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van der Vaart LR, Vollebregt A, Pruijssers B, Milani AL, Lagro-Janssen AL, Roovers JPWR, van der Vaart CH. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022; 19:270-279. [PMID: 34969614 DOI: 10.1016/j.jsxm.2021.11.008] [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: 08/28/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue. AIM Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP. METHODS A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy. OUTCOMES Change in PISQ-IR between pessary and surgical intervention. RESULTS The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy. CLINICAL IMPLICATIONS SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement. STRENGTHS & LIMITATIONS Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up. CONCLUSION Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy. van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270-279.
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Affiliation(s)
- Lisa R van der Vaart
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Astrid Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bente Pruijssers
- Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands
| | - Alfredo L Milani
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Antoine L Lagro-Janssen
- Department of General Practice/ Women's Studies Medicine, University Medical Centre Radboud, Nijmegen, the Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gynaecology, Bergman Clinics, Amsterdam, the Netherlands
| | - Carl H van der Vaart
- Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands; Department of Gynaecology, Bergman Clinics, Hilversum, the Netherlands
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van der Vaart LR, Vollebregt A, Milani AL, Lagro-Janssen AL, Duijnhoven RG, Roovers JP, Van der Vaart CH. Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study. BJOG 2021; 129:820-829. [PMID: 34559932 PMCID: PMC9298049 DOI: 10.1111/1471-0528.16950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the 24-month efficacy of pessary or surgery as the primary treatment for symptomatic pelvic organ prolapse (POP). DESIGN Multicentre prospective comparative cohort study. SETTING Twenty-two Dutch hospitals. POPULATION Women referred with symptomatic POP of stage ≥2 and moderate-to-severe POP symptoms. METHODS The primary outcome was subjective improvement at the 24-month follow-up according to the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes included improvement in prolapse-related symptoms measured with the Pelvic Floor Distress Inventory (PFDI-20), improvement in subjective severeness of symptoms according to the Patient Global Impression of Severity (PGI-S) scale and crossover between therapies. The primary safety outcome was the occurrence of adverse events. MAIN OUTCOME MEASURE PGI-I at 24 months. RESULTS We included 539 women, with 335 women (62.2%) in the pessary arm and 204 women (37.8%) in the surgery arm. After 24 months, subjective improvement was reported by 134 women (83.8%) in the surgery group compared with 180 women (74.4%) in the pessary group (risk difference 9.4%, 95% CI 1.4-17.3%, P < 0.01). Seventy-nine women (23.6%) switched from pessary to surgery and 22 women (10.8%) in the surgery group underwent additional treatment. Both groups showed a significant reduction in bothersome POP symptoms (P ≤ 0.01) and a reduction in the perceived severity of symptoms (P ≤ 0.001) compared with the baseline. CONCLUSIONS Significantly more women in the surgery group reported a subjective improvement after 24 months. Both therapies, however, showed a clinically significant improvement of prolapse symptoms. TWEETABLE ABSTRACT Pessary treatment and vaginal surgery are both efficacious in reducing the presence and severity of prolapse symptoms, although the chance of significant improvement is higher following surgery.
