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Fisher-Yosef T, Lidsky Sachs D, Edel SS, Nammouz H, Zoabi AE, Adler L. Pelvic Floor Dysfunction among Reproductive-Age Women in Israel: Prevalence and Attitudes-A Cross-Sectional Study. Healthcare (Basel) 2024; 12:390. [PMID: 38338275 PMCID: PMC10855918 DOI: 10.3390/healthcare12030390] [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: 12/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Objectives: Our study aimed to investigate the prevalence of female pelvic floor dysfunction (PFD) in Israeli women who experienced vaginal delivery and are in their reproductive years (premenopausal), as well as to understand their attitudes and health-seeking behavior and barriers towards treating this problem. Methods: In this cross-sectional study, we conducted a questionnaire-based Internet survey. The surveys were sent to Israeli women in their fertile years (18-50 years old). We asked the women about their PFD symptoms, attitudes, and help-seeking behaviors. We used two validated questionnaires, including the USIQ and the PFDI-20. The combined questionnaire was submitted in both Hebrew and Arabic. We assessed the prevalence of PFD symptoms in the study population. Symptomatic women were asked about their help-seeking behaviors and their beliefs, desires, and barriers regarding the clinical management of symptoms. Results: Between July and September 2020, 524 women completed the questionnaire (response rate 44%). In total, 95% reported at least one symptom (mostly urinary-related) at any grade of severeness in at least one category, and 66.8% suffered from at least one moderate to severe symptom in at least one category. Most women (93.7%) reported that they wanted to be asked and offered voluntary information about PFD from physicians and nurses; however, only 16.6% reported receiving such information. Barriers to seeking treatment were mainly related to low awareness. The study's main limitation was selection bias due to the questionnaire's design. Conclusions: These findings show the importance of raising awareness of the different therapeutic solutions to PFD symptoms and designing more available services for this common problem.
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Affiliation(s)
- Tehila Fisher-Yosef
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dina Lidsky Sachs
- The Azrieli Faculty of Medicine, Bar Ilan University, Zefat 1311502, Israel
| | - Shiri Sacha Edel
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Hanan Nammouz
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Abd Ellatif Zoabi
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Fitz FF, Bortolini MAT, Pereira GMV, Salerno GRF, Castro RA. PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse-a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs. Int Urogynecol J 2023; 34:2007-2032. [PMID: 37256322 DOI: 10.1007/s00192-023-05569-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The literature is scarce regarding the effects of comorbidities, clinical parameters, and lifestyle as risk factors for pelvic organ prolapse (POP). This study was performed to systematically review the literature related to body mass index (BMI), waist circumference, diabetes mellitus (DM), hypertension (HT), dyslipidemia, chronic constipation, smoking, chronic cough, occupation, and striae and varicose veins as determinants for POP. METHODS Search terms in accordance with Medical Subject Headings were used in PubMed, Embase, LILACS, and the Cochrane Library. Clinical comparative studies between women with and without POP and containing demographic and/or clinical raw data related to lifestyle and/or comorbidities were included. The ROBINS-I (risk of bias in non-randomized studies of interventions) instrument was used. Fixed-effects and random-effects models were used for homogeneous and heterogeneous studies, respectively. RESULTS Forty-three studies were included in the meta-analysis. BMI < 25 kg/m2 was found to be a protective factor for POP [OR 0.71 (0.51, 0.99); p = 0.04], and BMI > 30 kg/m2 was a risk factor for POP [OR 1.44 (1.37, 1.52); p < 0.00001]. Waist circumference (≥ 88 cm) was reported as a risk factor for POP [OR 1.80 (1.37, 2.38); p < 0.00001], along with HT [OR 1.18 (1.09, 1.27); p = 0.04], constipation [OR 1.77 (1.23, 2.54); p < 0.00001], occupation [OR 1.86 (1.21, 2.86); p < 0.00001], persistent cough [OR 1.52 (1.18, 1.94); p < 0.0001]), and varicose veins [OR 2.01 (1.50, 2.70); p = 0.12]. CONCLUSIONS BMI < 25 kg/m2 is protective while BMI > 30 kg/m2 is a risk factor for POP. Large waist circumference, dyslipidemia, HT, constipation, occupation, persistent cough, and varicose veins are also determinants for POP.
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Affiliation(s)
- Fátima Faní Fitz
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil.
| | - Maria Augusta Tezelli Bortolini
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil
| | - Gláucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Gisela Rosa Franco Salerno
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil
| | - Rodrigo Aquino Castro
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil
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Fluids affecting bladder urgency and lower urinary symptoms: results from a randomized controlled trial. Int Urogynecol J 2022; 33:1329-1345. [PMID: 35435467 DOI: 10.1007/s00192-022-05090-z] [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: 03/30/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Caffeinated, alcoholic, artificially sweetened, carbonated, and acidic beverages are pervasive and consumed in large quantities. Reputedly, these beverages are "irritating to the bladder" and result in heightened void frequency, but prior studies lack control for intake volume. We tested the null hypothesis that women recruited from the community who demonstrate overactive bladder symptoms will show no difference by groups in void frequency when one group is instructed to replace listed beverages by substituting non-irritants (emphasis on water or milk) and the other group is instructed in healthy eating. METHODS This was a parallel-group randomized controlled trial design with a three-period fixed sequence (baseline and 2 and 6 weeks post-baseline). We recruited 105 community women with overactive bladder symptoms. INCLUSION CRITERIA >7 voids per day or 2 voids per night, daily intake of ≥16 oz. (473 ml) of beverages containing the ingredients listed above, and ≥ 32 oz. (946 ml) of total fluid intake. Stratified randomization was conducted. The primary outcome was average daily void frequency on a 3-day diary. RESULTS Participants were 86% white, mean (SD) age was 46.6 (17.6) years, and baseline void frequency was 9.2 (2.9) voids per day. At 2 and 6 weeks, estimated average (SD) difference in void frequency between group 1 and group 2 was -0.46 (0.57) and -0.31 (0.57) voids per day (p > 0.05); the null hypothesis was not rejected. CONCLUSIONS Women who reduce potentially irritating beverages while maintaining total fluid volume intake is not predictive of void frequency. Further research on type and volume of beverage intake is recommended.
