfully, and the anterior and posterior walls of vagina and/or trans-vaginal hysterectomy were repaired as appropriate. Except the total vaginal length (TVL), the P values of numerical analysis for all points before, three months after, and six months after the operation were all <0.05, being statistically significant. Conclusion This method is effective in the treatment of moderate and severe pelvic organ prolapse with few complications, but more cases and longer-term follow-up data are needed to determine the long-term effect of this procedure. For the selection of puncture sites, more anatomical data are needed to get more accurate result.
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Affiliation(s)
| | - Zhiyong Dong
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | | | | | | | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Correspondence: Jiming Chen Bairong Xia
| | - Bairong Xia
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Correspondence: Jiming Chen Bairong Xia
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Brandt C, van Vuuren EJ. Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial. Physiother Can 2022; 74:126-138. [PMID: 37323710 PMCID: PMC10262738 DOI: 10.3138/ptc-2020-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/25/2020] [Accepted: 11/08/2020] [Indexed: 12/01/2023]
Abstract
Purpose: Postoperative physiotherapy in conjunction with pelvic organ prolapse (POP) surgery is still under-investigated and controversial. In this randomized controlled trial, pelvic floor muscle training (PFMT) and abdominal training were compared with a control condition (standard in-hospital treatment). Method: Eighty-one women were randomized to one of three groups. The Prolapse Quality of Life questionnaire, two-dimensional ultrasound, Pelvic Organ Prolapse Quantification System scale, the PERFECT (power, endurance, repetitions, fast contractions, every contraction timed) scheme, electromyography, Sahrmann scale, and pressure biofeedback unit (PBU) were used to measure quality of life (QOL), POP, and pelvic floor and abdominal muscle function. A mixed-model analysis of variance and the Kruskal-Wallis test was used for analysis. Results: Beneficial effects (p < 0.05) were found for the PFMT group - increased power, number of fast contractions, amount of movement, endurance, and Sahrmann and PBU measures - compared with the control group. Abdominal training led to a significant (p < 0.05) increase in bulging and discomfort, number of pelvic floor muscle contractions, and Sahrmann and PBU measures compared with the control condition; both groups showed significantly increased urinary frequency (p < 0.05). Conclusions: Postoperative physiotherapy did not have a beneficial effect on QOL or POP symptoms. PFMT and abdominal training had beneficial effects on pelvic floor muscle function and abdominal muscle measures. Additional abdominal training led to increased symptoms.
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Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - E.C. Janse van Vuuren
- School of Allied Health Professions, University of the Free State, Bloemfontein, Free State, South Africa
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Giagio S, Innocenti T, Salvioli S, Lami A, Meriggiola MC, Pillastrini P, Gava G. Completeness of exercise reporting among randomized controlled trials on pelvic floor muscle training for women with pelvic organ prolapse: A systematic review. Neurourol Urodyn 2021; 40:1424-1432. [PMID: 34058016 PMCID: PMC8362041 DOI: 10.1002/nau.24712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
AIMS This systematic review aimed to assess the completeness of exercise reporting in randomized controlled trials (RCTs) on pelvic floor muscle training (PFMT) for women with pelvic organ prolapse (POP). METHODS MEDLINE, Cochrane Central, CINHAL, Embase, SCOPUS, and PEDro databases were searched up to October 2020. Full-text RCTs comparing PFMT to any type of intervention among women with any type and stage of POP were eligible for inclusion. Completeness of intervention was evaluated with t20he template for intervention description and replication (TIDieR) and the consensus on exercise reporting template (CERT). Inter-rater agreement for each item of the tools was calculated. RESULTS Twenty-six RCTs were included. None of the studies completely reported all intervention descriptors. On average 57.1% (6.8 ± 2.4; out of 12) of the overall TIDieR items and 35.3% (6.7 ± 2.9; out of 19) of the CERT were well described. In particular, 7 and 5 items were completely reported more than 50% of the time for the TIDieR and CERT, respectively. Frequent shortcomings were the undetailed reporting of information regarding tailoring and modifications of exercises and their adherence. Detailed descriptions of exercise repetitions to enable replication were missing in 53.8%. According to the CERT, only 11.5% of the RCTs sufficiently described the main providers' characteristics. CONCLUSION The completeness of PFMT reporting for women with POP is still below desirable standards and it is insufficient to ensure transferability into practice. The present results may add relevant knowledge and contribute to improving adequate reporting of exercise.
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Affiliation(s)
- Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziano Innocenti
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, The Netherlands
| | - Stefano Salvioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Alessandra Lami
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Gava
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Mathew S, Nyhus MØ, Salvesen Ø, Salvesen KÅ, Stafne SN, Volløyhaug I. The effect of preoperative pelvic floor muscle training on urinary and colorectal-anal distress in women undergoing pelvic organ prolapse surgery-a randomized controlled trial. Int Urogynecol J 2021; 32:2787-2794. [PMID: 33580809 PMCID: PMC8455377 DOI: 10.1007/s00192-021-04684-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis Pelvic floor muscle training (PFMT) improves urinary incontinence and mild pelvic organ prolapse (POP). We aimed to investigate the effect of preoperative PFMT on urinary and colorectal-anal distress and related quality of life (QoL) in women with severe POP scheduled for surgery. Methods Randomized controlled trial of 159 women scheduled for POP surgery (intervention = 81, controls = 78). Intervention consisted of daily PFMT from inclusion to the day of surgery. Symptoms and QoL were assessed at inclusion, day of surgery and 6 months postoperatively using the Urinary Distress Inventory (UDI-6), Colorectal-Anal Distress Inventory (CRADI-8), Urinary Impact Questionnaire (UIQ) and Colorectal-Anal Impact Questionnaire (CRAIQ) (range 0–100). Mixed model statistical analyses were used. Results One hundred fifty-one (95%) women completed the study (intervention = 75, controls = 76). Mean waiting times until surgery and follow-up were 22 and 28 weeks. There was no difference in mean postoperative symptom and QoL scores (95% CI) between the intervention and control group: UDI-6 16 (12–21) vs. 17 (13–22), CRADI-8 15 (11–18) vs. 13 (10–16), UIQ 11 (7–15) vs. 10 (6–13) and CRAIQ 5 (2–7) vs. 6 (4–9), all p > 0.05. Overall mean scores were reduced from baseline to postoperative follow-up: UDI-6 37 (33–41) vs. 17 (14–20), CRADI-8 22 (19–25) vs. 14 (11–16); UIQ 28 (24–32) vs. 10 (7–13) and CRAIQ 16 (12–19) vs. 5 (3–7), all p < 0.01. Conclusions We found no added effect of preoperative PFMT on symptoms or QoL related to urinary and colorectal-anal distress in women scheduled for POP surgery. They achieved symptomatic improvement postoperatively regardless of PFMT. Clinical trial registration The study was registered in clinicaltrials.gov: NCT 03,064,750.
