Female Pelvic Floor Disorders Research Articles

MP56-15 SCREENING FOR URINARY INCONTINENCE IN MINNESOTA WOMEN USING A VALIDATED EPIDEMIOLOGIC SURVEY: A CROSS-SECTIONAL STUDY

INTRODUCTION AND OBJECTIVES:The prevalence of female pelvic floor disorders (PFDs) including urinary incontinence (UI) is felt to be high, however prior estimates vary. Estimates range from 1% to 5...

Patient-Reported Outcome Measures (PROMs) in Pelvic Floor Disorders.

Patient-reported outcome measures (PROMs) are tools that are widely used by clinicians and researchers across different medical specialties. In this review, we examine the use of PROMs in the evaluation of female pelvic floor disorders (PFD). PROM development in the assessment of urinary incontinence is more advanced than other pelvic disorders. Work is ongoing in the scientific community to improve currently available measures and create new robust tools where needed. Hundreds of PROMs are available for use in the evaluation of PFD, some more rigorously validated than others. They are used to screen for diseases, evaluate their impact on quality of life, determine the results of treatment, and measure patient's satisfaction with treatment. Careful consideration is required to choose the appropriate PROMs to care for a patient or include in a research study. The topic was reviewed in the Textbook of Female Urology and Urogynecology published in 2017. We reviewed recent literature (2015-2018) on the topic and summarized our findings.

The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction

ObjectiveFemale pelvic floor disorders, including female stress urinary incontinence (SUI) or sexual dysfunction are notorious for affecting the quality of women's life. It is reported that laser therapy might result in collagen remodeling and improvement in tissue firmness. The study was conducted to evaluate the short-term outcome of female pelvic floor disorders treated by laser therapy. Materials and methodsWomen with self-reported symptoms of female pelvic floor disorders (limited to SUI and sexual dysfunction) were included in the study. The participants were treated with the Er:YAG laser or the fractional microablative carbon dioxide (CO2) laser system. The therapeutic effect was focused on SUI symptoms and sexual dysfunction. ResultsThere were 31 women underwent laser treatment, including 21 patients treated with Erbium:YAG laser and 10 treated with CO2 laser. In the Erbium:YAG laser group, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ- SF) scores were dropped from 8.25 ± 5.66 to 5.00 ± 3.99 (P = 0.007); and in the CO2 laser group, scores were dropped from 11.11 ± 6.85 to 6.44 ± 4.25 (P = 0.035), contributing to the drop of ICI-Q-SF scores from 9.14 ± 6.08 to 5.45 ± 4.05 for all enrolled patients (P = 0.001). However, objective measure using pad test did not show a statistically significant difference between before and after treatment (from 3.20 ± 5.84 g to 1.54 ± 3.18 g, P = 0.224). Sexual dysfunction was improved in 13 patients (44.83%), but Female Sexual Function Index (FSFI) scores were not different before and after laser treatment (44.22 ± 23.36 vs. 44.09 ± 24.51, P = 0.389). ConclusionLaser therapy either by Erbium:YAG laser or CO2 laser seemed to be useful for female pelvic floor disorders, especially on improvement of SUI symptoms; however, the effectiveness needs further confirmation.

Disparities in Female Pelvic Floor Disorders

Pelvic floor disorders include urinary incontinence, pelvic organ prolapse, fecal incontinence, and other sensory and emptying abnormalities of the lower urinary and gastrointestinal tracts which are widely prevalent among women and largely undertreated. Many disparities exist among women with pelvic floor disorders which may affect prevalence estimates and treatment options offered. Findings suggest that there are many disparities among women with pelvic floor disorders including age, race, inadequate knowledge, access to care, and socioeconomic status. Better understanding disparities among women with pelvic floor disorders can help to guide further programs for education, outreach, and treatment of women with pelvic floor disorders.

Impact of Distance to Treatment Center on Care Seeking for Pelvic Floor Disorders.

