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Pecorella G, Morciano A, Sparic R, Tinelli A. Literature review, surgical decision making algorithm, and AGREE II-S comparison of national and international recommendations and guidelines in pelvic organ prolapse surgery. Int J Gynaecol Obstet 2024. [PMID: 38760975 DOI: 10.1002/ijgo.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II-S (AGREE II-S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German-speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous-hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
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Qian X, Ren D, Gu L, Ye C. Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy. BMC Womens Health 2024; 24:105. [PMID: 38331777 PMCID: PMC10851496 DOI: 10.1186/s12905-024-02942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI. STUDY DESIGN From January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals. RESULTS Only 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05). CONCLUSIONS Hysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.
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Affiliation(s)
- XiaoHong Qian
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - DongFang Ren
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - liJuan Gu
- Department of Obstetrics, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - Cong Ye
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China.
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Chen Y, Song X, Fang W, Lv T, Huang J, Cai Z, Lv J. Correlation of serum circulating testosterone levels with stress urinary incontinence in postmenopausal women. World J Urol 2023; 41:3651-3656. [PMID: 37906265 DOI: 10.1007/s00345-023-04681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Our study aimed to elucidate the possible relationship between endogenous circulating testosterone and the beginning and development of stress urinary incontinence (SUI) in postmenopausal women. PATIENTS AND METHODS The clinical data of female patients with SUI who underwent surgery at our hospital from January 2014 to February 2023 and healthy female volunteers recruited during the same period were retrospectively analyzed according to age and body mass index (BMI). Venous blood samples were taken from all subjects, and levels of estradiol, luteinizing hormone, prolactin, follicle-stimulating hormone, progesterone, and testosterone were measured by radioimmunoassay. After adjusting for age, BMI, hypertension, mode of delivery, hysterectomy, and profession, multiple logistic regression analysis was used to determine the relationship between SUI and serum testosterone levels in postmenopausal women. RESULTS Serum testosterone levels were significantly lower in women with SUI than in healthy control women (0.92 ± 0.67 vs. 1.28 ± 1.10; P < 0.05). Further comparison of testosterone levels between postmenopausal SUI women and healthy postmenopausal women in postmenopausal subjects revealed that testosterone levels were significantly lower in postmenopausal SUI women than in healthy postmenopausal women (0.84 ± 0.64 vs. 1.23 ± 1.10; P < 0.05). This difference in testosterone levels remained significant after controlling for age, BMI, hypertension, mode of delivery, hysterectomy, and profession in postmenopausal women. CONCLUSION The results of the present study indicate that low levels of serum testosterone are associated with an increased likelihood of stress urinary incontinence in women. Low serum testosterone levels may be a risk factor for SUI in postmenopausal women.
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Affiliation(s)
- Yingxiu Chen
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
- Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Xin Song
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Weilin Fang
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Tingting Lv
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Jin Huang
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Zhikang Cai
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China
| | - Jianwei Lv
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, 219 Miao Pu Road, Shanghai, 200135, China.
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Yuk JS, Cho IC, Lee JH. The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids. Int Neurourol J 2023; 27:252-259. [PMID: 38171325 PMCID: PMC10762370 DOI: 10.5213/inj.2346192.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). METHODS This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. RESULTS After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. CONCLUSION Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Inje University Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Chen CC, Peng IT, Wu MP. The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery. Gynecol Minim Invasive Ther 2023; 12:203-210. [PMID: 38034113 PMCID: PMC10683956 DOI: 10.4103/gmit.gmit_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 12/02/2023] Open
Abstract
In the "boat at the dock" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.