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Affiliation(s)
- Seema Mathew
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Maria Øyasæter Nyhus
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olavs University Hospital, Trondheim, Norway
| | - Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Basnet R. Impact of pelvic floor muscle training in pelvic organ prolapse. Int Urogynecol J 2021; 32:1351-1360. [PMID: 33416965 DOI: 10.1007/s00192-020-04613-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This review article was aimed at evaluating the effectiveness of pelvic floor muscle training (PFMT) during conservative management and as an adjunct to prolapse surgery based on recently published articles. METHODS The PubMed and PEdro databases were searched from 2005 to 2020 for all types of studies reporting on PFMT as the primary treatment for conservative management of prolapse as well as an adjunct for prolapse surgery. RESULT The result of this review demonstrated that PFMT is effective in conservative management, especially in women with mild to moderate prolapse(stages I-III), for those who wish to have more children, who are not willing to undergo surgery, who are frail because of co-morbidities, and for those who need to delay surgery. However, results evaluating the effectiveness of PFMT as an adjunct to surgery demonstrated insufficient evidence to support the benefit of PFMT in addition to prolapse surgery over the use of surgery alone. CONCLUSION Through this review, we have concluded that PFMT shows a more prominent effect when applied as conservative management. Currently available evidence demonstrated no additional clinically significant augmentation of PFMT as an adjunct to surgery compared with prolapse surgery alone.
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Affiliation(s)
- Ritu Basnet
- Department of Physiotherapy, Scheer Memorial Adventist Hospital, Banepa, Kavre, Nepal.
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Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol 2020; 31:485-493. [PMID: 31609735 DOI: 10.1097/gco.0000000000000584] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. RECENT FINDINGS Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. SUMMARY PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.
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Nyhus MØ, Mathew S, Salvesen Ø, Salvesen KÅ, Stafne S, Volløyhaug I. Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:28-36. [PMID: 32144829 DOI: 10.1002/uog.22007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the effect of preoperative pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction, symptoms of pelvic organ prolapse (POP) and anatomical POP, 6 months after prolapse surgery, and to assess the overall changes in PFM contraction, POP symptoms and pelvic organ descent after surgery. METHODS This was a randomized controlled trial of 159 women with symptomatic POP, Stage 2 or higher, scheduled for surgery. Participants were randomized to intervention including daily PFMT from inclusion to surgery (n = 81) or no intervention (controls; n = 78). Participants were examined at inclusion, on the day of surgery and 6 months after surgery. PFM contraction was assessed by: vaginal palpation using the Modified Oxford scale (MOS; 0-5); transperineal ultrasound, measuring the percentage change in levator hiatal anteroposterior diameter (APD) from rest to maximum PFM contraction; vaginal manometry; and surface electromyography (EMG). POP distance from the hymen in the compartment with the most dominant prolapse and organ descent in the anterior, central and posterior compartments were measured on maximum Valsalva maneuver. POP symptoms were assessed based on the sensation of vaginal bulge, which was graded using a visual analog scale (VAS; 0-100 mm). Linear mixed models were used to assess the effect of PFMT on outcome variables. RESULTS Of the 159 women randomized, 151 completed the study, comprising 75 in the intervention and 76 in the control group. Mean waiting time for surgery was 22 ± 9.7 weeks and follow-up was performed on average 28 ± 7.8 weeks after surgery. Postoperatively, no difference was found between the intervention and control groups with respect to PFM contraction assessed by vaginal palpation (MOS, 2.4 vs 2.2; P = 0.101), manometry (19.4 vs 19.7 cmH2 O; P = 0.793), surface EMG (33.5 vs 33.1 mV; P = 0.815) and ultrasound (change in hiatal APD, 20.9% vs 19.3%; P = 0.211). Furthermore, no difference between groups was found for sensation of vaginal bulge (VAS, 7.4 vs 6.0 mm; P = 0.598), POP distance from the hymen in the dominant prolapse compartment (-1.8 vs -2.0 cm; P = 0.556) and sonographic descent of the bladder (0.5 vs 0.8 cm; P = 0.058), cervix (-1.3 vs -1.1 cm; P = 0.569) and rectal ampulla (0.3 vs 0.4 cm; P = 0.434). In all patients, compared with findings at initial examination, muscle contraction improved after surgery, as assessed by palpation (MOS, 2.1 vs 2.3; P = 0.007) and ultrasound (change in hiatal APD, 17.5% vs 20.1%; P = 0.001), and sensation of vaginal bulge was reduced (VAS, 57.6 vs 6.7 mm; P < 0.001). In addition, compared with the baseline examination, POP distance from the hymen in the dominant prolapse compartment (1.9 vs -1.9 cm; P < 0.001) and sonographic descent of the bladder (1.3 vs 0.6 cm; P < 0.001), cervix (0.0 vs -1.2 cm; P < 0.001) and rectal ampulla (0.9 vs 0.4 cm; P = 0.001) were reduced. CONCLUSIONS We found no effect of preoperative PFMT on PFM contraction, POP symptoms or anatomical prolapse after surgery. In all patients, PFM contraction and POP symptoms were improved at the 6-month follow-up, most likely due to the anatomical correction of POP. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ø Nyhus
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Mathew
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ø Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Services, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - I Volløyhaug
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Duarte TB, Bø K, Brito LGO, Bueno SM, Barcelos TM, Bonacin MA, Ferreira CH. Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial. J Physiother 2020; 66:27-32. [PMID: 31843420 DOI: 10.1016/j.jphys.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
QUESTION In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? DESIGN Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-six women with an indication for POP surgery. INTERVENTION The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. OUTCOME MEASURES Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. RESULTS There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference -6, 95% CI -25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference -4, 95% CI -23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference -0.4 (95% CI -0.8 to -0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. CONCLUSION In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function. TRIAL REGISTRATION ReBEC, RBR-29kgz5.