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Phé V, Gamé X. [Definition, epidemiology and impact of non-neurogenic overactive bladder]. Prog Urol 2021; 30:866-872. [PMID: 33220814 DOI: 10.1016/j.purol.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common condition with a significant functional impact in patients. OBJECTIVE To synthesize current knowledge on the definition, epidemiology and impact of OAB. METHOD A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020. RESULTS OAB is defined by urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. In France, OAB affects 14 % of the general population and this prevalence increases with age. This condition is a source of major deterioration in patients' quality of life with a physical (falls, fractures, sleep disorders, fatigue), psychic (anxiety, depression) social (limitation of leisure, isolation) and economic impact. CONCLUSION The definition of OAB is standardized. OAB is a frequent condition and has significant functional consequences with a notable deterioration in quality of life.
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Affiliation(s)
- V Phé
- Sorbonne université, service d'urologie, hôpital Pitié-Salpêtrière, assistance publique-hôpitaux de Paris, Paris, France.
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier, Toulouse, France
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Himmler M, Kohl M, Rakhimbayeva A, Witczak M, Yassouridis A, Liedl B. Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation. Int Urogynecol J 2021; 32:2777-2786. [PMID: 33502548 DOI: 10.1007/s00192-020-04649-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the prevalence for voiding dysfunction and if symptom improvement can be achieved by adequate pelvic floor surgery. METHODS We evaluated the Propel Study data from 281 women with pelvic organ prolapse (POP) stage 2-4. Bother caused by obstructive micturition, voiding dysfunction, and coexisting pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI) preoperatively and 6, 12, and 24 months after vaginal prolapse repair. Successful reconstruction (Pelvic Organ Prolapse Quantification [POP-Q] stage 0-I throughout the 2-year follow-up at all compartments, "responders"), was compared with all others ("non-responders"). RESULTS Prevalence of voiding dysfunction was significantly reduced after surgery for all patients with "moderate" to "quite a bit" of bother ("R2") regarding all examined PFDI questions. Defects of the posterior/apical compartment and lower stage defects were found to cause obstructive micturition, which improved significantly after POP surgery. Six months after surgery, the prevalence of R2 for voiding dysfunction symptoms was reduced significantly for responders compared with non-responders. Significant reduction of R2 in patients with rectoceles could be shown for some PFDI questions, whereas the rate was lower in patients with cystoceles. Other pelvic floor symptoms often coexisted in patients with voiding dysfunction symptoms and improved significantly after surgery as well. CONCLUSIONS Symptoms of voiding dysfunction are frequent in female patients with POP and can significantly improve after vaginal mesh-augmented prolapse repair even for posterior and minor defects. Before counseling patients to undergo POP surgery because of their obstructive symptoms, other causes of voiding dysfunction must first have been ruled out.
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Affiliation(s)
- Maren Himmler
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Martin Kohl
- Center of Reconstructive Urogenital Surgery, Urologische Klinik Planegg, Planegg, Germany
| | - Aidana Rakhimbayeva
- Center of Reconstructive Urogenital Surgery, Urologische Klinik Planegg, Planegg, Germany
| | - Magdalena Witczak
- Center of Reconstructive Urogenital Surgery, Urologische Klinik Planegg, Planegg, Germany
| | | | - Bernhard Liedl
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Center of Reconstructive Urogenital Surgery, Urologische Klinik Planegg, Planegg, Germany
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Pelvic Floor Sensations After the First Vaginal Delivery: A Qualitative Study. Female Pelvic Med Reconstr Surg 2021; 27:e234-e246. [PMID: 31145228 DOI: 10.1097/spv.0000000000000742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Current validated instruments to screen for pelvic organ prolapse and its sequelae address bulge symptoms, bowel and bladder changes, and sexual intimacy. However, sensitivity is lower in younger women, and there is no instrument specifically designed to screen in postpartum, primiparous women for early changes, that is, changes that may be noticed before the symptom of a bulge or signs of pelvic organ prolapse occur. Our goal was to elucidate early sensations of pelvic floor support changes in primiparous women after their first vaginal delivery. These could be the focus of future studies differentiating such sensations from a normal postpartum, aiding identification of women for further follow-up. METHODS Using comparative focused ethnographic methods, we purposefully sampled and interviewed 17 multiparous women diagnosed with pelvic organ prolapse and 60 primiparous women, half Euro-American and half Mexican American, English or Spanish speaking. Audiotapes were transcribed and then translated. Using inductive coding and matrix analysis, we used constant comparison across transcript data and clustered coded data into body systems-level matrices to arrive at categories of early changes. RESULTS We identified early changes by ethnic group in pelvic area sensations and bowel, bladder, and sexual function, including sensations not mentioned in extant questionnaires. CONCLUSIONS Early changes may be distressing but difficult for women to introduce in a clinical conversation. Querying these changes may enhance patient-provider communication. Future research is needed to validate these items in questionnaires designed to identify women with persistent early changes that may lead to subsequent objective pelvic organ prolapse.
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Efficacy of biofeedback-assisted pelvic floor muscle training in females with pelvic floor dysfunction. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Fradet-Menard C, Deparis J, Gachon B, Sichitiu J, Pierre F, Fritel X, Desseauve D. Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study. Eur J Obstet Gynecol Reprod Biol 2018; 226:40-46. [DOI: 10.1016/j.ejogrb.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
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Foust-Wright C, Wissig S, Stowell C, Olson E, Anderson A, Anger J, Cardozo L, Cotterill N, Gormley EA, Toozs-Hobson P, Heesakkers J, Herbison P, Moore K, McKinney J, Morse A, Pulliam S, Szonyi G, Wagg A, Milsom I. Development of a core set of outcome measures for OAB treatment. Int Urogynecol J 2017; 28:1785-1793. [PMID: 28948362 PMCID: PMC5705742 DOI: 10.1007/s00192-017-3481-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Standardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB). METHODS The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input. RESULTS The standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included. CONCLUSIONS The standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research.