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Affiliation(s)
- Chin-Chiu Chen
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Ting Peng
- Division of Obstetrics, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Gupta A, Balk EM, Lenger SM, Yang LC, Misal M, Balgobin S, Chang OH, Sharma V, Stuparich M, Behbehani S, Nihira M, Alas A, Jampa A, Sheyn D, Meriwether K, Antosh DD. Changes in Pelvic Floor Symptoms After Procedural Interventions for Uterine Leiomyomas: A Systematic Review. Obstet Gynecol 2023; 142:319-329. [PMID: 37411023 DOI: 10.1097/aog.0000000000005260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To conduct a systematic review to evaluate the effect of procedural interventions for leiomyomas on pelvic floor symptoms. DATA SOURCES PubMed, EMBASE, and ClinicalTrials.gov were searched from inception to January 12, 2023, searching for leiomyoma procedures and pelvic floor disorders and symptoms, restricted to primary study designs in humans. METHODS OF STUDY SELECTION Double independent screening for studies of any study design in all languages that reported pelvic floor symptoms before and after surgical (hysterectomy, myomectomy, radiofrequency volumetric thermal ablation) or radiologic (uterine artery embolization, magnetic resonance-guided focused ultrasonography, high-intensity focused ultrasonography) procedures for management of uterine leiomyomas. Data were extracted, with risk-of-bias assessment and review by a second researcher. Random effects model meta-analyses were conducted, as feasible. TABULATION, INTEGRATION, AND RESULTS Six randomized controlled trials, one nonrandomized comparative study, and 25 single-group studies met criteria. The overall quality of the studies was moderate. Only six studies, reporting various outcomes, directly compared two procedures for leiomyomas. Across studies, leiomyoma procedures were associated with decreased symptom distress per the UDI-6 (Urinary Distress Inventory, Short Form) (summary mean change -18.7, 95% CI -25.9 to -11.5; six studies) and improved quality of life per the IIQ-7 (Incontinence Impact Questionnaire, Short Form) (summary mean change -10.7, 95% CI -15.8 to -5.6; six studies). There was a wide range of resolution of urinary symptoms after procedural interventions (7.6-100%), and this varied over time. Urinary symptoms improved in 19.0-87.5% of patients, and the definitions for improvement varied between studies. Bowel symptoms were inconsistently reported in the literature. CONCLUSION Urinary symptoms improved after procedural interventions for uterine leiomyomas, although there is high heterogeneity among studies and few data on long-term outcomes or comparing different procedures. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021272678.
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Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology, & Women's Health, University of Louisville School of Medicine, Louisville, Kentucky; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, Ohio; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of OBGYN, Division of Urogynecology, UT Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; the Department of Obstetrics and Gynecology, Jacobi Medical Center, and the Albert Einstein College of Medicine, Bronx, New York; the Department of Obstetrics and Gynecology, University of California, Riverside School of Medicine, Riverside, and KPC Healthcare, Hemet, California; the Jawaharlal Nehur Medical College, Belgaum, India; and the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up. Arch Gynecol Obstet 2022; 306:2069-2075. [PMID: 36044047 PMCID: PMC9633478 DOI: 10.1007/s00404-022-06737-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022]
Abstract
Purpose Hysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse. Methods We included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence. Results The re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03). Conclusion Hysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.
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Shin JH, Gwak CH, Park MU, Choo MS. Effects of different types of hysterectomies on postoperative urodynamics and lower urinary tract symptoms. Investig Clin Urol 2022; 63:207-213. [PMID: 35244995 PMCID: PMC8902418 DOI: 10.4111/icu.20210393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the effects of different hysterectomies—simple hysterectomy (SH) and radical hysterectomy (RH) with or without radiation therapy (RT) on urodynamics and lower urinary tract symptoms (LUTS). Materials and Methods Among patients who underwent urodynamic study between 2009 and 2019, those with RH history due to cervical cancer and SH for uterine myoma were included. Clinical parameters were compared after adjusting clinically significant baseline variables with multivariate regression. Results A total of 289 patients (RH-only, n=57; RH+RT, n=72; SH, n=160) were included. Age at hysterectomy, gap between urodynamic study and hysterectomy, body mass index, hypertension and vaginal delivery history were adjusted. Stress urinary incontinence was more likely to occur in SH group (p<0.001), while urgency urinary incontinence was more prevalent in patients with history of RH (odds ratio [OR] 6.4, 95% confidence interval 2.171–18.855; p=0.001). There was no difference in OR of mixed urinary incontinence. Higher proportion of RH patients complained of recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. On urodynamic study, RH groups had lower maximal flow rate, larger post-void residual, decreased bladder sensation and impaired detrusor contractility (all p<0.001) than SH group. Adjuvant RT resulted in decreased compliance and decrease in volume of the first sense to void. Conclusions Predominant LUTS differed among patients after different types of hysterectomy. RH resulted in inefficient bladder emptying, leading to recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. Adjuvant RT exacerbated bladder compliance and increased bladder sensation.
