Pelvic Floor Disorders In Women Research Articles

Influence of Pelvic Floor Disorders on Sleep Quality in Women.

Pelvic floor disorders, the impact of their symptoms, and their association with sleep quality and sleep disorders is a little studied area. The aim of this study was to determine if an association exists between pelvic floor disorders in women and sleep disorders. An observational study was conducted among women in Spain during 2021 and 2022. A self-developed questionnaire was used to collect sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems. A validated questionnaire, the Pittsburgh Sleep Quality Index (PSQI), was used to assess the quality of sleep. The presence and impact of pelvic floor problems was assessed with the Pelvic Floor Distress Inventory (PFDI-20). Odds ratios (OR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals were calculated using logistic regression. A total of 1396 women participated in the study. The total PSQI indicated that 75.36% (1052) of women have altered general sleep quality. Women with pelvic floor disorders have a higher probability of developing sleep alterations (aOR: 1.32; 95% CI: 1.22-1.42; for every 20 points). A high BMI (aOR: 1.04; 95% CI: 1.01-1.07; for each point) and the presence of musculoskeletal disorders (aOR: 3.14; 95% CI: 1.20-8.27) are also associated with sleep quality in women. Women with pelvic floor disorders are more likely to develop sleep disorders, probably due to all the discomfort they entail.

Cross-Cultural Adaptation and Measurement Properties Analysis of the Brazilian Portuguese Version of the ICIQ-VS.

The high prevalence of pelvic floor disorders in women requires assessments using validated instruments. We aimed to translate, cross-culturally adapt to Brazilian Portuguese, and analyze the measurement properties of the International Consultation on Incontinence Questionnaire Vaginal Symptoms Module (ICIQ-VS-Br). Participants were Brazilian women older than 18years presenting vulvovaginal symptoms according to the Vulvovaginal Symptoms Questionnaire (VSQ-Br). The development of the ICIQ-VS-Br included the steps of translation, synthesis, back-translation, expert meeting, and pre-test. We analyzed construct validity by correlating the ICIQ-VS-Br and VSQ-Br. The participants answered the ICIQ-VS-Br the second time 7 to 10days after the first response. We measured test-retest reliability using intraclass correlation coefficient (ICC), internal consistency using Cronbach's alpha, and construct validity using Pearson's correlation coefficient. The study included 313 women. Reproducibility was analyzed for the three subscales of the ICIQ-VS-Br, resulting in an ICC of 0.92 (95% CI 0.89 to 0.94) for "vaginal symptoms," 0.85 (95% CI 0.78 to 0.89) for "sexual matters," and 0.87 (95% CI 0.81 to 0.91) for "quality of life." Construct validity showed a moderate correlation between ICIQ-VS-Br and VSQ-Br, confirming our hypotheses. The ICIQ-VS-Br demonstrated validity and reproducibility, indicating that the instrument can be used in scientific research and clinical practice.

Prevalence of pelvic floor dysfunctions in women with endometriosis

Background: Endometriosis is a benign disease that has the potential for agressive tissue-invasion. Endometriosis and pelvic floor disorders (PFD) share common pathogenic mechanisms, but it is unknown whether endometriosis can cause them to develop or induce worsening PFD, including lower urinary tract symptoms, fecal incontinence and constipation. This study aimed to clarify the prevalence of symptoms of PFD in women with endometriosis.

The (commercialised) experience of operating: Embodied preferences, ambiguous variations and explaining widespread patient harm.

This article provides a detailed account of how surgeons perceived and used a device-procedure that caused widespread patient harm: transvaginal mesh for the treatment of pelvic floor disorders in women. Drawing from interviews with 27 surgeons in Canada, the UK, the United States and France and observations of major international medical conferences in North America and Europe between 2015 and 2018, we describe the commercially driven array of operative variations in the use of transvaginal mesh and show that surgeons' understanding of their hands-on, sensory experience with these variations is central to explaining patient harm. Surgeons often developed preferences for how to manage actual and anticipated dangers of transvaginal mesh procedures through embodied operative adjustments, but collectively the meaning of these preferences was fragmented, contested and deferred. We critically reflect on surgeons' understandings of their operative experience, including the view that such experience is not evidence. The harm in this case poses a challenge to some ways of thinking about uncertainty and errors in medical sociology, and calls for attention to a specific feature of surgical work: the extent and persistence of operative practices that elude classification as right or wrong but are still most certainly better and worse.