The aim of this study was to evaluate the impact of distance from residence to treatment center on access to care for female pelvic floor disorders at an academic institution. A retrospective cross-sectional study was conducted of women seen for pelvic floor disorders at an academic institution from 2008 to 2014. Patient characteristics were extracted from charts. Geographical and US census data was obtained from public records and used to calculate distance from patient residence to physician office. Statistical analysis was performed using R Software (Version 0.98.1102) and Microsoft Excel (Version 14.4.7). Statistical significance was defined as a 2-sided P value of less than 0.05, and the χ test was used to determine associations of categorical variables. A total of 3015 patients were included in the analysis. The mean distance traveled was 93 miles. Thirty percent of patients traveled more than 50 miles. Many patients (43%) reported having the symptoms for more than 2 years. Patients who traveled farther were significantly more likely to be white, English-speaking, and with pelvic organ prolapse as primary complaint. These patients were more likely to plan surgery at the first visit than patients who traveled less far (29% vs 14%). Patients who traveled farther were also more likely to live in counties with a low percentage of persons older than 65 years and low percentage of female inhabitants. Women who travel the farthest for treatment of pelvic floor disorders have experienced the symptoms for longer duration and are more willing to plan surgery at presentation. These women also come from counties with fewer elderly women, suggesting future outreach care should focus on similar geographic areas.

Pelvic floor disorders in women: an overview

Urinary incontinence affects 10% to 58% of community-dwelling women and up to 50% of nursing home residents. Prevalence of incontinence appears gradually to increase during young adult life, has a broad peak around middle age, and then a steady increase in the elderly. It has been shown to affect a person's social, clinical, and psychological well-being. The majority of women with incontinence do not seek medical help. The estimated annual direct cost of urinary incontinence alone in women in the United States (in U.S. dollars) is 12.4 billion. The proportion of the United States population over age 75 was 22% in the year 1999 and is expected to grow substantially during the coming decades. Pelvic floor disorders such as urinary incontinence, fecal incontinence, and pelvic organ prolapse affect older women disproportionately. Because of this relationship, it is estimated that the growth in demand for services to care for female pelvic floor disorders will increase at twice the rate of growth of the population over the next 30 years. Approximately 10% of women have surgery for pelvic organ prolapse or urinary incontinence in their lifetime and nearly 30% of these operations are for recurrent disease. This fact suggests that failure rates after surgery for pelvic floor disorders are high, in spite of the introduction of many new surgical diagnostic techniques, tools and operations. Numerous techniques have been developed to evaluate the type and extent of urinary and fecal incontinence and prolapse. A number of treatment options exist, ranging from behavioral to medical and surgical approaches. This document will discuss some of the general issues related to pelvic floor disorders and suggest areas for future research.

Re: Effects of Bariatric Surgery on Female Pelvic Floor Disorders.

Re: Effects of Bariatric Surgery on Female Pelvic Floor Disorders.

Effects of Bariatric Surgery on Female Pelvic Floor Disorders

To assess the effect of weight loss on urinary incontinence (UI), pelvic organ prolapse, colorectal-anal complaints, and sexual dysfunction among obese women undergoing bariatric surgery. One hundred sixty consecutive women who underwent bariatric surgery were prospectively enrolled. Four validated questionnaires (International Consultation on Incontinence Questionnaire-UI [ICIQ-UI], Bristol Female Lower Urinary Tract Symptoms-SF [BFLUTS-SF], Pelvic Floor Distress Inventory-20 [PFDI-20], and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 [PISQ-12]) were used to evaluate pelvic floor disorders and sexual dysfunction before and 3-6 months after surgery. One hundred fifty participants (mean age: 43 ± 12.8 years; mean preoperative body mass index: 42 ± 4.6 kg/m2) completed all pre- and postoperative questionnaires. Preoperatively, 56 (37.3%) women had UI, 44 (29.3%) women had pelvic organ prolapse symptoms, and 66 (44%) women had colorectal-anal symptoms. Overall, surgically induced weight loss was associated with statistically significant improvement in UI (mean ICIQ score: 9.3 ± 3.9 vs 3.3 ± 3.8, P <.001), pelvic organ prolapse symptoms (mean PFDI score: 19 ± 13.2 vs 11 ± 12.8, P <.001), and colorectal-anal symptoms (mean PFDI score: 21 ± 15.9 vs 14 ± 14.9, P = .004). Moreover, half of preoperatively incontinent women and more than one quarter of women who had either pelvic organ prolapse or colorectal-anal symptoms reported complete resolution of their symptoms. Statistically significant improvement in sexual function was suggested by both BFLUTS-SF (0.3 ± 0.8 vs 0.1 ± 0.6; P = .011) and PISQ-12 (37.9 ± 6.1 vs 39.5 ± 5; P = .003) questionnaires. Surgically induced weight loss was associated with a significant improvement in pelvic floor disorders, including UI, pelvic organ prolapse, and colorectal-anal symptoms, as well as improved sexual performance.