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Affiliation(s)
- Thaiana B Duarte
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences and Department of Obstetrics and Gynecology, University Hospital, Lørenskog, Norway
| | - Luiz Gustavo O Brito
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sabrina M Bueno
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Thays Mr Barcelos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marília Ap Bonacin
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Cristine Hj Ferreira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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Liang Y, Li X, Wang J, Liu Y, Yang Yang, Dong M. Effect of Pelvic Floor Muscle Training on Improving Prolapse-related Symptoms After Surgery. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mastwyk S, McClelland J, Rosamilia A, Frawley H. The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review. Neurourol Urodyn 2019; 38:1467-1481. [DOI: 10.1002/nau.24025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sally Mastwyk
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Jodie McClelland
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Anna Rosamilia
- Department of Obstetrics and GynaecologyMonash UniversityClayton Victoria Australia
- Monash HealthClayton Victoria Australia
| | - Helena Frawley
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourne Victoria Australia
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Brandt C, Janse van Vuuren EC. Dysfunction, activity limitations, participation restriction and contextual factors in South African women with pelvic organ prolapse. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:933. [PMID: 30863799 PMCID: PMC6407468 DOI: 10.4102/sajp.v75i1.933] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pelvic organ prolapse (POP) is a multifactorial, poorly understood condition impacting quality of life (QOL). The pathology and aetiology might imply population-specific differences in domains of the International Classification of Function, Disability and Health (ICF). There is, however, a lack of research in this regard in South Africa. Objectives To describe the dysfunction, activity limitations, participation restrictions and contextual factors in South African women with POP. Method One hundred women were conveniently sampled in a primary health care setting. They completed a self-compiled medical and exercise history questionnaire, the standardised Prolapse-Quality of Life (P-QOL) questionnaire and the Visual Faces Scale. The stage of prolapse was determined by the Pelvic Organ Prolapse Quantification (POP-Q) Scale. Means, medians, standard deviations, percentages and frequencies were calculated. Results Eighty-six per cent had a stage III POP, 57% had overactive bladder, 50% had constipation, 37% had stress urinary incontinence, 31% had urge urinary incontinence, 32% had incomplete emptying and 30% had anal incontinence. Comorbidities included cardiovascular disease (65%), depressive symptoms (12%) and hypothyroidism (18%). Other contextual factors included limited physical activity (80%), an increased body mass index (29 kg/m2), older age (59 years) and unemployment (80%). Quality of life was affected in the severity, social, emotional and sleep/energy domains (median scores were 66.7% – 33.3%). Conclusion The dysfunction domain of the ICF was similar to other populations with POP. Activity and participation restrictions included social, emotional and sleep/energy aspects. Contextual factors seem to be population-specific, possibly leading to differences comparing QOL amongst different populations. Clinical implications Activity and participation restrictions, as well as contextual factors, may differ in different populations with POP. Interactions between contextual factors and movement impairment should be considered during management and be further investigated.
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Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, University of the Witwatersrand, South Africa
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Haya N, Feiner B, Baessler K, Christmann‐Schmid C, Maher C. Perioperative interventions in pelvic organ prolapse surgery. Cochrane Database Syst Rev 2018; 8:CD013105. [PMID: 30121957 PMCID: PMC6513581 DOI: 10.1002/14651858.cd013105] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pelvic organ prolapse (POP) affects as many as 50% of parous women, with 14% to 19% of women undergoing a surgical correction. Although surgery for the treatment of POP is common, limited supportive data can be found in the literature regarding the preoperative and postoperative interventions related to these procedures. The main goal of perioperative interventions is to reduce the rate of adverse events while improving women's outcomes following surgical intervention for prolapse. A broad spectrum of perioperative interventions are available, and although the benefits of interventions such as prophylactic antibiotics before abdominal surgery are well established, others are unique to women undergoing POP surgeries and as such need to be investigated separately. OBJECTIVES The aim of this review is to compare the safety and effectiveness of a range of perioperative interventions versus other interventions or no intervention (control group) at the time of surgery for pelvic organ prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In Process, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings (searched 30 November 2017), and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) of women undergoing surgical treatment for symptomatic pelvic organ prolapse that compared a perioperative intervention related to pelvic organ prolapse surgery versus no treatment or another intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Our primary outcomes were objective failure at any site and subjective postoperative prolapse symptoms. We also measured adverse effects, focusing on intraoperative blood loss and blood transfusion, intraoperative ureteral injury, and postoperative urinary tract infection. MAIN RESULTS We included 15 RCTs that compared eight different interventions versus no treatment for 1992 women in five countries. Most interventions were assessed by only one RCT with evidence quality ranging from very low to moderate. The main limitation was imprecision, associated with small sample sizes and low event rates.Pelvic floor muscle training (PFMT) compared with no treatment (three RCTs) - peri-operative intervention The simplest of the PFMT programmes required women to attend six perioperative consultations in the three months surrounding prolapse surgery. Trial results provided no clear evidence of a difference between groups in objective failure at any site at 12 to 24 months (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.56 to 1.54; two RCTs, 327 women; moderate-quality evidence). With respect to awareness of prolapse, findings were inconsistent. One RCT found no evidence of a difference between groups at 24 months (OR 1.07, 95% CI 0.61 to 1.87; one RCT, 305 women; low-quality evidence), and a second small RCT reported symptom reduction from the Pelvic Organ Prolapse Symptom Questionnaire completed by the intervention