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Affiliation(s)
- Jung Hyun Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Chan Hoon Gwak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Uk Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study. Int Urogynecol J 2018; 30:1711-1717. [DOI: 10.1007/s00192-018-3796-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
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10
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Clinical application and mid-term results of modified vaginal closure: pelvic symptoms, quality of life, satisfaction, and regret rate. Menopause 2018; 26:395-400. [PMID: 30300298 DOI: 10.1097/gme.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of a modified vaginal closure in older women with severe pelvic organ prolapse (POP) with respect to symptoms, quality of life, postoperative satisfaction, regret rate, and complications METHODS:: From March, 2014 to December, 2016, in all, 32 women were enrolled in the study. All the participants underwent a modified vaginal closure. Records were reviewed to collect demographic characteristics and perioperative parameters. The Pelvic Floor Distress Inventory-short form 20 (PFDI-20) and the Short Form 36 Health Survey Profile (SF-36) were used to evaluate pelvic symptoms and self-perceived quality of life, respectively, 6 months postoperatively and at the latest follow-up. The Patient Global Impression of Change (PGI-C) was used to estimate the satisfaction. The satisfaction and regret rates were assessed at the latest follow-up. RESULTS After an average follow-up period of 23 months (range 8-41 months), none of the 32 women experienced recurrence of prolapse that required reoperation. During follow-up, significant improvements were observed in the Pelvic Organ Prolapse Distress Inventory (POPDI-6), Urinary Distress Inventory (UDI-6), and SF-36 results (P < 0.001). However, the Colorectal-Anal Distress Inventory (CRADI-8) results did not improve significantly (P = 0.074). None of the participants regretted undergoing this procedure, and the PGI-C indicated a satisfaction rate of 93.8%. CONCLUSIONS The modified vaginal closure showed a positive impact on POP and urinary symptoms, and consequently improved quality of life of the 32 participants. This procedure achieved a relatively high satisfaction rate and a low regret rate.
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Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, Grimes CL, Sleemi A, Singh R, Dieter AA, Crisp CC, Rahn DD. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219:129-146.e2. [PMID: 29353031 DOI: 10.1016/j.ajog.2018.01.018] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to systematically review the literature on apical pelvic organ prolapse surgery with uterine preservation compared with prolapse surgeries including hysterectomy and provide evidence-based guidelines. DATA SOURCES The sources for our data were MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to January 2017. STUDY ELIGIBILITY CRITERIA We accepted randomized and nonrandomized studies of uterine-preserving prolapse surgeries compared with those involving hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality. If 3 or more studies compared the same surgeries and reported the same outcome, a meta-analysis was performed. RESULTS We screened 4467 abstracts and identified 94 eligible studies, 53 comparing uterine preservation to hysterectomy in prolapse surgery. Evidence was of moderate quality overall. Compared with hysterectomy plus mesh sacrocolpopexy, uterine preservation with sacrohysteropexy reduces mesh exposure, operative time, blood loss, and surgical cost without differences in prolapse recurrence. Compared with vaginal hysterectomy with uterosacral suspension, uterine preservation in the form of laparoscopic sacrohysteropexy improves the C point and vaginal length on the pelvic organ prolapse quantification exam, estimated blood loss, postoperative pain and functioning, and hospital stay, but open abdominal sacrohysteropexy worsens bothersome urinary symptoms, operative time, and quality of life. Transvaginal mesh hysteropexy (vs with hysterectomy) decreases mesh exposure, reoperation for mesh exposure, postoperative bleeding, and estimated blood loss and improves posterior pelvic organ prolapse quantification measurement. Transvaginal uterosacral or sacrospinous hysteropexy or the Manchester procedure compared with vaginal hysterectomy with native tissue suspension both showed improved operative time and estimated blood loss and no worsening of prolapse outcomes with uterine preservation. However, there is a significant lack of data on prolapse outcomes >3 years after surgery, the role of uterine preservation in obliterative procedures, and longer-term risk of uterine pathology after uterine preservation. CONCLUSION Uterine-preserving prolapse surgeries improve operating time, blood loss, and risk of mesh exposure compared with similar surgical routes with concomitant hysterectomy and do not significantly change short-term prolapse outcomes. Surgeons may offer uterine preservation as an option to appropriate women who desire this choice during apical prolapse repair.