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Affiliation(s)
- Caroline Foust-Wright
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | - Elizabeth Olson
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | | | - Jennifer Anger
- Department of Urologic Reconstruction, Urodynamics, and Female Urology, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Nikki Cotterill
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Elizabeth Ann Gormley
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - John Heesakkers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Herbison
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kate Moore
- Department of Urogynaecology, University of New South Wales, Sydney, NSW, Australia
| | - Jessica McKinney
- Center for Pelvic and Women's Health, Marathon Physical Therapy and Sports Medicine, LLC, Norton, MA, USA
| | - Abraham Morse
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Samantha Pulliam
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - George Szonyi
- Department of Geriatric Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Adrian Wagg
- Geriatric Medicine, University of Alberta, Edmonton, Canada
| | - Ian Milsom
- Department of Obstetrics & Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-416 85, Gothenburg, Sweden.
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Saiki L, Meize-Grochowski R. Urinary Incontinence and Psychosocial Factors Associated With Intimate Relationship Satisfaction Among Midlife Women. J Obstet Gynecol Neonatal Nurs 2017; 46:555-566. [PMID: 28477970 DOI: 10.1016/j.jogn.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore associations among symptoms of urinary incontinence, severity of symptoms, and measures of psychosocial health that may be assessed during a well-woman screening examination and the possible contribution of these variables to the relationship satisfaction of partnered midlife women living with urinary incontinence. DESIGN Exploratory correlational design using self-report questionnaires. SETTING Community recruitment by posted fliers, advertisements, and social media. PARTICIPANTS Partnered women, ages 45 to 65 years, with urinary incontinence (N = 57). METHODS Self-report measures of severity of incontinence symptoms, relationship satisfaction, self-concept/emotional health (self-esteem, body image, depression, anxiety), and relationship factors (sexual quality of life, incontinence-related communication). Data were analyzed using Spearman rho correlation with an exploration of the contribution of study factors to relationship satisfaction through standard multiple regression. RESULTS The severity of urinary incontinence symptoms had no significant correlation with scores on relationship satisfaction or psychosocial health. Measures of self-concept/emotional health and relationship factors were significantly correlated with each other (rs = .40-.75, p < .01) and with relationship satisfaction (rs = .35-.71, p < .05). Preliminary exploration of the contribution of study factors to relationship satisfaction through exploratory regression analysis showed unique contributions from sexual quality of life (18.7%, p < .001) and depression (8.7%, p = .004). CONCLUSION Midlife women with urinary incontinence, regardless of symptom severity, might benefit from screening for poorer sexual quality of life and mild depression symptoms because these two study factors significantly contributed to poorer intimate relationship satisfaction among this study's participants.
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Deparis J, Bonniaud V, Desseauve D, Guilhot J, Masanovic M, De Tayrac R, Fauconnier A, Fritel X. [Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French]. Prog Urol 2017; 27:576-584. [PMID: 28461041 DOI: 10.1016/j.purol.2017.03.008] [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: 02/22/2017] [Revised: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 11/16/2022]
Abstract
AIMS The Female Pelvic Floor Questionnaire (FPFQ) is a self-administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties. METHODS After cross-cultural adaptation into French, acceptability and reliability of the questionnaire were assessed through a sample of 56 women in a test-retest. Discriminative construct validity was evaluated by comparing the results obtained by the FPFQ to those of other validated questionnaires. Longitudinal follow-up of the 282 pregnant women included in the PreNatal Pelvic floor Prevention trial (3PN) was used to analyze responsiveness. RESULTS The proportion of missing data did not exceed 4 % for questions about bladder function, bowel function and pelvic organ prolapse; 10 % for issues related to sexual function. Question 9 was considered difficult to understand by 14 % of women. After rewriting, this issue was retested in a new sample of 52 women and presented no further problems. The intra-class correlation coefficient was greater than or equal to 0.7 for all domains during the test-retest. The FPFQ was strongly and significantly correlated (Spearman r>0.5) with the other validated questionnaires. The French version of FPFQ recorded changes in urinary and sexual symptoms for the women involved in 3PN trial with a standardized response mean equal to 0.83 and 0.44, respectively. CONCLUSION The French version of the FPFQ is self-administered, reliable, valid, and can detect a change in symptoms during follow-up. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- J Deparis
- Université de Poitiers, faculté de médecine et pharmacie, CHU de Poitiers, 86000 Poitiers, France.
| | - V Bonniaud
- Rééducation, réseau de pelvi-périnéologie, centre hospitalier universitaire de Dijon, 21000 Dijon, France
| | - D Desseauve
- Université de Poitiers, faculté de médecine et pharmacie, CHU de Poitiers, 86000 Poitiers, France
| | - J Guilhot
- Inserm CIC 1402, CHU de Poitiers, 86000 Poitiers, France
| | - M Masanovic
- Centre hospitalier universitaire de la Réunion, 97400 Saint-Denis, Réunion
| | - R De Tayrac
- Centre hospitalier universitaire de Nîmes, 30000 Nîmes, France
| | - A Fauconnier
- Centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France; Research unit EA 7285 (RISCQ), université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - X Fritel
- Université de Poitiers, faculté de médecine et pharmacie, CHU de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, CHU de Poitiers, 86000 Poitiers, France
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Méndez-Rubio S, Salinas-Casado J, Esteban-Fuertes M, Méndez-Cea B, Sanz-de-Burgoa V, Cozar-Olmo JM. Urological disease and tobacco. A review for raising the awareness of urologists. Actas Urol Esp 2016; 40:424-33. [PMID: 26920096 DOI: 10.1016/j.acuro.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. OBJECTIVE To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. ACQUISITION AND SYNTHESIS OF EVIDENCE We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. CONCLUSION Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation.