group at 12 months (mean difference (MD) -3.90, 95% CI -6.11 to -1.69; one RCT, 27 women; low-quality evidence). Researchers found no clear differences between groups at 24-month follow-up in rates of repeat surgery (or pessary) for prolapse (OR 1.92, 95% CI 0.74 to 5.02; one RCT, 316 women; low-quality evidence).Other interventionsSingle RCTs evaluated the following interventions: preoperative guided imagery (N = 44); injection of vasoconstrictor agent at commencement of vaginal prolapse surgery (N = 76); ureteral stent placement during uterosacral ligament suspension (N = 91); vaginal pack (N = 116); prophylactic antibiotics for women requiring postoperative urinary catheterisation (N = 159); and postoperative vaginal dilators (N = 60).Two RCTs evaluated bowel preparation (N = 298), and four RCTs assessed the method and timing of postoperative catheterisation (N = 514) - all in different comparisons.None of these studies reported our primary review outcomes. One study reported intraoperative blood loss and suggested that vaginal injection of vasoconstrictors at commencement of surgery may reduce blood loss by a mean of about 30 mL. Another study reported intraoperative ureteral injury and found no clear evidence that ureteral stent placement reduces ureteral injury. Three RCTs reported postoperative urinary tract infection and found no conclusive evidence that rates of urinary tract infection were influenced by use of a vaginal pack, prophylactic antibiotics, or vaginal dilators. Other studies did not report these outcomes. AUTHORS' CONCLUSIONS There was a paucity of data about perioperative interventions in pelvic organ prolapse surgery. A structured programme of pelvic floor muscle training before and after prolapse surgery did not consistently demonstrate any benefit for the intervention; however, this finding is based on the results of two small studies. With regard to other interventions (preoperative bowel preparation and injection of vasoconstrictor agent, ureteral stent placement during uterosacral ligament suspension, postoperative vaginal pack insertion, use of vaginal dilators, prophylactic antibiotics for postoperative catheter care), we found no evidence regarding rates of recurrent prolapse and no clear evidence that these interventions were associated with clinically meaningful reductions in adverse effects, such as intraoperative or postoperative blood transfusion, intraoperative ureteral injury, or postoperative urinary tract infection.
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Affiliation(s)
- Nir Haya
- Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion‐Israel Institute of TechnologyDepartment of Obstetrics and Gynaecology6 Michal StHaifaIsrael34364
| | - Benjamin Feiner
- Hillel Yaffe Medical Center, Technion UniversityDepartment of Urogynecology & Reconstructive Pelvic SurgeryHa‐Shalom StHaderaIsrael38100
| | - Kaven Baessler
- Franziskus and St Joseph Hospitals BerlinUrogynaecology DepartmentBudapester Str. 15‐19BerlinGermany10787
| | | | - Christopher Maher
- Royal Brisbane and Women's HospitalUniversity QueenslandBrisbaneQueenslandAustralia
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Lasak AM, Jean-Michel M, Le PU, Durgam R, Harroche J. The Role of Pelvic Floor Muscle Training in the Conservative and Surgical Management of Female Stress Urinary Incontinence: Does the Strength of the Pelvic Floor Muscles Matter? PM R 2018; 10:1198-1210. [PMID: 29753829 DOI: 10.1016/j.pmrj.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/06/2018] [Accepted: 03/02/2018] [Indexed: 01/23/2023]
Abstract
The purpose of this review is to provide an in-depth overview of the role of pelvic floor muscle (PFM) training in the management of stress urinary incontinence (SUI). The definition, epidemiology, and pathogenesis of SUI are described. We review the anatomy of the PFM and the importance of PFM strength in maintaining urinary continence and establishing normal voiding function. A brief description of the surgical options currently available for SUI and the existing data regarding the role of perioperative PFM training for SUI are included. Critical research questions to better evaluate and assess PFM training during the perioperative period are proposed. Promising novel approaches in the treatment of SUI are also presented. This review is useful for physiatrists, urogynecologists, female urologists, and nurse practitioners who specialize in the management and treatment of women with SUI. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Anna Maria Lasak
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(∗)
| | | | - Phuong Uyen Le
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, 150 East 210(th) Street, 2(nd) floor, Bronx, NY 10467(‡).
| | - Roshni Durgam
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(§)
| | - Jessica Harroche
- Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(¶)
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Duarte TB, Bonacin MAP, Brito LGO, Frawley H, Dwyer PL, Thomas E, Ferreira CHJ. Does pelvic floor muscle maximum voluntary contraction improve after vaginal pelvic organ prolapse surgery? A prospective study. Neurourol Urodyn 2018. [DOI: 10.1002/nau.23503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thaiana B. Duarte
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Marília A. P. Bonacin
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Luiz G. O. Brito
- Department of Gynecology and Obstetrics; School of Medical Sciences; University of Campinas; Brazil
| | - Helena Frawley
- Department of Physiotherapy; School of Primary and Allied Health Care; Monash University; Melbourne Australia
| | - Peter L. Dwyer
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Elizabeth Thomas
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Cristine H. J. Ferreira
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
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Weidner AC, Barber MD, Markland A, Rahn DD, Hsu Y, Mueller ER, Jakus-Waldman S, Dyer KY, Warren LK, Gantz MG. Perioperative Behavioral Therapy and Pelvic Muscle Strengthening Do Not Enhance Quality of Life After Pelvic Surgery: Secondary Report of a Randomized Controlled Trial. Phys Ther 2017; 97:1075-1083. [PMID: 29077924 PMCID: PMC6075557 DOI: 10.1093/ptj/pzx077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/25/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transvaginal reconstructive surgery for prolapse. OBJECTIVE The purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). DESIGN This study is a secondary report of a 2 × 2 factorial randomized controlled trial. SETTING This study was a multicenter trial. PARTICIPANTS Participants were adult women with stage 2-4 POP and SUI. INTERVENTION Perioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided. MEASUREMENTS Participants undergoing transvaginal surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores. RESULTS The 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures. LIMITATIONS The clinicians providing BPMT had variable expertise. Findings might not apply to vaginal prolapse procedures without slings or abdominal apical prolapse procedures. CONCLUSIONS Perioperative BPMT performed as an adjunct to vaginal surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care.