Traduction française de la terminologie commune International Urogynecological Association (IUGA)/International Continence Society (ICS) sur les troubles de la statique pelvienne chez la femme initialement publiée dans Int Urogynecol J 2010;21(1):5–26

Given its increasing complexity, the terminology for female pelvic floor disorders needs to be updated in addition to existing terminology of the lower urinary tract. To do this, it seems preferable to adopt a female-specific approach and build on a consensus based on clinical practice. This paper summarizes the work of the standardization and terminology committees of two international scientific societies, namely the International Urogynecological Association (IUGA) and the International Continence Society (ICS). These committees were assisted by many external expert referees. A ranking into relevant major clinical categories and sub-categories was developed in order to allocate an alphanumeric code to each definition. An extensive process of 15 internal and external reviews was set up to study each definition in detail, with decisions taken collectively (consensus). Terminology was developed for female pelvic floor disorders, bringing together more than 250 definitions. It is clinically based and the six most common diagnoses are defined. The emphasis was placed on clarity and user-friendliness to make this terminology accessible to practitioners and trainees in all the specialties involved in female pelvic floor disorders. Imaging investigations (ultrasound, radiology, MRI) exclusively for women have been added to the text, relevant figures have also been included to complete the text and help clarify the meaning. Regular reviews are planned and are also required to keep the document up-to-date and as widely acceptable as possible. The work conducted led to the development of a consensual terminology of female pelvic floor disorders. This document has been designed to provide substantial assistance in clinical practice and research. 4.

Bariatric surgery improves female pelvic floor disorders

Obesity aggravates pelvic floor disorders in women. Weight loss improves these disorders. The purpose of this study was to assess the evolution of pelvic floor disorders in women who have undergone bariatric surgery. A prospective single-center study was conducted from December 2012 to February 2014. The parameters studied were diabetes, BMI, excess weight loss, multiparity, mode of delivery and their relation to obesity and pelvic floor disorders. We evaluated anorectal and urethral sphincter disorders using the PFDI-20 questionnaire preoperatively, at 1 month and then every 6 months thereafter. One hundred and sixteen patients underwent bariatric surgery. Seventy questionnaires were completed preoperatively and postoperatively. Weight loss was significant with an excess weight loss of 57.1%. The mean body mass index (BMI) decreased from 44.5 ± 6.31 kg/m(2) (range: 35.0-63.23) to 31.83 ± 5.83 kg/m(2) (range: 20.9-49.6). The average length of follow-up was 11.3 ± 5.2 months (range: 5-25). The incidence of urinary symptoms improved after surgery (P=0.003), as did the UDI-6 score (Urogenital distress inventory) (P=0.009). There was no improvement in other symptoms such as prolapse and colorectal-anal dysfunction. The prevalence of pelvic floor disorders is high among obese women; in this study, colorectal disorders were present in 53% and urinary disorders in 71.5%. Bariatric surgery-induced weight loss led to improvement in urinary continence disorders when assessed over an average follow-up of 11 months.

Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide (CAPABLe) trial: Design and methods

The goals of this trial are to determine the efficacy and safety of two treatments for women experiencing fecal incontinence. First, we aim to compare the use of loperamide to placebo and second, to compare the use of anal sphincter exercises with biofeedback to usual care. The primary outcome is the change from baseline in the St. Mark's (Vaizey) Score 24weeks after treatment initiation. As a Pelvic Floor Disorders Network (PFDN) trial, subjects are enrolling from eight PFDN clinical centers across the United States. A centralized data coordinating center supervises data collection and analysis. These two first-line treatments for fecal incontinence are being investigated simultaneously using a two-by-two randomized factorial design: a medication intervention (loperamide versus placebo) and a pelvic floor strength and sensory training intervention (anal sphincter exercises with manometry-assisted biofeedback versus usual care using an educational pamphlet). Interventionists providing the anal sphincter exercise training with biofeedback have received standardized training and assessment. Symptom severity, diary, standardized anorectal manometry and health-related quality of life outcomes are assessed using validated instruments administered by researchers masked to randomized interventions. Cost effectiveness analyses will be performed using prospectively collected data on care costs and resource utilization. This article describes the rationale and design of this randomized trial, focusing on specific research concepts of interest to researchers in the field of female pelvic floor disorders and all other providers who care for patients with fecal incontinence.

Radiation Dosimetry of Pelvic Floor and Non-Reproductive Sexual Organs in External Beam Radiation Therapy for Gynecologic Cancers

Sexual dysfunction and pelvic floor disorders are common in gynecologic cancer survivors. With the increasing use of MRI in radiation therapy (RT) treatment planning, small yet critical female pelvic structures that were previously unseen during planning CT scans can now be visualized. In this study, we determined the degree of RT dose delivered to anatomic structures of clinical importance in female sexual dysfunction and pelvic floor disorders by pelvis external beam RT.

Sexual experiences of male partners before and after female pelvic floor surgery: a qualitative study

To obtain a precise idea of the partner's thoughts and experiences with regard to the effect of female pelvic floor disorders and surgery on his sexual life. Qualitative semi-structured interviews were conducted in 8 partners of women undergoing pelvic floor surgery prior to, and in 6 partners at a median of 18 weeks after surgery. The data gathered were systematically analysed using data matrices. Although most men evaluated their sex life prior to surgery in a positive way, one or more changes in the sexual life of our participants as a result of the female pelvic floor disorder were common. This was a result of changes in the man's physical sensations and behaviour during sex (direct changes), and changes in the female partner's sexual behaviour and reduced body confidence (indirect changes). The cure of the pelvic floor disorder and changes in vaginal tightness following surgery caused direct improvements in the man's physical sensations, as well as indirect improvements in his sexual experience as a result of positive changes in the woman's sexual behaviour and body confidence. As only a small group of men participated in this study, the results should be interpreted with caution. The information gathered in our study can provide guidance to clinicians on possible aspects to explore with their patients prior to and after pelvic floor surgery, and can form the basis of disease-specific male sexual function questionnaires that can be used in quantitative studies on this topic.

History and Development of an Integrated Model of Care for Female Pelvic Medicine and Surgery

Urologists and gynecologists manage most of the patients with female pelvic floor disorders. However, lack of a single focused approach among these two disciplines and other related fields may hinder advances in clinical care and research. Herein, along with describing the background of birth of the new subspeciality, we present a practical approach by which we established an integrated model of care and discovery for FPFD at our institution. With the recent approval of this subspeciality by the Accreditation Council for Graduate Medical Education (ACGME), it is plausible that other institutions would wish to initiate similar steps toward establishment of an integrated model of care for FPFD, and hence move this new subspecialty to its new frontiers.

Pelvic Mesh Complications in Women Before and After the 2011 FDA Public Health Notification

On July 13, 2011, the US Food and Drug Administration (FDA) released a public health notification with concerns regarding vaginal mesh for the treatment of pelvic organ prolapse. Our study compares the frequency and type of mesh complications related to female pelvic floor disorders presenting to our center before and after this notification. We performed a retrospective cohort study comparing the percentage of women found to have mesh complications related to pelvic floor disorders for the year preceding and the 6 months following the FDA notification. The 2011 International Urogynecological Association/International Continence Society (IUGA/ICS) guidelines were used to classify mesh complications. We identified 109 women in the 12 months before and 98 women in the 6 months after the FDA notification who presented for new consultation with a history of pelvic mesh placement. Of the women with prior mesh, a higher percentage had a mesh complaint after the FDA notification (31.2% before vs 45.9% after notification; P = 0.029). There was no difference in the frequency of diagnosed mesh complications (38.5% before vs 43.9% after notification; P = 0.435) or the types of complications seen as classified by the IUGA/ICS guidelines. The rate of complications among women with a prior sacral colpopexy (35%) or midurethral sling (30%) was higher than expected for both time periods. Whereas the number of patient-perceived mesh complications increased after the FDA notification, neither the frequency, type, or location of complications changed. The complications were not limited to transvaginal mesh, and an unexpectedly high proportion of the complications were related to sacral colpopexy and midurethral sling procedures.