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Affiliation(s)
- Kate V Meriwether
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Cedric K Olivera
- Department of Obstetrics and Gynecology, New York University, New York, NY
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Miles Murphy
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, PA
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | | | - Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL
| | - Alexis A Dieter
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | | | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX
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Rahkola-Soisalo P, Savolainen-Peltonen H, Gissler M, Hoti F, Vattulainen P, Ylikorkala O, Mikkola TS. Increased risk for stress urinary incontinence in women with postmenopausal hormone therapy. Int Urogynecol J 2018; 30:251-256. [PMID: 29946829 DOI: 10.1007/s00192-018-3682-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of estradiol-based hormone therapy (HT) on the incidence of stress urinary incontinence (SUI) is unknown. Therefore, we compared the use of such HT regimens and tibolone in women with and without SUI. METHODS The women with a history of SUI operation (N = 15,002) were identified from the Finnish National Hospital Discharge Register, and the control women without such an operation (N = 44,389) from the Finnish Central Population Register. The use of HT was traced from the National Drug Reimbursement Register, and the odd ratios (ORs) with 95% confidence intervals (95% CIs) for SUI were calculated by using the conditional logistic regression analysis. RESULTS The cases had used any HT more often than the controls. The use of systemic estradiol-only or estradiol-progestin therapy was accompanied by an increased SUI risk (OR 3.8, 95% CI: 3.6-4.0 and OR 2.7, 95% CI: 2.6-2.9 respectively). The use of estradiol with noretisterone acetate showed a higher risk of increase than that with medroxyprogesterone acetate. Age over 55 years at the initiation of systemic HT was accompanied by a higher SUI risk increase than that under 55 years of age. The use of tibolone, an estradiol + levonorgestrel-releasing intrauterine device, or vaginal estradiol also increased the risk. CONCLUSIONS The use of HT regimens may predispose to the de novo development or worsening of pre-existing SUI. Thus, caution is needed when these regimens are prescribed to women with mild stress-related urine leakage or with established SUI risk factors.
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Affiliation(s)
- Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Hanna Savolainen-Peltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00029, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fabian Hoti
- EPID Research Oy, Metsäneidonkuja 12, 02130, Espoo, Finland
| | | | - Olavi Ylikorkala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Tomi S Mikkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland. .,Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00029, Helsinki, Finland.
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13
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A Population-Based Assessment of Urologic Procedures and Operations After Surgery or Pelvic Radiation for Cervical Cancer. Int J Gynecol Cancer 2018; 28:989-995. [DOI: 10.1097/igc.0000000000001266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe treatment of cervical cancer can result in genitourinary morbidity. We measured selected urologic procedures after the treatment of cervical cancer with either surgery or radiation.MethodsWe used administrative data from the province of Ontario Canada to identify adult women who had nonmetastatic cervical cancer and were treated with surgery or radiation between 1994 and 2014. Study outcomes were surgical or procedure codes representing ureteric repair or fistula repair. Stress incontinence surgery, minimally invasive urologic procedures, open bowel/bladder surgeries, and secondary malignancy were measured to compare between treatment modalities. Multivariable Cox proportional hazards models were used.ResultsOur final cohort consisted of 7311 women (median follow-up, 7.0 years [interquartile range, 2.9–13.3 years]), of which 3354 (44.9%) underwent radiation, and 3957 (54.1%) underwent surgery. After treatment of cervical cancer, ureteral repair was less common after surgery (3.4%) compared with radiation (10.3%) (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.19–0.32). Fistula repair was uncommon (0.9%) and occurred significantly more often in the surgery and radiation group compared with the radiation-alone group (HR, 4.02; 95% CI, 1.80–9.00). Overall, stress incontinence surgery was uncommon (2.2%) but was significantly more likely after surgery versus radiation (HR, 3.73; 95% CI, 2.13–6.53). Minimally invasive urologic procedures were less common after surgery compared with radiation (HR, 0.49; 95% CI, 0.44–0.54). Open bowel/bladder surgeries were similar among treatment modalities, and secondary malignancy was less common after treatment with surgery versus radiation (HR, 0.60; 95% CI, 0.39–0.92;P= 0.02).ConclusionsWomen treated for cervical cancer undergo ureteral stricture interventions at 0.8% per year over the 20 years after their treatment; this risk is higher among women who receive radiation treatment. Fistula repair is rare after cervical cancer.