Prevalence of urinary incontinence and other pelvic floor disorders in women with myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is a neuromuscular disease that can affect the pelvic floor muscles but few studies have investigated pelvic floor disorders, including urinary incontinence. The main purpose of this study was to document the prevalence, characteristics, and impacts of urinary incontinence and other pelvic floor disorders in women with DM1. Associations between pelvic floor disorders and phenotypes, considering age and parity, were explored. Eighty adult women aged 47,1±13,7 years old participated in a cross-sectional study using validated questionnaires, including the International Consultation Incontinence Questionnaire – Urinary Incontinence short form (ICIQ-UI-SF)), the Pelvic Floor Disorder Inventory (PFDI), and the Pelvic Floor Impact Questionnaire short form (PFIQ-SF). The mean score for the ICIQ-UI-SF was 4.3. The mean scores for the subscales of the PFDI were 36.8 for the urinary distress inventory, 74.1 for the colorectal-anal distress inventory, and 43.8 for the pelvic organ prolapse distress inventory. A total of 60% of women reported urinary incontinence and 56.3% anal incontinence. Pelvic prolapse symptoms (>1 symptom) were reported by 25% of women. Findings reveal high prevalence and significant related impacts of these disorders. This provides evidence regarding the importance of screening for these disorders in a clinical setting and the need to explore treatment approaches.

The value of transperineal ultrasound as compared to urodynamic test in assessment of stress urinary incontinence

Background: The value of imaging modalities especially transperineal ultrasound in assessment and categorization of pelvic floor disorders in women remains ambiguous. The aim of this study was to compare the diagnostic value of transperineal ultrasound with urodynamic test in assessment of stress urinary incontinence. Methods: This cross-sectional study was conducted on women referred to pelvic floor clinic at Mahdieh hospital with the complaint of stress urinary incontinence. Along with physical examination, urodynamic test and pelvic floor ultrasound were requested for all participants. Results: The patients were divided into two groups with pelvic organ prolapse (n=25) and without pelvic organ prolapse (n=18). There was no difference between the two groups with and without pelvic organ prolapse in β angle greater than 120 degrees during rest and maneuvering Valsalva, and the rate of bladder neck funneling. In the groups with and without prolapsed, the sensitivity and specificity of β angle greater than 120 degrees measuring by ultrasound at rest to determine stress urinary incontinence were 80.0% and 60.0% in the group with prolapsed and 70.0% and 50.0% in those without prolapse. The pointed values for β angle greater than 120 degrees during Valsalva maneuver were 93.3% and 40.0% in those without prolapsed and 80.0% and 12.5% in those without prolapse respectively. The evaluation of bladder neck funneling by ultrasound could diagnose stress urinary incontinence with a sensitivity of 10.0% and a specificity of 62.5% in the group without pelvic organ prolapse and with a sensitivity of 53.8% and a specificity of 80.0% in those with pelvic organ prolapse respectively. Conclusion: The use of ultrasound alone is not sufficient to diagnose stress urinary incontinence, especially in cases where there is no evidence of pelvic organ prolapse, and thus comprehensive use of physical examinations and imaging techniques for such a diagnosis is recommended.

Skeletal Muscle Relaxants for the Treatment of Myofascial Pelvic Pain and High Tone Pelvic Floor Disorders in Women: A Scoping Review

Study Objective To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. Design A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Setting Scoping review. Patients or Participants N/A. Interventions N/A. Measurements and Main Results Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Conclusion Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes. To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Scoping review. N/A. N/A. Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Effect of Pelvic Floor Descent on Posterior Pelvic Floor Disorders in Women with Obstructed Defecation Syndrome

Effect of Pelvic Floor Descent on Posterior Pelvic Floor Disorders in Women with Obstructed Defecation Syndrome

Evaluating the Prevalence of Pelvic Floor Disorders in Women in Nonmetropolitan Communities.