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Affiliation(s)
- L R van der Vaart
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - A L Milani
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - A L Lagro-Janssen
- Department of General Practice/Women's studies Medicine, University Medical Centre Radboud, Nijmegen, The Netherlands
| | - R G Duijnhoven
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J-Pwr Roovers
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Gynaecology, Bergman Clinics, Amsterdam, The Netherlands
| | - C H Van der Vaart
- Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, The Netherlands.,Department of Gynaecology, Bergman Clinics, Bilthoven, The Netherlands
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Drost LE, Stegeman M, Mos LM, Lamers RED, Ezendam NPM, Gerritse MBE, Dam AHDM, Vos MC. SHAred DEcision making in Pelvic Organ Prolapse (SHADE-POP); Implementation is not as easy as it seems. PATIENT EDUCATION AND COUNSELING 2021; 104:2004-2011. [PMID: 33495029 DOI: 10.1016/j.pec.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Despite the positive effects of decision aids (DAs), implementation remains a significant challenge. The aim of the current study was to determine what barriers clinicians experience using a DA for pelvic organ prolapse (POP). METHODS This study was conducted with a qualitative descriptive design including in-depth semi-structured interviews according to COREQ-criteria. Participants included clinicians and patients. Grounded theory analysis was used to describe the main themes. RESULTS A total of 9 clinicians and 4 patients participated. Four major themes (1) opinions about shared decision making (SDM), (2) current practice, (3) experience with the DA, (4) suggestions for improvement and one minor theme (5) experience with the study, emerged. Clinicians were predominantly positive about the DA. CONCLUSION Despite the positive attitudes of the clinicians in this study, the implementation of a DA is still challenging. The DA is forgotten regularly as improvement of logistics is needed, clinicians assume they already provide good care which might result in a reluctance to change and more engagement of physicians is needed. PRACTICE IMPLICATIONS Regular contact with clinicians to remind, help and increase engagement and a decrease of the logistic burden is needed to ensure all patients can fully benefit of the DA.
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Affiliation(s)
- L E Drost
- Dept. of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| | - M Stegeman
- Dept. of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - L M Mos
- Dept. of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - R E D Lamers
- Dept. of Urology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - N P M Ezendam
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - M B E Gerritse
- Dept. of Obstetrics and Gynaecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - A H D M Dam
- Dept. of Obstetrics and Gynaecology, Viecuri Hospital, Venlo, the Netherlands
| | - M Caroline Vos
- Dept. of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
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Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2021; 27:337-343. [PMID: 34080581 DOI: 10.1097/spv.0000000000001069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors. METHODS This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores. RESULTS Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.5], P = 0.56). Global Health scores correlated with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire scores (all P's < 0.0001). In multivariable models, menopause was associated with better physical QOL, and constipation, coronary artery disease, pelvic pain, and increased body mass index with worse physical QOL. Age was associated with better mental QOL, and constipation, fecal incontinence, pelvic pain, and coronary artery disease with worse mental QOL. CONCLUSIONS Women choosing POP surgery versus pessary had similar physical and mental generic QOL.
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Randomized Controlled Trial to Assess the Impact of Intraurethral Lidocaine on Urodynamic Voiding Parameters. Female Pelvic Med Reconstr Surg 2020; 25:265-270. [PMID: 29300256 DOI: 10.1097/spv.0000000000000544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of the study was to determine whether intraurethral anesthesia decreases voiding efficiency (VE; voided volume/(voided volume + residual volume)) and impacts other urodynamic parameters in healthy female volunteers during urodynamic studies. METHODS This was a randomized double-blind placebo-controlled study of asymptomatic women aged 18 to 60 years. Subjects completed a visual analog scale and baseline questionnaires to assess pain and lower urinary tract symptoms, respectively. They performed an uninstrumented baseline uroflow, followed by physiologic filling to 250 mL or greater. Subjects were randomized to receive 5 mL of intraurethral aqueous gel or 2% lidocaine gel and then underwent a second uninstrumented uroflow. They then completed complex cystometry, urethral pressure profilometry, and pressure-flow studies. RESULTS Twenty-three randomized subjects (12 placebo, 11 lidocaine) were included. Baseline uroflow VE was similar between the placebo and lidocaine groups. After study drug administration, VE was not different between groups (89.3 [85.9-93.9] vs 89.5 [82.5-91.7], P = 0.74). There were also no differences between groups in visual analog scale scores, sensation during cystometry, maximum urethral closure pressure, or micturition parameters (maximum detrusor pressure and detrusor pressure at maximum flow). The placebo group had a lower percentage of interrupted flow pattern (0% vs 36%, P = 0.02) and a lower rate of increased electromyographic activity during micturition (25% vs 73%, P = 0.02). CONCLUSIONS In this pilot study of 23 asymptomatic women, intraurethral administration of lidocaine did not decrease VE compared with placebo. The lidocaine group had a greater percentage of interrupted flow patterns and increased electromyographic activity during micturition.