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Affiliation(s)
- Alison C. Weidner
- A.C. Weidner, MD, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Dr, Suite 310, Durham, NC 27707 (USA).,Address all correspondence to Dr Weidner at:
| | - Matthew D. Barber
- M.D. Barber, MD, MHS, Department of Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alayne Markland
- A. Markland, MD, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - David D. Rahn
- D.D. Rahn, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yvonne Hsu
- Y. Hsu, MD, Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, Utah
| | - Elizabeth R. Mueller
- Elizabeth R. Mueller, MD, Department of Urology, Loyola University Medical Center Stritch School of Medicine, Chicago, Illinois
| | - Sharon Jakus-Waldman
- Sharon Jakus-Waldman, MD, MPH, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Downey, California
| | - Keisha Y. Dyer
- K.Y. Dyer, MD, MPH, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, California
| | - Lauren Klein Warren
- Lauren Klein Warren, MS, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Marie G. Gantz
- Marie G. Gantz, PhD, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
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Prehabilitation in gynecological surgery? What do gynecologists know and need to know. Arch Gynecol Obstet 2017; 297:27-31. [DOI: 10.1007/s00404-017-4565-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]
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Beckenbodenfunktionsstörung. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, Fünfgeld C, Gabriel B, Henscher U, Hetzer FH, Hübner M, Junginger B, Jundt K, Kropshofer S, Kuhn A, Logé L, Nauman G, Peschers U, Pfiffer T, Schwandner O, Strauss A, Tunn R, Viereck V. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Affiliation(s)
- K. Baeßler
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - T. Aigmüller
- Universitätsklinik für Gynäkologie und Geburtshilfe, Med Uni Graz, Austria
| | - S. Albrich
- Praxis “Frauenärzte Fünf Höfe” München, München, Germany
| | | | - D. Finas
- Evangelisches Krankenhaus Bielefeld EvKB, Bielefeld, Germany
| | - T. Fink
- Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | | | - B. Gabriel
- St. Josefʼs Hospital Wiesbaden, Wiesbaden, Germany
| | - U. Henscher
- Praxis für Physiotherapie, Hannover, Germany
| | | | - M. Hübner
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - B. Junginger
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - K. Jundt
- Frauenarztpraxis am Pasinger Bahnhof, München, Germany
| | | | - A. Kuhn
- Inselspital Bern, Bern, Switzerland
| | - L. Logé
- Sana Klinikum Hof GmbH, Hof, Germany
| | - G. Nauman
- Helios Klinikum Erfurt, Erfurt, Germany
| | | | - T. Pfiffer
- Asklepios Klinik Hamburg Harburg, Hamburg, Germany
| | | | - A. Strauss
- Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - R. Tunn
- St. Hedwig Krankenhaus, Berlin, Germany
| | - V. Viereck
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Kow N, Siff L, Ferzandi TR. Nonsurgical vs. Surgical Treatment Options for Pelvic Organ Prolapse: Review of the Current Evidence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pelvic organ prolapse in women: how is it diagnosed and treated currently? MENOPAUSE REVIEW 2015; 14:155-60. [PMID: 26528102 PMCID: PMC4612550 DOI: 10.5114/pm.2015.54338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/17/2022]
Abstract
The aim of the paper was to summarize the current opinions about the management of pelvic organ prolapse in women. Food and Drug Administration safety announcements from 2008 and 2011 triggered the discussion about the methods of treatment of pelvic organ prolapse and the used materials and a partial return to the methods which had been totally criticized before the implementation of meshes. The decrease in mesh usage is also observed. The studies did not demonstrate the prevalence of any particular surgical procedure. The amount of studies concerning the evaluation and the treatment of pelvic organ prolapse ensures that the quality of care provided to women with urogynecological problems is continuously increasing.
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Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2015; 27:981-92. [PMID: 26407564 DOI: 10.1007/s00192-015-2846-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to assess the effectiveness of pelvic floor muscle training (PFMT) as a treatment for women with pelvic organ prolapse (POP) or as an adjunct to prolapse surgery. METHODS Relevant literature sources were searched using databases including PubMed, Ovid, Web of Science, Scopus, ClinicalTrials.gov, EBSCO, CINAHL, the Cochrane Central Register of Controlled Trials, CNKI, VIP, Wanfang, and CBM until 5 July 2015. Eligible studies were restricted to randomized controlled trials (RCT). The available data were pooled using Review Manager version 5.2. For data deemed not appropriate for synthesis, a narrative overview was conducted. RESULTS In total, 13 studies with 2,340 patients were included. Our results indicated women receiving PFMT gained a greater improvement than controls in prolapse symptom score [mean difference (MD) -3.07, 95 % confidence interval (CI) -3.91 to -2.23] and POP stages [risk ratio (RR) 1.70, 95 % CI 1.19-2.44]. The number of women who said their prolapse was getting better was higher (RR 5.48, 95 % CI 2.19-13.72) and other discomfort syndromes, such as vaginal, bladder, and rectum, were lower in the PFMT groups than in controls. Meanwhile, women after PFMT had greater improvement in muscle strength and endurance but did not show a significant difference for further treatment needs. In addition, the results evaluating PFMT as an adjunct to prolapse surgery were inconclusive because of the variability in methods of measuring outcome. CONCLUSIONS Our meta-analysis demonstrated women who received PFMT showed a greater subjective improvement in prolapse symptoms and an objective improvement in POP severity.