Prevalence rates of pelvic floor disorders in women in nonmetropolitan communities compared with metropolitan communities are unknown. We hypothesize that the rates are higher in women in nonmetropolitan communities. We accessed the health survey data from the NHANES (National Health and Nutrition Examination Survey) from 2009 to 2010 divided by geocodes into nonmetropolitan (<50,000 inhabitants) and metropolitan communities (>50,000). Responses were analyzed for the following conditions: urinary incontinence and nocturia, bowel urgency and anal incontinence, and symptomatic vaginal bulge. Age-adjusted prevalence rates were estimated using logistic regression. The 2009-2010 NHANES survey was completed nationwide by 302 women in nonmetropolitan communities and 2201 women in metropolitan communities. Overall, prevalence rates of PFDs did not significantly differ between groups. Prevalence rates of urinary incontinence and nocturia at least weekly were similar between metropolitan and nonmetropolitan groups (16.2% vs 14.6%, P = 0.47), with stress incontinence being more common than urgency and other types of incontinence (40% vs 23% and 8%). Women in metropolitan communities reported more bowel urgency than women in nonmetropolitan communities (33.3% vs 26.8%, P = 0.02); however, prevalence rates between both groups are similar with regards to anal incontinence at least once a month or more (9.2% vs 9.0%, P = 0.76). Prolapse symptoms were also not significantly different between the groups (2.4% in both). There was an increase in prevalence in each of the pelvic floor disorder symptoms with age. Pelvic floor disorders are prevalent and increase with age in women in nonmetropolitan communities at rates similar to women in metropolitan communities.

From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh.

Beginning in the late 1990s, surgeons around the world widely adopted the transvaginal placement of permanent synthetic mesh for the treatment of several common pelvic floor disorders in women. By 2012 it had become the subject of extensive litigation, including one of the biggest mass-tort cases in U.S. history, with litigants reporting debilitating and unexpected complications. Based on qualitative research that includes interviews with surgeons, observations of medical conferences, and analysis of archival materials, we argue the adoption of transvaginal mesh cannot be fully explained without recognizing the role of mindlines, or collective moral-epistemological ways of knowing and acting responsibly. The adoption of mesh was anchored in a mindline focused on repairing anatomy. The harms that resulted from transvaginal mesh necessitated a shift to a focus on patient experience. We analyze the role of evidence-based medicine (EBM) in the re-organization of these surgeons' mindlines, showing that mindlines are not reducible to evidence as defined by EBM and that evidence thus defined facilitated the adoption of transvaginal mesh.

The Role of MRI in the Diagnosis of Pelvic Floor Disorders.

This article provides an overview of MRI as a dynamic imaging modality as well as recent updates on the role of MRI in the evaluation of female pelvic floor disorders, including pelvic organ prolapse (POP), rectal prolapse, and defecatory dysfunction. Pelvic floor disorders in women are common, and demand for treatment is high. Recently, multidisciplinary guidelines for dynamic MRI have been published to reflect this need. Despite criticisms that MRI is an expensive modality, cost-analysis studies are demonstrating utility for MRI in surgical decision-making trees for patients at risk for treatment failure after POP repairs. Novel measures such as anterior pelvic area and levator volumes are being used to predict and study patients with and at risk for POP. Recent standardized radiographic guidelines as reviewed in this paper will likely lead to improved reproducibility of dynamic MRI techniques across institutions, making complex pelvic floor assessment increasingly accessible to patients while creating opportunities for novel and collaborative research.

Pelvic floor disorders in women who consult primary care clinics: development and validation of case definitions using primary care electronic medical records.

To date, there has been no validated method to identify cases of pelvic floor disorders in primary care electronic medical record (EMR) data. We aimed to develop and validate symptom-based case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse in women, for use in primary care epidemiologic or clinical research. Our retrospective study used EMR data from the Southern Alberta Primary Care Research Network (SAPCReN) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in southern Alberta. Trained researchers remotely reviewed a random sample of EMR charts of women aged 18 years or older from 6 rural and urban clinics to validate case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and estimated SAPCReN prevalence as appropriate. Charts of 900 women were included. Sensitivity was 81.9% (95% confidence interval [CI] 75.1-87.2) for urinary incontinence, 61.2% (95% CI 46.2-74.5) for fecal incontinence, and 51.8% (95% CI 40.6-62.8) for pelvic organ prolapse. Corresponding specificity values were 71.9% (95% CI 68.4-75.1), 99.2% (95% CI 98.2-99.6) and 98.8% (95% CI 97.7-99.4), PPVs 40.6% (95% CI 35.4-46.0), 81.1% (95% CI 64.3-91.4) and 81.1% (95% CI 67.6-90.1), and NPVs 94.4% (95% CI 92.1-96.1), 97.8% (95% CI 96.5-98.6) and 95.3% (95% CI 93.6-96.6). The SAPCReN-observed prevalence for urinary incontinence was 29.7% (95% CI 29.3-30.0), but the adjusted prevalence was 2.97%. The case definition for urinary incontinence met our standard for validity (sensitivity and specificity > 70%), and the case definitions for fecal incontinence and pelvic organ prolapse had PPVs greater than 80%. The urinary incontinence definition may be used in epidemiologic research, and those for fecal incontinence and pelvic organ prolapse may be used in quality-improvement studies or creation of disease registries. Our symptom-based case definitions could also be adapted for research in other EMR settings.