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Affiliation(s)
- S Méndez-Rubio
- Servicio de Urología, Hospital Universitario Sanitas La Moraleja, Madrid, España.
| | - J Salinas-Casado
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, España
| | - M Esteban-Fuertes
- Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, España
| | - B Méndez-Cea
- Facultad de Biología, Universidad Complutense de Madrid, Madrid, España
| | | | - J M Cozar-Olmo
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España
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Deparis J, Bonniaud V, Desseauve D, Guilhot J, Masanovic M, de Tayrac R, Fauconnier A, Fritel X. Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French. Neurourol Urodyn 2015; 36:253-258. [PMID: 26587906 DOI: 10.1002/nau.22932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022]
Abstract
AIMS The Female pelvic floor questionnaire (FPFQ) is a self-administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties. METHODS After cross-cultural adaptation into French, acceptability and reliability of the questionnaire were assessed through a sample of 56 women in a test-retest. Discriminative construct validity was evaluated by comparing the results obtained by the FPFQ to those of other validated questionnaires. Longitudinal follow-up of the 282 pregnant women included in the PreNatal Pelvic floor Prevention trial (3PN) was used to analyze responsiveness. RESULTS The proportion of missing data did not exceed 4% for questions about bladder function, bowel function, and pelvic organ prolapse; 10% for issues related to sexual function. Question 9 was considered difficult to understand by 14% of women. After rewriting, this issue was retested in a new sample of 52 women and presented no further problems. The intra-class correlation coefficient was greater than or equal to 0.7 for all domains during the test-retest. The FPFQ was strongly and significantly correlated (Spearman r > 0.5) with the other validated questionnaires. The French version of FPFQ recorded changes in urinary and sexual symptoms for the women involved in 3PN trial with a standardized response mean equal to 0.83 and 0.44, respectively. CONCLUSION The French version of the FPFQ is self-administered, reliable, valid, and can detect a change in symptoms during follow-up. Neurourol. Urodynam. 36:253-258, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Julia Deparis
- Université de Poitiers, Faculté de Médecine et Pharmacie, CHU de Poitiers, Poitiers, France
| | - Véronique Bonniaud
- Réseau de Pelvi-Périnéologie, Rééducation, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - David Desseauve
- Université de Poitiers, Faculté de Médecine et Pharmacie, CHU de Poitiers, Poitiers, France
| | | | - Margot Masanovic
- Centre Hospitalier Universitaire de La Réunion, Saint-Denis, France
| | | | - Arnaud Fauconnier
- Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France.,Research unit EA 7285 (RISCQ), Université Versailles St-Quentin, Montigny-le-Bretonneux, France
| | - Xavier Fritel
- Université de Poitiers, Faculté de Médecine et Pharmacie, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
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A Novel Operative Procedure for Pelvic Organ Prolapse Utilizing a MRI-Visible Mesh Implant: Safety and Outcome of Modified Laparoscopic Bilateral Sacropexy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:860784. [PMID: 25961042 PMCID: PMC4417564 DOI: 10.1155/2015/860784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023]
Abstract
Introduction. Sacropexy is a generally applied treatment of prolapse, yet there are known possible complications of it. An essential need exists for better alloplastic materials. Methods. Between April 2013 and June 2014, we performed a modified laparoscopic bilateral sacropexy (MLBS) in 10 patients using a MRI-visible PVDF mesh implant. Selected patients had prolapse POP-Q stages II-III and concomitant OAB. We studied surgery-related morbidity, anatomical and functional outcome, and mesh-visibility in MRI. Mean follow-up was 7.4 months. Results. Concomitant colporrhaphy was conducted in 1/10 patients. Anatomical success was defined as POP-Q stage 0-I. Apical success rate was 100% and remained stable. A recurrent cystocele was seen in 1/10 patients during follow-up without need for intervention. Out of 6 (6/10) patients with preoperative SUI, 5/6 were healed and 1/6 persisted. De-novo SUI was seen in 1/10 patients. Complications requiring a relaparoscopy were seen in 2/10 patients. 8/10 patients with OAB were relieved postoperatively. The first in-human magnetic resonance visualization of a prolapse mesh implant was performed and showed good quality of visualization. Conclusion. MLBS is a feasible and safe procedure with favorable anatomical and functional outcome and good concomitant healing rates of SUI and OAB. Prospective data and larger samples are required.
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Pierce H, Perry L, Gallagher R, Chiarelli P. Pelvic floor health: a concept analysis. J Adv Nurs 2015; 71:991-1004. [PMID: 25675895 DOI: 10.1111/jan.12628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 12/01/2022]
Abstract
AIM To report an analysis of the concept 'pelvic floor health'. BACKGROUND 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. DESIGN Rodger's evolutionary view was used to guide this analysis. DATA SOURCES Academic literature databases and public domain websites viewed via the Internet search engine Google. REVIEW METHODS Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. RESULTS Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. CONCLUSION This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision.
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Affiliation(s)
- Heather Pierce
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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The self-report fecal incontinence and constipation questionnaire in patients with pelvic-floor dysfunction seeking outpatient rehabilitation. Phys Ther 2014; 94:273-88. [PMID: 24114438 DOI: 10.2522/ptj.20130062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Fecal incontinence and constipation affect men and women of all ages. OBJECTIVE The purpose of this study was to psychometrically analyze the Fecal Incontinence and Constipation Questionnaire (FICQ) in patients seeking outpatient rehabilitation services due to pelvic-floor dysfunction (PFD). DESIGN This was a retrospective analysis of cross-sectional data from 644 patients (mean age=52 years, SD=16, range=18-91) being treated for PFD in 64 outpatient rehabilitation clinics in 20 states (United States). METHODS We assessed the 20-item FICQ for unidimensionality and local independence, differential item functioning (DIF), item fit, item hierarchical structure, and test precision using an item response theory model. RESULTS Factor analyses supported the 2-factor subscales as originally defined; items related to severity of leakage or constipation. Removal of 2 leakage items improved unidimensionality and local independence of the leakage scale. Among the remaining items, 2 items were suggestive of adjustment for DIF by age group and by number of PFD comorbid conditions. Item difficulties were suitable for patients with PFD with no ceiling or floor effect. Mean item difficulty parameters for leakage and constipation subscales ranged from 38.8 to 62.3 and 28.1 to 63.3 (0-100 scale), respectively. Endorsed leakage items representing highest difficulty levels were related to delay defecation and confidence to control bowel leakage. Endorsed constipation items representing highest difficulty levels were related to the need to strain during a bowel movement and the frequency of bowel movements. LIMITATIONS A limitation of this study was the lack of medical diagnostic criteria to classify patients. CONCLUSIONS After removing 2 items and adjusting for DIF, the results supported sound psychometric properties of the FICQ items and its initial use for patients with PFD in outpatient rehabilitation services.