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6
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McKee DC, Gonzalez EJ, Amundsen CL, Grill WM. Randomized Controlled Trial to Assess the Impact of High Concentration Intraurethral Lidocaine on Urodynamic Voiding Parameters. Urology 2019; 133:72-77. [PMID: 31465791 DOI: 10.1016/j.urology.2019.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess whether intraurethral anesthesia decreased voiding efficiency (VE), reduced catheterization pain, and impacted urodynamic parameters in healthy adult females. METHODS In a randomized, double-blind, placebo-controlled trial, participants received two 5 mL doses of either intraurethral aqueous gel or 4% lidocaine gel. The primary outcome was VE during randomized condition uroflow, defined as voided volume/(voided volume + residual volume). The secondary outcomes were pain during catheterization and to confirm previously reported pressure-flow changes. A sample size of 10 per group was planned to detect a clinically significant decrease in VE with a power (1-β) of 0.99. RESULTS From October to December 2018, 23 women were screened and 18 were randomized to receive placebo (n = 10) or lidocaine (n = 8). Baseline uroflow VE was similar between the placebo and lidocaine groups (88 ± 6.6% vs 91 ± 5.8%, P = .33). After study drug administration, the changes in VE (post-pre) were similar between placebo and lidocaine groups (-5.4 ± 14% vs 1.7 ± 6.4%, P = .21). Visual analog scores were similar following catheterizations (26.7 ± 12.8 mm vs 36.9 ± 26.8 mm, P = .34). The lidocaine group exhibited lower average flow rates per voided volume (0.04 ± 0.02 s-1 vs 0.02 ± 0.01 s-1, P = .04). CONCLUSION Intraurethral administration of 4% lidocaine did not decrease VE compared to placebo and did not change pain scores following catheterization. In the lidocaine group, the average flow rate per voided volume was lower. The decrease in flow rate after local anesthesia to the urethra may indicate that urethral sensory feedback contributes to voiding in human micturition.
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Affiliation(s)
- Dana C McKee
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - Eric J Gonzalez
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Duke University Hospital, Durham, NC
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC.
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7
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Vollstedt A, Meeks W, Triaca V. Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes. Ther Adv Urol 2019; 11:1756287219868593. [PMID: 31447937 PMCID: PMC6689921 DOI: 10.1177/1756287219868593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/15/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Our aim was to investigate longer-term surgical and quality of life (QOL) outcomes in a cohort of women undergoing robotic-assisted laparoscopic sacrocolpopexy (RALS) for pelvic organ prolapse (POP). METHODS We performed a retrospective cohort study at a single institution of female patients undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient's PFDI and PFIQ postoperative score by ⩾70%. RESULTS Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p = 0.011) and worse preoperative American Urological Association (AUA) Quality of Life score (OR 1.42, p = 0.046) were associated with clinical improvement. Within the PFIQ, 35.6% of patients saw clinical improvement with their bowel symptoms, compared with bladder (54.1%, p < 0.001) and prolapse (45.6%, p = 0.053) symptoms. Within the PFDI, 45.5% of patients reached clinical improvement with their bowel symptoms, compared with bladder (56.7%, p = 0.035) and prolapse (62.6%, p < 0.001) symptoms. Of the patients who had a rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score, and 51% saw clinical improvement in the bowel portion of the PDFI. CONCLUSIONS Significantly fewer patients reached clinical improvement within the portions of the surveys that focus on bowel symptoms, compared with symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement with their bowel symptoms.
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Affiliation(s)
- Annah Vollstedt
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - William Meeks
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD, USA
| | - Veronica Triaca
- Concord Hospital Center for Urologic Care, Geisel School of Medicine at Dartmouth, NH, USA
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Colla C, Paiva LL, Ferla L, Trento MJB, de Vargas IMP, Dos Santos BA, Ferreira CF, Ramos JGL. Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery. Int J Gynaecol Obstet 2018; 143:94-100. [PMID: 29876920 DOI: 10.1002/ijgo.12561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/15/2018] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). METHODS The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. RESULTS A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). CONCLUSION The type of delivery was not associated with differences in the short-term development of postpartum PFD.