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Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 536 Changle Road, Shanghai, 200040, China.
| | - Yuping Gong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
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Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, Herbert J, Hay-Smith J, Frawley H, McClurg D, Dean S. Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies-2011 ICS State-of-the-Science Seminar Research Paper II of IV. Neurourol Urodyn 2015; 34:615-21. [PMID: 25998493 DOI: 10.1002/nau.22794] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/17/2015] [Indexed: 11/05/2022]
Abstract
AIMS This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. METHOD Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. RESULTS The literature was scarce for most of the studied populations except for limited research on women with UI. OUTCOME MEASURES Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. STRATEGIES Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. CONCLUSION The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
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Affiliation(s)
- Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.,Urogynacological Health and Aging Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - Dianne Alewijnse
- Patient Education, PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Kari Bo
- Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Suzanne Hagen
- Health Services Research, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Diane Stark
- Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom
| | - Marijke Van Kampen
- Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium
| | | | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Helena Frawley
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Research, Cabrini Health, Melbourne, Australia
| | - Doreen McClurg
- Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sarah Dean
- Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom
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Zhang FW, Wei F, Wang HL, Pan YQ, Zhen JY, Zhang JX, Yang KH. Does pelvic floor muscle training augment the effect of surgery in women with pelvic organ prolapse? A systematic review of randomized controlled trials. Neurourol Urodyn 2015; 35:666-74. [PMID: 25932625 DOI: 10.1002/nau.22784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/20/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is often used as a treatment for pelvic organ prolapse (POP) and can improve function. However, the effectiveness of this modality as an adjunct to prolapse surgery for women with POP is unknown. AIMS To evaluate whether the use of pelvic floor muscle training as an adjunct to prolapse surgery is superior to surgery alone for women with pelvic organ prolapse. METHODS We searched PubMed, Embase, the Cochrane Library, and the Web of Science from their inception dates to June 30, 2014 for data describing randomized controlled trials (RCTs) that compare the efficacy of PFMT with or without lifestyle modification plus surgery versus surgery alone for women with POP. Additional relevant studies were identified by searching the references of retrieved articles and using Google Scholar. Two investigators independently reviewed and selected relevant studies that met the pre-specified inclusion criteria, extracted the data, and assessed the risk of bias in the included studies according to the Cochrane Handbook, version 5.1.0. Due to great heterogeneity in the choice and reporting of outcome measures and the different durations of follow-up among the studies, this analysis is confined to a qualitative systematic review. RESULTS Five RCTs involving 591 women were reviewed (treatment group [TG], 292 cases; control group [CG], 299 cases). Generally, the five RCTs exhibited low risk of bias. This study indicated no significant improvement in prolapse symptoms, in quality of life, or in the degree of prolapse for women with POP in the TG compared to those in the CG. CONCLUSIONS Insufficient evidence was found to support adding perioperative PFMT to surgery over the use of surgery alone in women undergoing surgery for POP. Adequately, powered RCTs with longer follow-up periods are required to evaluate the long-term effect of perioperative PFMT. Neurourol. Urodynam. 35:666-674, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Feng-Wa Zhang
- The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China.,Evidence Based Medicine Center of Lanzhou University, Lanzhou, Gansu, China.,Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of, Gansu Province, Lanzhou, Gansu, China
| | - Fen Wei
- Department of Obstetric, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Hai-Lin Wang
- The Second Department of Gynecology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuan-Qing Pan
- Department of Medical Psychology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Jie-Yu Zhen
- The Second Department of Gynecology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jv-Xia Zhang
- Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ke-Hu Yang
- Evidence Based Medicine Center of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of, Gansu Province, Lanzhou, Gansu, China
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Burgio KL. Update on behavioral and physical therapies for incontinence and overactive bladder: the role of pelvic floor muscle training. Curr Urol Rep 2014; 14:457-64. [PMID: 23913199 DOI: 10.1007/s11934-013-0358-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Behavioral and physical therapies have been used for many years to treat incontinence and overactive bladder (OAB). This paper focuses on programs that include pelvic floor muscle training (PFMT) as a component in treatment for women or men. PFMT was long used almost exclusively for treatment of stress incontinence. When it became evident that voluntary pelvic floor muscle contraction can be used to control bladder function, PFMT was also integrated into the treatment of urge incontinence and OAB as part of a broader behavioral urge suppression strategy. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment. The collective literature indicates that PFMT is effective for incontinence, as well as urgency, frequency, and nocturia. It can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms.