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Laparoscopic sacropexy and obstructed defecation syndrome: an anatomoclinical study. Int Urogynecol J 2013; 24:1623-30. [PMID: 23538995 DOI: 10.1007/s00192-013-2077-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/18/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic sacropexy (LSP) is associated with obstructed defecation syndrome (ODS) in 10-50% of cases. An anatomoclinical study was carried out to investigate whether there is any correlation between iatrogenic denervation during LSP and ODS. METHODS Five female cadavers were dissected to identify possible sites of nerve injury during LSP. Subsequently, the videos of 18 LSP were blindly reviewed to assess the location of sacral dissection and tacks, the position and depth of the peritoneal tunnel, and another 4 variables. An anatomical triangle was defined on the right lumbosacral spine so as to clearly describe the sites of the surgical variables, which were then statistically correlated with the patients' postoperative outcome. RESULTS The only variable associated with postsurgical ODS was dissection in the 90° angle of the anatomical triangle, where the superior hypogastric plexus was observed in all cadavers. CONCLUSIONS Medial and midline dissection over the sacral promontory might be associated with postoperative ODS.
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Johnson P, Larson KA, Hsu Y, Fenner DE, Morgan D, Delancey JOL. Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center. Int J Gynaecol Obstet 2012; 120:53-6. [PMID: 23073228 DOI: 10.1016/j.ijgo.2012.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/06/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the characteristics of recurrent pelvic organ prolapse (POP). METHODS A convenience sample of patients presenting with recurrent POP symptoms between October 2007 and February 2010 completed questionnaires. The survey focused on timing of recurrence(s), symptoms, and demographics. RESULTS Ninety-seven women completed questionnaires. Thirty-four (35.1%) had undergone multiple prior treatments. Overall, 23 of 76 (30.3%) women had not informed their surgeon of the recurrence. Twenty-seven of 59 (45.8%) women reported that their symptoms were the same as before treatment, whereas 23 of 59 (39.0%) reported more severe symptoms. POP was considered to be persistent if symptoms returned within 3 months, and recurrent if symptom relief exceeded 3 months. After primary surgery, 28 of 79 (35.4%) cases were considered to be persistent, whereas 51 (64.6%) cases were recurrent. Similar percentages were seen after second and third treatments. CONCLUSION Overall, 35% of participants experienced early return of symptoms. Almost one-third of participants had not informed their surgeon of the recurrence, indicating that there may not be an accurate self-assessment of outcome in the absence of careful follow-up.
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Affiliation(s)
- Payton Johnson
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
BACKGROUND Pelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, especially women. OBJECTIVE The purposes of this study were: (1) to describe the characteristics of individuals with disorders associated with PFD who were seeking outpatient physical therapy services and (2) to identify the prevalence of specific pelvic-floor disorders in the group. DESIGN This was a prospective, longitudinal, cohort study of 2,452 patients (mean age=50 years, SD=16, range=18-91) being treated in 109 outpatient physical therapy clinics in 26 states (United States) for their PFD. METHODS This study examined patient demographic variables and summarized patient self-reported responses to questions related to urinary and bowel functioning at admission prior to receiving the therapy for their PFD disorders. RESULTS Patients primarily were female (92%), were under 65 years of age (39%: 18 to <45 years; 39%: 45 to <65 years; 21%: 65 years or older), and had chronic symptoms (74%). Overall, 67% of the patients reported that they had urinary problems, 27% reported bowel problems, and 39% had pelvic pain. Among those who had urinary or bowel disorders, 32% and 54% reported leakage and constipation, respectively, as their only problem. Among patients who had pelvic pain, most (56%) reported that the pain was in the abdominal area. Combinations of urinary, bowel, or pelvic-floor pain disorders occurred in 31% of the patients. LIMITATIONS Because this study was a secondary analysis of data collected prospectively, the researchers were not in control of the data collection procedure. Missing data were common. CONCLUSIONS Data suggested most patients with PFD receiving outpatient physical therapy services were female, younger than 65 years, and had disorders lasting for more than 90 days. Combinations of urinary, bowel, or pelvic-floor pain disorders were not uncommon.
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Gleason JL, Richter HE, Redden DT, Goode PS, Burgio KL, Markland AD. Caffeine and urinary incontinence in US women. Int Urogynecol J 2012; 24:295-302. [PMID: 22699886 DOI: 10.1007/s00192-012-1829-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/10/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of this study was to characterize associations between caffeine consumption and severity of urinary incontinence (UI) in US women. We hypothesized that moderate and high caffeine intake would be associated with UI in US women when controlling for other factors associated with UI. METHODS US women participated in the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative survey. Using the Incontinence Severity Index, UI was categorized as "any" and "moderate/severe". Types of UI included stress, urge, mixed, and other. Food diaries were completed, and average water (grams/day), total dietary moisture (grams/day), and caffeine (milligrams/day) intake were calculated into quartiles. Stepwise logistic regression models were constructed adjusting for sociodemographics, chronic diseases, body mass index, self-rated health, depression, physical activity, alcohol use, dietary water and moisture intake, and reproductive factors. RESULTS From the 4,309 nonpregnant women (aged ≥20 years) who had complete UI and dietary data, UI prevalence for any UI was 41.0 % and 16.5 % for moderate/severe UI, with stress UI the most common type (36.6 %). Women consumed a mean caffeine intake of 126.7 mg/day. After adjusting for multiple factors, caffeine intake in the highest quartile (≥204 mg/day) was associated with any UI [prevalence odds ratio (POR) 1.47, 95 % confidence interval (CI) 1.07-2.01], but not moderate/severe UI (POR 1.42, 95 % CI 0.98-2.07). Type of UI (stress, urgency, mixed) was not associated with caffeine intake. CONCLUSIONS Caffeine intake ≥204 mg/day was associated with any UI but not with moderate/severe UI in US women.
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Affiliation(s)
- Jonathan L Gleason
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA.