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Affiliation(s)
- Cássia Colla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana L Paiva
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lia Ferla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria J B Trento
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isadora M P de Vargas
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca A Dos Santos
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles F Ferreira
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - José G L Ramos
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Dellú MC, Schmitt ACB, Cardoso MRA, Pereira WMP, Pereira ECA, Vasconcelos ÉDSF, Aldrighi JM. Prevalence and factors associated with urinary incontinence in climacteric. Rev Assoc Med Bras (1992) 2017; 62:441-6. [PMID: 27656854 DOI: 10.1590/1806-9282.62.05.441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women. METHOD In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0. RESULTS Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006). CONCLUSION The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.
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Affiliation(s)
- Máyra Cecilia Dellú
- PhD - Lecturer of the Department of Physiotherapy, Universidade de Taubaté (Unitau), Taubaté, SP, Brazil
| | - Ana Carolina Basso Schmitt
- PhD - Lecturer of the Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maria Regina Alves Cardoso
- PhD - Lecturer of the Department of Epidemiology, Faculdade de Saúde Pública, Universidade de São Paulo (FSP/USP), São Paulo, SP, Brazil
| | - Wendry Maria Paixão Pereira
- PhD - Lecturer of the Department of Physiotherapy, Universidade de Taubaté (Unitau), Taubaté, SP, Brazil.,PhD - Lecturer at Fundação Universitária Vida Cristã, Pindamonhangaba, SP, Brazil
| | | | | | - José Mendes Aldrighi
- PhD - Lecturer of the Department of Mother and Child Health, FSP/USP, São Paulo, SP, Brazil
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10
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Losada L, Amundsen CL, Ashton-Miller J, Chai T, Close C, Damaser M, DiSanto M, Dmochowski R, Fraser MO, Kielb SJ, Kuchel G, Mueller ER, Parker-Autry C, Wolfe AJ, Mallampalli MP. Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span. J Womens Health (Larchmt) 2016; 25:1086-1096. [PMID: 27285829 PMCID: PMC5116700 DOI: 10.1089/jwh.2016.5895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.
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Affiliation(s)
- Liliana Losada
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
| | - Cindy L Amundsen
- 2 Departments of Obstetrics and Gynecology and Surgery, Duke University , Durham, North Carolina
| | - James Ashton-Miller
- 3 Department of Biomechanical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Toby Chai
- 4 Department of Urology, Yale School of Medicine , New Haven, Connecticut
| | - Clare Close
- 5 Close Pediatric Urology , Las Vegas, Nevada
| | - Margot Damaser
- 6 Department of Biomedical Engineering, Cleveland Clinic and Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio
| | - Michael DiSanto
- 7 Department of Biomedical Sciences and Surgery, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Roger Dmochowski
- 8 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Matthew O Fraser
- 9 Department of Surgery, Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Stephanie J Kielb
- 10 Department of Urology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - George Kuchel
- 11 Department of Geriatrics and Gerontology, UConn Center on Aging , Farmington, Connecticut
| | - Elizabeth R Mueller
- 12 Department Obstetrics/Gynecology and Urology, Loyola University Medical Center, Loyola University Chicago , Maywood, Illinois
| | - Candace Parker-Autry
- 13 Department of Obstetrics and Gynecology, Wake Forest University , Baptist Medical Center, Winston-Salem, North Carolina
| | - Alan J Wolfe
- 14 Department of Microbiology and Immunology, Loyola University Chicago , Maywood, Illinois
| | - Monica P Mallampalli
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
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Advanced therapeutic directions to treat the underactive bladder. Int Urol Nephrol 2014; 46 Suppl 1:S35-44. [DOI: 10.1007/s11255-014-0809-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
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12
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Comparison of midurethral sling outcomes with and without concomitant prolapse repair. Obstet Gynecol Sci 2014; 57:50-8. [PMID: 24596818 PMCID: PMC3924735 DOI: 10.5468/ogs.2014.57.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/22/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022] Open
Abstract
Objective We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair. Methods We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis. Results We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970). Conclusion The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.