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Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, Menefee SA, Lukacz ES, Norton P, Schaffer J, Nguyen JN, Borello-France D, Goode PS, Jakus-Waldman S, Spino C, Warren LK, Gantz MG, Meikle SF. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311:1023-34. [PMID: 24618964 PMCID: PMC4083455 DOI: 10.1001/jama.2014.1719] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE More than 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE To compare outcomes between (1) SSLF and ULS and (2) perioperative BPMT and usual care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS Multicenter, 2 × 2 factorial, randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 US medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS The surgical intervention was transvaginal surgery including midurethral sling with randomization to SSLF (n = 186) or ULS (n = 188); the behavioral intervention was randomization to receive perioperative BPMT (n = 186) or usual care (n = 188). MAIN OUTCOMES AND MEASURES The primary outcome for the surgical intervention (surgical success) was defined as (1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success), (2) no bothersome vaginal bulge symptoms, and (3) no re-treatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0-300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0-300, higher scores worse) and anatomic success. RESULTS At 2 years, surgical group was not significantly associated with surgical success rates (ULS, 59.2% [93/157] vs SSLF, 60.5% [92/152]; unadjusted difference, -1.3%; 95% CI, -12.2% to 9.6%; adjusted odds ratio [OR], 0.9; 95% CI, 0.6 to 1.5) or serious adverse event rates (ULS, 16.5% [31/188] vs SSLF, 16.7% [31/186]; unadjusted difference, -0.2%; 95% CI, -7.7% to 7.4%; adjusted OR, 0.9; 95% CI, 0.5 to 1.6). Perioperative BPMT was not associated with greater improvements in urinary scores at 6 months (adjusted treatment difference, -6.7; 95% CI, -19.7 to 6.2), prolapse scores at 24 months (adjusted treatment difference, -8.0; 95% CI, -22.1 to 6.1), or anatomic success at 24 months. CONCLUSIONS AND RELEVANCE Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, or adverse event outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse outcomes at 2 years. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00597935.
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Affiliation(s)
- Matthew D Barber
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Linda Brubaker
- Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Kathryn L Burgio
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham4Department of Veterans Affairs, Birmingham, Alabama
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Medical Center, Salt Lake City
| | - Alison C Weidner
- Department of Obstetrics and Gynecology, Duke University, Medical Center, Durham, North Carolina
| | - Shawn A Menefee
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, San Diego
| | - Emily S Lukacz
- Department of Reproductive Medicine, University of California San Diego Health Systems
| | - Peggy Norton
- Department of Obstetrics and Gynecology, University of Utah, Medical Center, Salt Lake City
| | - Joseph Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - John N Nguyen
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Downey
| | | | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham4Department of Veterans Affairs, Birmingham, Alabama
| | - Sharon Jakus-Waldman
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Downey
| | - Cathie Spino
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Lauren Klein Warren
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Marie G Gantz
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Susan F Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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McClurg D, Hilton P, Dolan L, Monga A, Hagen S, Frawley H, Dickinson L. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. Int Urogynecol J 2014; 25:883-91. [PMID: 24500453 PMCID: PMC4057627 DOI: 10.1007/s00192-013-2301-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/06/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is evidence that in nonsurgical populations, pelvic floor muscle training (PFMT) and lifestyle advice improves symptoms and stage of pelvic organ prolapse (POP). Some women, however, require surgery, after which de novo symptoms can develop or additional surgery is required due to recurrence. Robust evidence is required as to the benefit of perioperative PFMT in the postsurgery reduction of symptoms and POP recurrence. The aim of this study was to assess the feasibility of and collect pilot data to inform sample size (SS) calculation for a multicentre randomised controlled trial (RCT) of perioperative PFMT following surgical intervention for POP. METHODS Fifty-seven participants were recruited and randomised to a treatment group (one pre and six postoperative PFMT sessions) or a control group (usual care). The primary outcome measure was the Pelvic Organ Prolapse Symptom Score (POP-SS) at 12 months; secondary outcome measures included measurement of prolapse, the pelvic floor and questionnaires relating to urinary and bowel incontinence. All outcomes were measured at 0, 6 and 12 months. RESULTS Information on recruitment, retention and appropriateness of outcome measures for a definitive trial was gathered, and data enabled us to undertake an SS calculation. When compared with the control group (n = 29), benefits to the intervention group (n = 28) were observed in terms of fewer prolapse symptoms at 12 months [mean difference 3.94; 95 % confidence interval (CI) 1.35-6.75; t = 3.24, p = 0.006]; however, these results must be viewed with caution due to possible selection bias. CONCLUSION With modifications to design identified in this pilot study, a multicentre RCT is feasible.
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Affiliation(s)
- Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, G40BA, UK,
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Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J 2013; 25:153-63. [PMID: 23783578 DOI: 10.1007/s00192-013-2141-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS One of the main outcomes in the assessment of the treatment of pelvic organ prolapse in women is quality of life. Using quality of life as an outcome measure is increasing in the majority of clinical trials. The aim of current study was to determine the effects of the treatment of pelvic organ prolapse on patients' quality of life using systematic review and meta-analysis. METHODS A systematic search for finding randomized controlled studies on pelvic organ prolapse published before October 2012 was conducted. The JAMA users' guide to the medical literature quality assessment scales for randomized clinical trials was used to assess the quality of included articles. The mean difference in total quality of life score between before and after intervention (surgical or pelvic floor training) with 95 % confidence interval (CI) was considered as a primary summary measure. Egger's test was used to evaluate the publication bias. Heterogeneity was assessed using I(2) Index. RESULTS Fifty-seven RCT were critically appraised. Thirty-two articles were eligible after critical evaluation. Mean difference in change in the total quality of life score with 95 % CI for surgical treatment was 74.03 (66.3-81.6) by PFDI-20 and was 44.57 (22.53-66.65) by PFIQ-7. The mean difference in changed in the total quality of life score with 95 % CI was 1.32 (-2.8-5.4) for pelvic floor training (PFT). CONCLUSION We found that surgical interventions on prolapse can improve the quality of life of women. There was a relative effect of PFT on the quality of life of women with prolapse in systematic review. This effect was not seen in meta-analysis, probably because of finding few eligible studies to pool the effect size.
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Silva Filho AL, Fonseca AMRMD, Camillato ES, Cangussu RDO. Análise dos recursos para reabilitação da musculatura do assoalho pélvico em mulheres com prolapso e incontinência urinária. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Esta revisão teve como objetivo analisar os recursos e sua eficácia na reabilitação do assoalho pélvico no tratamento dos prolapsos genitais e incontinência urinária. As buscas foram realizadas nas bases de dados MEDLINE/PubMed, LILACS/SciELO e Biblioteca Cochrane. Foram encontrados 886 artigos, dos quais foram utilizados 34 estudos clínicos relevantes que respondiam às perguntas construídas pelos autores. Os estudos analisados mostraram que o treinamento do assoalho pélvico pode ser usado no tratamento dos prolapsos, porém são necessários mais estudos randomizados para sustentar essa evidência. Para a incontinência urinária a reabilitação do assoalho pélvico é eficiente e deve ser o tratamento de primeira escolha.