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Adıgüzel C, Saygılı Yılmaz ES, Arlıer S, Seyfettinoğlu S, Söker G, Uysal G, Yücel O, Sivaslıoğlu A. The importance of uterosacral ligament anatomy in overactive bladder: A preliminary study. Turk J Obstet Gynecol 2018; 15:65-69. [PMID: 29662719 PMCID: PMC5894539 DOI: 10.4274/tjod.73669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/03/2018] [Indexed: 12/20/2022] Open
Abstract
Objective: To evaluate whether uterosacral ligament (USL) thickness measured using magnetic resonance imaging (MRI) was associated with overactive bladder (OAB) in otherwise healthy women. Materials and Methods: The study comprised 27 women with OAB and 27 healthy women (control group) who were followed up at the Obstetrics and Gynecology Department of a tertiary referral center. All subjects were evaluated using pelvic MRI to determine the transverse USL thickness. These measurements were compared between the two groups. p values less than 0.05 were considered statistically significant. Results: The mean age of women in the OAB and control groups were 43.88±9.36 years and 39.92±5.36 years, respectively. The mean body mass index in the OAB group was 29.77±4.82 kg/m2 and 27.49±3.44 kg/m2 in the control group. In the comparison of Pelvic Organ Prolapse Quantification system stages between the groups, no statistically significant relationship was determined. In the OAB group, the mean right USL thickness was 2.04±0.34 mm, and the mean left USL was 2.04±0.52 mm. In the control group, the mean right USL thickness was 2.17±0.47 mm, and the mean left USL was 2.09±0.51 mm. There were no statistically significant differences in terms of USL thickness between the OAB and control groups (p>0.05). Conclusion: No previous studies have been identified in the literature that have investigated the relationship between USL thicknesses and urinary incontinence. In the present study, no significant relationship could be demonstrated between right and left USL thicknesses of the OAB and control groups. This was a preliminary study, and further research with larger sample sizes is required to reach a final conclusion.
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Affiliation(s)
- Cevdet Adıgüzel
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | | | - Sefa Arlıer
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Sevtap Seyfettinoğlu
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Gökhan Söker
- Adana Numune Training and Research Hospital, Clinic of Radiology, Adana, Turkey
| | - Gülsüm Uysal
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Oğuz Yücel
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Akın Sivaslıoğlu
- Muğla Sıtkı Koçman University Faculty of Medicine, Department of Obstetrics and Gynecology, Muğla, Turkey
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Urinary Dysfunction after Hysterectomy: Incidence, Risk Factors and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0442-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Bodner-Adler B, Bodner K, Kimberger O, Halpern K, Rieken M, Koelbl H, Umek W. Role of serum steroid hormones in women with stress urinary incontinence: a case-control study. BJU Int 2017; 120:416-421. [DOI: 10.1111/bju.13902] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Bodner-Adler
- Department of General Gynaecology and Gynaecological Oncology; Medical University of Vienna; Vienna Austria
| | - Klaus Bodner
- Department of General Gynaecology and Gynaecological Oncology; Medical University of Vienna; Vienna Austria
| | - Oliver Kimberger
- Department of Anaesthesiology; Medical University of Vienna; Vienna Austria
- Outcomes Research Consortium; Cleveland OH USA
| | - Ksenia Halpern
- Department of General Gynaecology and Gynaecological Oncology; Medical University of Vienna; Vienna Austria
| | - Malte Rieken
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Heinz Koelbl
- Department of General Gynaecology and Gynaecological Oncology; Medical University of Vienna; Vienna Austria
| | - Wolfgang Umek
- Department of General Gynaecology and Gynaecological Oncology; Medical University of Vienna; Vienna Austria
- Department of Special Gynaecology and Obstetrics; Karl Landsteiner Institute; Vienna Austria
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Yang TH, Wu LY, Chuang FC, Kung FT, Huang KH. Comparing the midterm outcome of single incision vaginal mesh and transobturator vaginal mesh in treating severe pelvic organ prolapse. Taiwan J Obstet Gynecol 2017; 56:81-86. [DOI: 10.1016/j.tjog.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/29/2022] Open