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Effects of transvaginal repair of symptomatic rectocele on symptom-specific distress and impact on quality of life. Int J Gynaecol Obstet 2012; 117:224-7. [DOI: 10.1016/j.ijgo.2012.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/07/2012] [Accepted: 02/22/2012] [Indexed: 11/19/2022]
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The efficacy of posterior tibial nerve stimulation for the treatment of overactive bladder in women: a systematic review. Int Urogynecol J 2012; 23:1591-7. [DOI: 10.1007/s00192-012-1712-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Lohsiriwat S, Hirunsai M, Chaiyaprasithi B. Effect of caffeine on bladder function in patients with overactive bladder symptoms. Urol Ann 2011; 3:14-8. [PMID: 21346827 PMCID: PMC3036994 DOI: 10.4103/0974-7796.75862] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/01/2010] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the effect of caffeine at the dose of 4.5 mg/kg on bladder function in overactive bladder (OAB) adults. Materials and Methods: Nine women and three men aged 21-40 years with OAB symptoms were included. Each subject drank 8 ml/kg of water with and without caffeine at two separate sessions. Cystometry and uroflowmetry were performed 30 minutes after each drink. The effects of caffeine on urodynamic parameters were compared. Results: After caffeine ingestion, the mean volume at bladder filling phase decreased at first desire to void and normal desire to void (P<0.05), compared to the mean volume after taking water (control) drink. The mean volume at strong desire to void, urgency and maximum cystometric capacity also tended to decrease. No change in the detrusor pressure at filling phase was found. At voiding phase, the maximal flow rate, average flow rate and voided volume were increased (P<0.05). The urine flow time and time to maximal flow rate were not changed. Conclusion: Caffeine at 4.5 mg/kg caused diuresis and decreased the threshold of sensation at filling phase, with an increase in flow rate and voided volume. So, caffeine can promote early urgency and frequency of urination. Individuals with lower urinary tract symptom should avoid or be cautious in consuming caffeine containing foodstuffs.
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Affiliation(s)
- Supatra Lohsiriwat
- Department of Physiology, Division of Urology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jura YH, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol 2011; 185:1775-80. [PMID: 21420114 DOI: 10.1016/j.juro.2011.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Although caffeine consumption is common and generally believed to affect bladder function, little is known about caffeine intake and incident urinary incontinence. MATERIALS AND METHODS We performed a prospective cohort study in 65,176 women 37 to 79 years old without incontinence in the Nurses' Health Study and the Nurses' Health Study II. Incident incontinence was identified from questionnaires during 4 years of followup. Caffeine intake was measured using food frequency questionnaires administered before incontinence development. The multivariate adjusted relative risk of the relation between caffeine intake and incontinence risk as well as attributable risk were calculated. RESULTS Caffeine was not associated with incontinence monthly or more. However, there was a modest, significantly increased risk of incontinence at least weekly in women with the highest (greater than 450 mg) vs the lowest (less than 150 mg) daily intake (RR 1.19, 95% CI 1.06-1.34) and a significant trend of increasing risk with increasing intake (p for trend = 0.01). This risk appeared focused on incident urgency incontinence (greater than 450 vs less than 150 mg daily, RR 1.34, 95% CI 1.00-1.80, p for trend = 0.05) but not on stress or mixed incontinence (p for trend = 0.75 and 0.19, respectively). The attributable risk of urgency incontinence associated with high caffeine intake was 25%. CONCLUSIONS Findings suggest that high but not lower caffeine intake is associated with a modest increase in the incidence of frequent urgency incontinence. A fourth of the cases with the highest caffeine consumption would be eliminated if high caffeine intake were eliminated. Confirmation of these findings in other studies is needed before recommendations can be made.
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Affiliation(s)
- Ying H Jura
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
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The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population. Int Urogynecol J 2010; 22:569-75. [PMID: 21104400 PMCID: PMC3072516 DOI: 10.1007/s00192-010-1323-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/04/2010] [Indexed: 12/02/2022]
Abstract
Introduction and hypothesis To study the prevalence and risk factors of overactive bladder (OAB) symptoms and its relationship with symptoms of pelvic organ prolapse (POP). Methods This is a cross-sectional study including women aged between 45 and 85 years, registered in eight general practices. All women were asked to self complete the validated Dutch translated questionnaires. All symptoms were dichotomized as present or absent based on responses to each symptom and degree of bother. Results Forty-seven percent of the women filled out the questionnaire. Prevalence of urgency was 34% and the prevalence of any OAB symptoms 49%. Prevalence of OAB symptoms increased with advancing age. Symptoms of POP were an independent risk factor for symptomatic OAB. Other risk factors were continence and prolapse surgery in the past, age above 75, overweight, postmenopausal status and smoking. Conclusions The prevalence of any OAB symptoms was 49%. POP symptoms were an independent risk factor for symptomatic OAB.
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Ricci Arriola P, Solà Dalenz V, Pardo Schanz J. [Occult stress incontinence identified by preoperative urodynamic study in women with severe pelvic organ prolapse]. Actas Urol Esp 2008; 32:827-32. [PMID: 19013982 DOI: 10.1016/s0210-4806(08)73942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the effectiveness of preoperative urodynamic study made with correction of the severe genital prolapse by Bresky valve in the diagnosis of urinary occult incontinence, in order to plan a correction with a prophylactic sub-mid urethral mesh in the prolapse surgery. PATIENTS AND METHOD Patients of the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic, between January 2006 and December 2007, with grade III or IV cystocele. A condition was patients without previous prolapse and/or incontinence surgeries. A non multichannel urodynamics test was made with prolapse correction by a Bresky valve. The urethra retro resistance measurement and cystometry was made. In the women in whom the occult urinary incontinence was discards the prolapse surgery was made with Prolift mesh. In the women with occult incontinence a prophylactic sub-mid urethral tape was applied in the prolapse surgery, to avoid the appearance of incontinence after surgery. RESULTS Thirty eight women fulfilled the criterion to enter in this study, 14 (36.8%) of them did not register occult urinary incontinence in the urodynamic test. In the 24 (63.2%) with occult incontinence: Type I in 1: type II in 2: type III in 1 and type II+III in 10. During the cystometry 3 of them registered an asymptomatic hyperactive detrusor. In 1 (4.2%) of the 24 patients with prophylactic incontinence surgery, in the immediate postoperative time a failure was observed. The rest 23 women did not present incontinence during the observation period between 4 to 24 months. In the 14 women only with prolapse surgery incontinence was not registered. CONCLUSIONS The preoperative urodynamic test with correction of severe genital prolapse by Bresky valve is an efficient method to detect the occult urinary incontinence. This allows planning a prophylactic incontinence surgery. According to our experience this method is safe and effective to avoid that the occult incontinence appears after a severe cystocele surgery repair and allows to given an integral solution to the pelvic floor problems that frequently sees associate, because they risk factors are the same to these conditions and both cause a high degree of deterioration of quality of life.