The Role of Sacral Nerve Stimulation in Female Pelvic Floor Disorders

Female pelvic floor disorders, such as urge incontinence, nonobstructive urinary retention, painful bladder syndrome, fecal incontinence, chronic constipation, and sexual dysfunction, represent multiple challenges to the treating physicians. Sacral nerve modulation (SNM) gives a promising alternative and a minimally invasive treatment option for chronic pelvic floor disorders resistant to conventional treatment. This review covers the mechanism of action and surgical procedure of the SNM as well as the current and expanding indications for SNM in female pelvic floor disorders.

Female genital cosmetic surgery: a review of techniques and outcomes

The aesthetic and functional procedures that comprise female genital cosmetic surgery (FGCS) include traditional vaginal prolapse procedures as well as cosmetic vulvar and labial procedures. The line between cosmetic and medically indicated surgical procedures is blurred, and today many operations are performed for both purposes. The contributions of gynecologists and reconstructive pelvic surgeons are crucial in this debate. Aesthetic vaginal surgeons may unintentionally blur legitimate female pelvic floor disorders with other aesthetic conditions. In the absence of quality outcome data, the value of FGCS in improving sexual function remains uncertain. Women seeking FGCS need to be educated about the range and variation of labia widths and genital appearance, and should be evaluated for true pelvic support disorders such as pelvic organ prolapse and stress urinary incontinence. Women seeking FGCS should also be screened for psychological conditions and should act autonomously without coercion from partners or surgeons with proprietary conflicts of interest.

Role of conventional radiology and MRi defecography of pelvic floor hernias

BackgroundPurpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders.MethodsA MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'.ResultsThe prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI.ConclusionsMRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.

Division of Urogynecology and Reconstructive Pelvic Surgery

The Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Iowa includes Drs. Catherine Bradley a fellowship trained urogynecologist and a nurse practitioner with advanced clinical training, Diane Elas, ARNP. UIHC Urogynecology clinics focus on the outpatient evaluation and management of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, and other urinary and defecatory disorders. Outpatient diagnostic testing is available, including urodynamic tests and cystourethroscopy. We offer a wide spectrum of clinical care for pelvic floor disorders, including nonsurgical (e.g. pessaries and behavioral therapies) and surgical therapies. Clinic-based procedures (such as transurethral bulking injections and intra-detrusor botulinum toxin injections) are offered, as well as outpatient and inpatient surgeries. Special clinical initiatives include our minimally-invasive surgery program for urinary incontinence and prolapse, including outpatient slings and robotic hysterectomy and sacrocolpopexy.

Female Pelvic Floor Symptoms Before and After Bariatric Surgery

Obesity is a risk factor for female pelvic floor disorders. The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery. This was a prospective cohort study of female patients that underwent bariatric surgery. Patients completed a demographic questionnaire, the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) before surgery and at 6 and 12months following surgery. Body mass index (BMI) was compared between time points using Student's t tests (P < 0.05 significant). Symptom and impact on quality of life prevalence were compared using McNemar's test and questionnaire scores were compared using the Wilcoxon matched pairs test (P < 0.025 significant). At 12months after surgery, 63 patients had completed the study. Even with significant weight loss (BMI, 43.7kg/m(2) to BMI, 29kg/m(2); P < 0.001), there was no significant difference in the prevalence of pelvic floor symptoms before and after surgery (94% to 81%, P = 0.2). Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery (56% to 30%; P = 0.004). Baseline PFDI-20 and PFIQ-7 scores were low; however, there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery (P < 0.001). Prevalence of pelvic floor symptoms did not vary greatly after surgery; however, significant weight reduction did improve the degree of bother and quality of life related to these symptoms.