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Brown KM, Handa VL, Macura KJ, DeLeon VB. Three-dimensional shape differences in the bony pelvis of women with pelvic floor disorders. Int Urogynecol J 2012; 24:431-9. [DOI: 10.1007/s00192-012-1876-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Prevention of postoperative stress urinary incontinence at the time of prolapse repair is controversial. There has been a shift away from colposuspension procedures to midurethral slings. As with any surgery, midurethral slings are associated with risks, which must be balanced against the benefits of preventing postoperative stress urinary incontinence. The aim of this overview is to review the controversy, discuss potential complications of midurethral slings, discuss the efficacy of concomitant sling placement, and suggest a method of systematically approaching patients with high-grade anterior compartment prolapse. RECENT FINDINGS Several studies have recently advocated for the routine use of anti-incontinence procedures at the time of prolapse surgery; however, applying these data to midurethral slings is problematic. Ultimately, the issue of treatment of the urethra at the time of prolapse repair should be discussed with the patient with treatment rendered depending on the risk the patient is willing to bear. SUMMARY The aim of this study is to discuss the risks and benefits of applying a midurethral sling in patients with high-grade anterior compartment prolapse. In these patients, placement of a suburethral sling may be approached systematically, taking into account the patients' variables and their own goals of therapy.
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Does concomitant prolapse repair at the time of midurethral sling affect recurrent rates of incontinence? Int Urogynecol J 2011; 22:819-25. [PMID: 21340646 DOI: 10.1007/s00192-011-1367-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 01/22/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared outcomes after midurethral sling (MUS) with and without concomitant repair for prolapse. METHODS Women who underwent MUS with or without concomitant repair for prolapse completed a follow-up survey. Outcomes were assessed with validated questionnaires and medical record review. Kaplan-Meier, Cox proportional hazards regression, and logistic regression models were used for analysis. RESULTS Of 317 women, 281 (89%) responded to the survey. During a median follow-up of 2.7 years, survival free of "any" incontinence (Incontinence Severity Index score, >0) was similar in both groups (adjusted hazard ratio, 1.07; P = 0.77). Women with concomitant repair for advanced prolapse tended to be more bothered by frequent urination (adjusted odds ratio, 1.78; P = 0.08) and more likely to require urethrolysis (odds ratio, 6.11; P = 0.04) than those without concomitant pelvic floor repair. CONCLUSIONS Prolapse repairs concomitant with MUS did not affect incontinence recurrence. However, repairs may cause increased lower urinary tract symptoms.
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The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J 2009; 20:1037-45. [PMID: 19444368 PMCID: PMC2721135 DOI: 10.1007/s00192-009-0902-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 04/21/2009] [Indexed: 12/03/2022]
Abstract
Introduction and hypothesis In selected populations, pelvic organ prolapse (POP) was associated with bladder/bowel symptoms, but data on the general female population are lacking. Our aim was to obtain normative data on the prevalence of POP and pelvic floor dysfunction (PFD) symptoms and signs and to identify associations. Methods Validated questionnaires on POP and PFD (urogenital distress inventory, (UDI) and defaecation distress inventory (DDI)) were sent to a general population of 2,979 women (aged 45–85 years). Data were analysed using the Kruskal–Wallis test, chi square test and Spearman’s rank correlation coefficient. Results Response rate was 62.7%. Associations between POP stage and parity (0.002) and vaginal bulging (<0.001) are significant. Anatomical locations of POP and PFD symptoms correlated significantly with incontinence of flatus, feeling anal prolapse, manual evacuation of stool, vaginal bulging, constipation and pain during faecal urge (p ≤ 0.005). Conclusions Strategies should be developed to alleviate obstructive bowel disorders associated with POP.
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