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Pelvic Symptoms, Body Image, and Regret after LeFort Colpocleisis: A Long-Term Follow-Up. J Minim Invasive Gynecol 2016; 24:415-419. [PMID: 28027972 DOI: 10.1016/j.jmig.2016.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of LeFort colpocleisis on body image, regret, and pelvic floor symptoms long-term after surgery. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Tertiary university-affiliated hospital. PATIENTS Between April 2011 and April 2015, 334 patients underwent LeFort colpocleisis. INTERVENTION LeFort colpocleisis. MEASUREMENT AND MAIN RESULTS Patient characteristics (e.g., age, body mass index, parity, blood loss, and length of operation), comorbidities, and complications were obtained from medical records. The Chinese version of the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) was used to evaluate self-perceived quality of life. A modified body image scale was used to assess self-image. Regret was assessed by the following question: "Do you regret choosing to undergo colpocleisis for pelvic organ prolapse (yes or no)?" In total, 278 women responded and were considered for statistical evaluation. Of these women, 234 (84%) had at least 1 comorbid condition. After a median 3-year follow-up (range, 1.5-4.5), only 1 woman had experienced recurrent prolapse and required a second surgery. The mean and total body image scores improved significantly from preoperation (p < .001). Approximately 97% of the patients were satisfied with their decision to undergo surgery, and none of the patients regretted their decision. Pelvic symptoms improved significantly from baseline (i.e., preoperation) to follow-up according to the following measures: PFDI-20, 67.5 ± 23.1 versus 23.8 ± 15.0 (p < .001); Pelvic Organ Prolapse Distress Inventory-6, 33.2 ± 19.6 versus 11.4 ± 10.6 (p < .001); Colorectal-Anal Distress Inventory-8, 10.8 ± 10.3 versus 3.6 ± 5.3 (p < .001); and Urinary Distress Inventory-6, 23.5 ± 18.5 versus 8.8 ± 9.7 (p < .001). CONCLUSIONS LeFort colpocleisis is a highly effective surgical treatment option for pelvic organ prolapse that improves both pelvic floor symptoms and body image. The high satisfaction and low regret in the long term after surgery indicate that LeFort colpocleisis is an excellent option for appropriate patients.
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19
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Hannan JL, Powers SA, Wang VM, Castiglione F, Hedlund P, Bivalacqua TJ. Impaired contraction and decreased detrusor innervation in a female rat model of pelvic neuropraxia. Int Urogynecol J 2016; 28:1049-1056. [PMID: 27987021 DOI: 10.1007/s00192-016-3223-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/21/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bilateral pelvic nerve injury (BPNI) is a model of post-radical hysterectomy neuropraxia, a common sequela. This study assessed the time course of changes to detrusor autonomic innervation, smooth muscle (SM) content and cholinergic-mediated contraction post-BPNI. METHODS Female Sprague-Dawley rats underwent BPNI or sham surgery and were evaluated 3, 7, 14, and 30 days post-BPNI (n = 8/group). Electrical field-stimulated (EFS) and carbachol-induced contractions were measured. Gene expression was assessed by qPCR for muscarinic receptor types 2 (M2) and 3 (M3), collagen type 1α1 and 3α1, and SM actin. Western blots measured M2 and M3 protein expression. Bladder sections were stained with Masson's trichrome for SM content and immunofluorescence staining for nerve terminals expressing vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH), and neuronal nitric oxide synthase (nNOS). RESULTS Bilateral pelvic nerve injury caused larger bladders with less SM content and increased collagen type 1α1 and 3α1 gene expression. At early time points, cholinergic-mediated contraction increased, whereas EFS-mediated contraction decreased and returned to baseline by 30 days. Protein and gene expression of M3 was decreased 3 and 7 days post-BPNI, whereas M2 was unchanged. TH nerve terminals surrounding the detrusor decreased in all BPNI groups, whereas VAChT and nNOS terminals decreased 14 and 30 days post-BPNI. CONCLUSIONS Bilateral pelvic nerve injury increased bladder size, impaired contractility, and decreased SM and autonomic innervation. Therapeutic strategies preventing nerve injury-mediated decline in neuronal input and SM content may prevent the development of a neurogenic bladder and improve quality of life after invasive pelvic surgery.