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Lakeman MME, Koops SES, Berghmans BC, Roovers JPWR. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapse surgery: supported by evidence or not? Int Urogynecol J 2012; 24:371-5. [PMID: 23152045 DOI: 10.1007/s00192-012-1973-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/08/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To provide a clinical opinion based on current literature reporting on the effects of peri-operative pelvic floor muscle training (PFMT) on postoperative pelvic floor symptoms, recurrent treatment after pelvic organ prolapse (POP) surgery and current clinical practice in the Netherlands. METHODS The PubMed database was searched, with dates from 1966 to May 2012, for all types of studies reporting on the effects of peri-operative PFMT on recurrent treatment and/or pelvic floor symptoms after POP surgery. Also, current clinical practice in the Netherlands was evaluated. RESULTS Two small randomised controlled trials (RCTs), with differences in the population included, were identified. The first RCT concluded that peri-operative PFMT reduced the risk of pelvic floor symptoms 12 weeks after surgery and improved the quality of life. The second trial concluded that there is no significant beneficial effect 12 months after surgery. However, when looking at the reported outcomes in this trial micturition symptoms and quality of life improved more in the treatment group too. Studies evaluating whether peri-operative PFMT reduced the rate of recurrent treatment for POP-related symptoms, were not identified. This lack of evidence reflects the current clinical practice, as most gynaecologists do not offer peri-operative PFMT to their patients. CONCLUSIONS Peri-operative PFMT may reduce the risk of pelvic floor symptoms and improve the quality of life after POP surgery, although evidence is insufficient to implement this in current clinical practice. Since the results of the two RCTs on this topic are promising, there is an urgent need for robust, well-designed trials to evaluate the efficacy and (cost-)effectiveness of peri-operative PFMT.
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Affiliation(s)
- Marielle M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, The Netherlands.
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Abstract
BACKGROUND Pelvic organ prolapse is common, and some degree of prolapse is seen in 50% of parous women. Women with prolapse can experience a variety of pelvic floor symptoms. Treatments include surgery, mechanical devices and conservative management. Conservative management approaches, such as giving lifestyle advice and delivering pelvic floor muscle training (PFMT), are often used in cases of mild to moderate prolapse. This is an update of a Cochrane review first published in 2004, and previously updated in 2006. OBJECTIVES To determine the effects of conservative management (physical and lifestyle interventions) for the prevention or treatment of pelvic organ prolapse in comparison with no treatment or other treatment options (such as mechanical devices or surgery). SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register (searched 6 May 2010), EMBASE (1 January 1996 to 6 May 2010), CINAHL (1 January 1982 to 10 May 2010), PEDro (January 2009), the UK National Research Register (January 2009), ClinicalTrials.gov (April 2009), Current Controlled Trials register (April 2009), CENTRAL (Issue 1, 2009) and ZETOC (January 2009) and the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi-randomised trials in women with pelvic organ prolapse that included a physical or lifestyle intervention in at least one arm of the trial. DATA COLLECTION AND ANALYSIS Two reviewers assessed all trials for inclusion/exclusion and methodological quality. Data were extracted by the lead reviewer onto a standard form and cross checked by another. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Six trials were included; three of these trials are new to this update. Four trials were small (less than 25 women per arm) and two had moderate to high risk of bias. Four trials compared PFMT as a treatment for prolapse against a control group (n = 857 women); two trials included women having surgery for prolapse and compared PFMT as an adjunct to surgery versus surgery alone (n = 118 women).PFMT versus controlThere was a significant risk of bias in two out four trials in this comparison. Prolapse symptoms and women's reports of treatment outcomes (primary outcomes) were measured differently in the three trials where this was reported: all three indicated greater improvement in symptoms in the PFMT group compared to the control group. Pooling data on severity of prolapse from two trials indicated that PFMT increases the chance of an improvement in prolapse stage by 17% compared to no PFMT. The two trials which measured pelvic floor muscle function found better function (or improvement in function) in the PFMT group compared to the control group; measurements were not known to be blinded. Two out of three trials which measured urinary outcomes (urodynamics, frequency and bother of symptoms, or symptom score) reported differences between groups in favour of the PFMT group. One trial reported bowel outcomes, showing less frequency and bother with symptoms in the PFMT group compared to the control group.PFMT supplementing surgery versus surgery aloneBoth trials were small and neither measured prolapse-specific outcomes. Pelvic floor muscle function findings differed between the trials: one found no difference between trial groups in muscle strength, whilst the other found a benefit for the PFMT group in terms of stronger muscles. Similarly findings relating to urinary outcomes were contradictory: one trial found no difference in symptom score change between groups, whilst the other found more improvement in urinary symptoms and a reduction in diurnal frequency in the PFMT group compared to the control group. AUTHORS' CONCLUSIONS There is now some evidence available indicating a positive effect of PFMT for prolapse symptoms and severity. The largest most rigorous trial to date suggests that six months of supervised PFMT has benefits in terms of anatomical and symptom improvement (if symptomatic) immediately post-intervention. Further evidence relating to effectiveness and cost-effectiveness of PFMT, of different intensities, for symptomatic prolapse in the medium and long term is needed. A large trial of PFMT supplementing surgery is needed to give clear evidence about the usefulness of combining these treatments. Other comparisons which have not been addressed in trials to date and warrant consideration include those involving lifestyle change interventions, and trials aimed at prolapse prevention.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK, G4 0BA
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perioperative Physiotherapy as an Adjunct to Prolapse Surgery: An In-Depth Analysis of a Study With a Negative Result. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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