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Affiliation(s)
- P Ricci Arriola
- Unidad de Uroginecología, Departamento de Ginecología, Clínica Las Condes, Santiago, Chile.
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Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study. Obstet Gynecol 2008; 111:1148-53. [PMID: 18448748 DOI: 10.1097/aog.0b013e31816a3b96] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women. METHODS This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI). RESULTS Mean age was 68+/-5 years, BMI 30+/-6 kg/m(2), and median parity 4. Ninety-five percent of women had POP-Q stages I-II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score. CONCLUSION Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I-II prolapse. LEVEL OF EVIDENCE II.
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Wren PA, Janz NK, FitzGerald MP, Barber MD, Burgio KL, Cundiff GW, Nygaard IE, Zyczynski HM, Gao X. Optimism in women undergoing abdominal sacrocolpopexy for pelvic organ prolapse. J Am Coll Surg 2008; 207:240-5. [PMID: 18656053 DOI: 10.1016/j.jamcollsurg.2008.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 02/18/2008] [Accepted: 02/20/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although studies suggest that optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study sought to explore the relationship between optimism, prolapse severity, and symptoms before operation; and examine whether optimism predicts postsurgical functional status, treatment satisfaction, and treatment success. STUDY DESIGN Data from the randomized Colpopexy and Urinary Reduction Efforts (CARE) study, in which stress continent women undergoing sacrocolpopexy to repair stage II to IV POP completed a baseline assessment of optimism and validated symptom and quality-of-life measures at baseline and 24 months. Relationships between optimism and demographics, clinical status, and functional and quality-of-life outcomes were assessed. RESULTS Of 322 Colpopexy and Urinary Reduction Efforts study participants, 305 (94.7%) completed 24-month followup interviews. At baseline, there were no notable differences in optimism with respect to POP stage or history of earlier operations for prolapse or urinary incontinence. At baseline, women with greater optimism reported markedly better physical and mental functioning (p <or= 0.001) and less symptom distress (p <or= 0.01). Two years after operation, the difference in symptom experience across the three optimism categories narrowed; all women reported improved health status, fewer symptoms, and less impact on daily activities. Satisfaction with treatment and perception of treatment success were not associated with optimism. CONCLUSIONS In women planning operation for POP, optimism is related to pelvic symptom severity, but is not associated with satisfaction with treatment or treatment success. Abdominal sacrocolpopexy resulted in substantial improvements in quality of life and functional outcomes that were not notably influenced by optimism.
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Affiliation(s)
- Patricia A Wren
- Department of Wellness, Health Promotion, and Injury Prevention, School of Health Sciences, Oakland University, Rochester, MI 48309, USA
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Smith SL, Bartlett WP, Gleeson PB, Sullivan NT, Mitchell K. Quality of Life Tools and Their Relevance for Females with Genital Lymphedema. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/01274882-200832030-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Tayrac R, Deval B, Fernandez H, Marès P. Validation linguistique en français des versions courtes des questionnaires de symptômes (PFDI-20) et de qualité de vie (PFIQ-7) chez les patientes présentant un trouble de la statique pelvienne. ACTA ACUST UNITED AC 2007; 36:738-48. [PMID: 17881153 DOI: 10.1016/j.jgyn.2007.08.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 08/28/2007] [Accepted: 08/29/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this work was to develop a linguistically validated French version of two short-form questionnaires on symptoms and quality of life in female patients with pelvic floor disorders (PFDI-20, PFIQ-7), originally developed and psychometrically validated in English. MATERIAL AND METHODS French versions of the short form Pelvic Floor Disorder Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) were developed after two independent forward translations (English-French), one back translation (French-English), a review by French clinicians and patient testing on a sample of patients with pelvic floor disorders. This linguistic validation process was led in collaboration with Mapi Research Institute and the author of the original English version, Dr Matthew Barber, and sponsored by Coloplast. RESULTS These two self-administered questionnaires are completed by patients without a medical presence. They cover urinary, colo-recto-anal and pelvic/vaginal symptoms related to pelvic floor disorders. Psychometric evaluation of the original US English questionnaires found a good correlation between answers provided and clinical symptoms leading the patient to seek medical attention. Their main advantage is their ease of interpretation through the use of a numeric score. Linguistic validation does not consist in translating original questionnaires literally, but rather in developing conceptually equivalent and culturally appropriate versions adapted to the target country. These questionnaires are invaluable instruments to evaluate functional aspects of various forms of pelvic organ prolapse. CONCLUSION The French versions of the PFDI-20 and PFIQ-7 are the first linguistically validated instruments available in French to evaluate symptoms and quality of life in patients with pelvic floor disorders.
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Affiliation(s)
- R de Tayrac
- Service de gynécologie-obstétrique, centre hospitalo-universitaire Carémeau, place du Professeur-Debré, 30029 Nîmes cedex 09, France.
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Bradley CS, Nygaard IE, Brown MB, Gutman RE, Kenton KS, Whitehead WE, Goode PS, Wren PA, Ghetti C, Weber AM. Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol 2007; 197:642.e1-8. [PMID: 18060963 DOI: 10.1016/j.ajog.2007.08.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 05/15/2007] [Accepted: 08/06/2007] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy. STUDY DESIGN This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II-IV prolapse. In addition to sacrocolpopexy (+/- Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon's discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively. RESULTS The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups. CONCLUSION Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.