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Affiliation(s)
- Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mail Stop 634, Greenville, NC, 27834-4354, USA. .,The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 420, Baltimore, MD, 21287, USA.
| | - Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mail Stop 634, Greenville, NC, 27834-4354, USA
| | - Vinson M Wang
- The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 420, Baltimore, MD, 21287, USA
| | - Fabio Castiglione
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.,Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Petter Hedlund
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Clinical and Experimental Pharmacology, Lund University, Lund, Sweden
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, and Department of Urology, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 420, Baltimore, MD, 21287, USA
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Juliato CRT, Baccaro LF, Pedro AO, Gabiatti JRE, Lui-Filho JF, Costa-Paiva L. Factors associated with urinary incontinence in middle-aged women: a population-based household survey. Int Urogynecol J 2016; 28:423-429. [PMID: 27640065 DOI: 10.1007/s00192-016-3139-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women. METHODS A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression. RESULTS The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45-2.49; P < 0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35-2.50; P < 0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02-1.06; P = 0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23-2.08; P = 0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06-1.81; P = 0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06-1.91; P = 0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03-1.92; P = 0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24-0.78; P = 0.006). CONCLUSIONS Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.
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Affiliation(s)
- Cássia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881.
| | - Luiz F Baccaro
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881
| | - Adriana O Pedro
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881
| | - José R E Gabiatti
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881
| | - Jeffrey F Lui-Filho
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881
| | - Lucia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil, 13083-881
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Long-term follow-up after LeFort colpocleisis: patient satisfaction, regret rate, and pelvic symptoms. Menopause 2016; 23:621-5. [DOI: 10.1097/gme.0000000000000604] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Callegari LS, Gray KE, Zephyrin LC, Harrington LB, Gerber MR, Cochrane BB, Weitlauf JC, Bean-Mayberry B, Bastian LA, Mattocks KM, Haskell SG, Katon JG. Hysterectomy and Bilateral Salpingo-Oophorectomy: Variations by History of Military Service and Birth Cohort. THE GERONTOLOGIST 2016; 56 Suppl 1:S67-77. [PMID: 26768393 DOI: 10.1093/geront/gnv666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Little is known about hysterectomy and bilateral salpingo-oophorectomy (BSO), which are associated with both health risks and benefits, among women Veterans. PURPOSE OF THE STUDY To compare the prevalence of hysterectomy with or without BSO, and early hysterectomy, between postmenopausal Veterans and non-Veterans. DESIGN AND METHODS We used baseline data from the Women's Health Initiative Clinical Trial and Observational Study. Multinomial logistic regression models examined differences in the prevalence of hysterectomy (neither hysterectomy nor BSO, hysterectomy without BSO, and hysterectomy with BSO) between Veterans and non-Veterans. Generalized linear models were used to determine whether early hysterectomy (before age 40) differed between Veterans and non-Veterans. Analyses were stratified by birth cohort (<65, ≥65 years at enrollment). RESULTS The unadjusted prevalence of hysterectomy without BSO was similar among Veterans and non-Veterans in both birth cohorts (<65: 22% vs 21%; ≥65: 22% vs 21%). The unadjusted prevalence of hysterectomy with BSO was equivalent among Veterans and non-Veterans in the >65 cohort (21%), but higher among Veterans in the <65 cohort (22% vs 19%). In adjusted analyses, although no differences were observed in the >65 cohort, Veterans in the <65 cohort had higher odds of hysterectomy without BSO (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03, 1.36) and with BSO (OR 1.26, 95% CI 1.10, 1.45), as well as elevated risk of early hysterectomy (relative risk 1.32, 95% CI 1.19, 1.47), compared with non-Veterans. IMPLICATIONS Aging women Veterans may have higher prevalence of hysterectomy and BSO than non-Veterans. This information contributes to understanding the health needs and risks of women Veterans and can inform clinical practice and policy for this population.
