PD50-05 DO LUTS CORRELATE WITH UTERINE FIBROID SIZE AND LOCATION?

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2018PD50-05 DO LUTS CORRELATE WITH UTERINE FIBROID SIZE AND LOCATION? Robyn K Shaffer, Amy D Dobberfuhl, Angela Fast, Kim N Vu, David Hovsepian, Deirdre Lum, Pejman Ghanouni, and Bertha Chen Robyn K ShafferRobyn K Shaffer More articles by this author , Amy D DobberfuhlAmy D Dobberfuhl More articles by this author , Angela FastAngela Fast More articles by this author , Kim N VuKim N Vu More articles by this author , David HovsepianDavid Hovsepian More articles by this author , Deirdre LumDeirdre Lum More articles by this author , Pejman GhanouniPejman Ghanouni More articles by this author , and Bertha ChenBertha Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2333AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uterine fibroids are prevalent and often co-exist with lower urinary tract symptoms (LUTS) in women. Fibroid bulk is thought to correlate with LUTS and pelvic floor symptom severity. However, these associations are under-studied and data are based mostly on ultrasound measurements. Correlations between LUTS and specific fibroid or pelvic dimensions may impact treatment counseling. We examined the correlation between LUTS and fibroids using MR imaging. METHODS A retrospective review (2013-2016) on Stanford Fibroid Clinic patients identified 238 patients with a complete Pelvic Floor Distress Inventory survey (PFDI; score 0-300, worse symptoms with higher scores) and pelvic MRI. PFDI scores and sub-scores, including urogenital (UDI-6) and colorectal anal (CRAD-8) distress inventory scores, were correlated to MRI data. Data were analyzed in STATA. RESULTS Patients had a mean age of 47.3 years (SD 7.2 years) and a mean PFDI score of 77.5 (SD 52.7). Pearson correlation analysis showed that dominant fibroid volume was inversely correlated with colorectal distress (CRAD-8 r=-0.14, p<0.05). Women with an anteverted uterus tilted towards the bladder reported worse stress incontinence scores [2.2 (n=176) vs 1.5 (n=45); p<0.05]. There was no association between fibroid location on the uterus (anterior, posterior, fundal) or within the uterine wall (intramural, submucosal, subserosal) and LUTS. Analysis of fibroids location relative to bony landmarks demonstrated that 29% of women had fibroids within the true pelvis only while 71% had fibroids extending into the abdomen. Women with anterior displacement of the abdominal wall visible on MRI due to fibroid mass effect reported fewer pelvic floor symptoms [PFDI 68.7 vs 82.0; p<0.05] and fewer colorectal symptoms [CRAD-8 12.5 vs 20.7; p<0.001] than those without abdominal wall distension. Worse pelvic floor and urogenital symptoms correlated to women with a deeper sacral curvature (PFDI r=0.16, p<0.05; UDI-6 r=0.15, p<0.05). Worse colorectal symptoms correlated with higher ratio of dominant fibroid diameter to the pelvic diameter (distance measured from sacral promontory to the superior symphysis) (CRAD-8 r=0.19, p<0.01). CONCLUSIONS Contrary to common belief, LUTS appear to inversely correlate with uterine volume. Women with a smaller pelvis or deeper sacral curvature relative to fibroid size may report worse symptoms unless the fibroid is displaced into the abdomen. Fibroid size relative to bony parameters may help providers counsel patients on whether removal of fibroids will provide symptom relief. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e971-e972 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Robyn K Shaffer More articles by this author Amy D Dobberfuhl More articles by this author Angela Fast More articles by this author Kim N Vu More articles by this author David Hovsepian More articles by this author Deirdre Lum More articles by this author Pejman Ghanouni More articles by this author Bertha Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...