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Affiliation(s)
- Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Wasserberg N, Haney M, Petrone P, Ritter M, Emami C, Rosca J, Siegmund K, Kaufman HS. Morbid obesity adversely impacts pelvic floor function in females seeking attention for weight loss surgery. Dis Colon Rectum 2007; 50:2096-103. [PMID: 17899277 DOI: 10.1007/s10350-007-9058-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 04/11/2007] [Accepted: 05/23/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to determine the impact of excess body mass on the prevalence of pelvic floor disorders in morbidly obese females. METHODS A total of 358 morbidly obese females (body mass index (BMI) >or= 35 kg/m(2)) completed two validated, condition-specific, quality of life questionnaires of pelvic floor dysfunction, which assessed stress/impact in three main domains of pelvic floor disorders: pelvic organ prolapse, colorectal-anal, and urogenital incontinence. Prevalence and severity scores in the study population were compared with data from 37 age-matched nonobese controls (BMI <or= 35 kg/m(2)). RESULTS Mean age was 43 +/- 11 years vs. 42 +/- 12 years, and mean BMI was 50 +/- 10 kg/m(2) vs. 26 +/- 4 kg/m(2) (p = 0.02) in the study and control groups, respectively. Parity and past obstetric history were similar between the groups. Pelvic floor disorders were prevalent in 91 percent of the morbidly obese females compared with 22 percent in the control group (p < 0.001). Scores were statistically significantly higher in the study group for all studied stress/impact domains (p < 0.001 and p = 0.001, respectively). Further stratifications in the study group revealed a significant impact on pelvic floor disorders with increased age (p < 0.003 and p < 0.009 for stress/impact mean scores, respectively) and the presence of other comorbidities (p< 0.008, p < 0.03 for stress/impact prevalence, respectively). Additional increases in BMI > 35 kg/m(2) did not show increased adverse impacts on pelvic floor disorders symptoms. CONCLUSION More than 90 percent of morbidly obese females experience some degree of pelvic floor disorders, and 50 percent of these females report that symptoms adversely impact quality of life. In morbidly obese females, obesity is as important as obstetric history in predicting pelvic floor dysfunction.
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Affiliation(s)
- Nir Wasserberg
- Department of Surgery, Division of Colorectal and Pelvic Floor Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Bradley CS, Brown MB, Cundiff GW, Goode PS, Kenton KS, Nygaard IE, Whitehead WE, Wren PA, Weber AM. Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol 2006; 195:1814-9. [PMID: 16996465 DOI: 10.1016/j.ajog.2006.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 07/05/2006] [Accepted: 07/10/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to measure associations between bowel symptoms and prolapse. STUDY DESIGN Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed. RESULTS Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. Colorectal-Anal Distress Inventory obstructive subscale scores were higher in stage II women (median 29 [interquartile range 8,92] versus 17 [0,33] and 25 [0,38] for stages III and IV, respectively; adjusted P = .01). The few statistically significant correlations between symptoms and vaginal descent were negative and weak (less than 0.2). CONCLUSION Bowel symptoms and questionnaire scores do not increase with prolapse stage in women presenting for sacrocolpopexy.
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Affiliation(s)
- Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Albo M, Brubaker L, Daneshgari F. Open and unresolved clinical questions in female pelvic medicine and reconstructive surgery. BJU Int 2006; 98 Suppl 1:110-6. [PMID: 16911616 DOI: 10.1111/j.1464-410x.2006.06409.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michael Albo
- Department of Urology, University of California San Diego, San Diego, CA, USA
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Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, Zyczynski H, Brown MB, Weber AM. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2006; 354:1557-66. [PMID: 16611949 DOI: 10.1056/nejmoa054208] [Citation(s) in RCA: 358] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND We designed this trial to assess whether the addition of standardized Burch colposuspension to abdominal sacrocolpopexy for the treatment of pelvic-organ prolapse decreases postoperative stress urinary incontinence in women without preoperative symptoms of stress incontinence. METHODS Women who did not report symptoms of stress incontinence and who chose to undergo sacrocolpopexy to treat prolapse were randomly assigned to concomitant Burch colposuspension or to no Burch colposuspension (control) and were evaluated in a blinded fashion three months after the surgery. The primary outcomes included measures of stress incontinence (symptoms, stress testing, or treatment) and measures of urge symptoms. Enrollment was stopped after the first interim analysis because of a significantly lower frequency of stress incontinence in the group that underwent the Burch colposuspension. RESULTS Of 322 women who underwent randomization, 157 were assigned to Burch colposuspension and 165 to the control group. Three months after surgery, 33.6 percent of the women in the Burch group and 57.4 percent of the controls met one or more of the criteria for stress incontinence (P<0.001) [Corrected]. There was no significant difference between the Burch group and the control group in the frequency of urge incontinence (32.7 percent vs. 38.4 percent, P=0.48). After surgery, women in the control group were more likely to report bothersome symptoms of stress incontinence than those in the Burch group who had stress incontinence (24.5 percent vs. 6.1 percent, P<0.001). CONCLUSIONS In women without stress incontinence who are undergoing abdominal sacrocolpopexy for prolapse, Burch colposuspension significantly reduced postoperative symptoms of stress incontinence without increasing other lower urinary tract symptoms.
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Affiliation(s)
- Linda Brubaker
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Ill, USA
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Abstract
OBJECTIVE To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms. METHODS In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus. RESULTS Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and feeling a bulge were associated with vaginal descensus. Obstructive urinary symptom scores increased as anterior (P = .04), posterior (P < .01), and maximal (P = .01) vaginal descensus increased. Urinary incontinence or bowel symptoms were not associated with descensus of any vaginal compartment. ''See or feel a bulge,'' reported by 11 women (4%), was associated with descensus in all compartments (P < or = .04 for all) and with prolapse at or beyond the hymen (P < .001). This symptom was specific (100%), but not sensitive (16%) for prolapse, defined as descensus at or beyond the hymen. CONCLUSION Vaginal support defects in older women are associated with obstructive urinary symptoms and the symptom of seeing or feeling a bulge. However, symptoms are not useful in discriminating between women with and without milder vaginal wall descensus. Based on these results, we suggest that other etiologies for bothersome bladder or bowel complaints be considered before performing surgery for early pelvic organ prolapse.
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Affiliation(s)
- Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
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