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Affiliation(s)
- Lisa S Callegari
- Department of Obstetrics and Gynecology, University of Washington, Seattle. VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington.
| | - Kristen E Gray
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle
| | - Laurie C Zephyrin
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA New York Harbor. Department of Obstetrics and Gynecology, New York University Langone School of Medicine. Department of Veterans Affairs, Veterans Health Administration, Washington, DC
| | - Laura B Harrington
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Megan R Gerber
- VA Boston Healthcare System, Massachusetts. Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Barbara B Cochrane
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
| | - Bevanne Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, California. Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Lori A Bastian
- VA Connecticut, West Haven. Division of General Internal Medicine, University of Connecticut, Farmington
| | - Kristin M Mattocks
- VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester
| | - Sally G Haskell
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA Connecticut Health Care System, New Haven
| | - Jodie G Katon
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle. VA Office of Patient Care, Women's Health Services, Washington, DC
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Prevalence and predictors of storage lower urinary tract symptoms in perimenopausal and postmenopausal women attending a menopause clinic. Menopause 2015; 22:1084-90. [DOI: 10.1097/gme.0000000000000432] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Associations between obesity, physical fitness, and urinary incontinence in non-institutionalized postmenopausal women: The elderly EXERNET multi-center study. Maturitas 2015; 82:208-14. [DOI: 10.1016/j.maturitas.2015.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/02/2015] [Accepted: 07/07/2015] [Indexed: 12/18/2022]
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Andersen LL, Alling Møller LM, Gimbel HM. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up. Eur J Obstet Gynecol Reprod Biol 2015; 193:40-5. [PMID: 26231437 DOI: 10.1016/j.ejogrb.2015.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. STUDY DESIGN Long-term follow-up of a randomized clinical trial of subtotal vs. total abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n=304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire. RESULTS We included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P=0.27); however, only 6/31 and 9/33 had symptoms (P=0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N=10) than in the subtotal hysterectomy group (N=4) (P=0.048). We found a higher mean maximum flow rate (Qmax) in the subtotal hysterectomy group (34.78ml/s) than in the total hysterectomy group (27.08ml/s) (P=0.042) as well as a higher mean functional capacity in the subtotal hysterectomy group (526ml) than in the total hysterectomy group (443ml) (P=0.0147) according to the voiding diary. CONCLUSION Subtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume.
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Affiliation(s)
- Lea L Andersen
- Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark; Department of Women and Children's Health 7821, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; University of Southern Denmark, Denmark.
| | | | - Helga M Gimbel
- Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Song X, Zhu L, Ding J. The value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling following pelvic prolapse surgery: a cohort study. World J Urol 2015; 34:361-7. [PMID: 26032966 DOI: 10.1007/s00345-015-1590-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Part of the patients with pelvic organ prolapse but without symptoms of stress urinary incontinence (SUI) may demonstrate SUI after prolapse surgery (occult SUI), and no optimal preoperative screening method is currently available for it. The aim of this study was to estimate the value of the preoperative 1-h pad test with pessary insertion for predicting the need for a mid-urethral sling (MUS) following prolapse surgery. METHODS Two hundred and six patients were enrolled for advanced prolapse without complaining of urinary incontinence (UI) in this prospective cohort study. Exclusion criteria included prior or concomitant anti-incontinence surgery. Preoperatively, a stress test, the 1-h pad test and uroflowmetry were performed with prolapse reduction. Primary outcome was postoperative de novo UI. Median follow-up was 31 months (range 12-48 months). RESULTS Of the 206 patients, 45 (21.8 %) had evidence of occult SUI preoperatively, 62 (30.1 %) exhibited de novo UI postoperatively, and only 13 (6.3 %) opted MUSs. Patients with occult SUI experienced higher de novo UI rate (53.3 vs. 23.6 %; P = 0.000). The OSUI and concomitant hysterectomy were identified as independent risk factors related to de novo UI (P = 0.000, P = 0.044). We performed receiver operating characteristic (ROC) curve analysis to evaluate the value of preoperative 1-h pad test. The area under ROC curve was 0.816 ± 0.085 (95 % CI 0.649-0.983); the cutoff value was 1.9 g (sensitivity 80.0 %, specificity 83.9 %). CONCLUSIONS The preoperative 1-h pad test with prolapse reduction is feasible for screening occult SUI, and more than 1.9 g may be a practical indicator of a postoperative subsequent MUS.
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Affiliation(s)
- Xiaochen Song
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
| | - Lan Zhu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China.
| | - Jing Ding
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
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