Pelvic floor disorders in women with premature ovarian insufficiency: a cross-sectional study.

This study aimed to investigate the prevalence of self-reported main pelvic floor disorders (PFD) (urinary incontinence [UI], pelvic organ prolapse [POP], and fecal incontinence [FI]) and its associated factors in women with premature ovarian insufficiency (POI) and a control group. This was a cross-sectional study wherein two groups were interviewed from August, 2017 to November, 2018-women with POI (n = 150) and a control group matched for age and body weight (n = 150). Sociodemographic variables and two questionnaires validated in Brazilian Portuguese language for PFD (Kings Health Questionnaire [KHQ] and Pelvic Floor Distress Inventory-20 [PFDI-20]) were used. Laycock's power, endurance, repetitions, fast contractions, every contraction timed (PERFECT) scale for pelvic floor muscle assessment was used in both groups. The prevalence of self-reported UI was 27.33% and 37.33% for POI and control groups (P > 0.05), respectively. There was no perceived difference regarding the prevalence of POP (9.33% POI group vs 8% control group; P = 0.682) and FI (8% POI vs 4% control group; P = 0.145). The P (power) (P = 0.46), E (endurance) (P = 0.91), R (repetitions) (P = 0.88), and F (fast contractions) (P = 0.19) values were statistically similar in both the groups. Multivariate analysis (n = 141) showed that higher weight (odds ratio [OR] 1.047 [1.018-1.076]; P < 0.001) and gravidity rates (OR 1.627 [1.169-2.266]; P < 0.01) were risk factors for UI and higher weight (OR 1.046 [1.010-1.084]; P = 0.01), and presence of comorbidities (OR 8.75 [1.07-71.44]; P < 0.01) were risk factors for POP in the POI group; there was no variable that was associated with FI. Women with POI did not have significant differences when compared with the control group regarding the prevalence of PFD and pelvic floor muscle assessment. Having higher weight and gravidity rates were associated with self-reported UI, while the presence of comorbidities and higher weight were risk factors for POP in the POI group. : Video Summary:http://links.lww.com/MENO/A555.

MR defecography in the assessment of anatomic and functional abnormalities in stress urinary incontinence before and after pelvic reconstruction

PurposeMagnetic resonance defecography (MRD) was used to evaluate anatomic and functional pelvic floor disorders in women with stress urinary incontinence (SUI) before and after midurethral sling (MUS) intervention. MethodWe performed MRD in both SUI patients and continent controls. Static MR was used to describe the anatomic abnormalities in levator ani muscle and periurethral ligaments (PUL). Dynamic MR was used to depict the function of the urethra and pelvic floor. We compared the MRD parameters between the SUI patients and continent controls before surgery. For SUI patients, dynamic MR images evaluated the functional changes of the urethra and pelvic floor after surgery. ResultsIn SUI group, 75.8 % have PUL defects, 65.7 % discontinuity or complete loss of pubococcygeal muscle, as compared to the continent groups (p < 0.01). There was no significant difference between the perimenopausal volunteers and SUI patients in the puborectalis defection (p > 0.05). The dynamic MR showed the urethral hypermobility, functional urethra shortening, bladder neck funneling, urethra opening and cystocele were significantly associated with SUI patients (p < 0.01). Postoperative MR indicated that SUI patients after MUS had a lower risk of bladder funneling and urethral opening at the defection phase (p < 0.01), but no significant difference in urethral hypermobility or pelvic floor prolapse was seen (p>0.05). ConclusionsMRD with high-resolution and defecation phases provides a detailed anatomic and functional evaluation of the pelvic floor in female SUI before and after pelvic reconstruction.

7: Impact of second stage pushing timing on maternal pelvic floor morbidity: Multicenter randomized controlled trial

Childbirth is the most significant risk factor for pelvic floor disorders in women, yet the impact of labor management such as timing of pushing in the second stage is unknown. We sought to determine whether immediate or delayed pushing results in higher measures of pelvic floor morbidity. Multicenter randomized trial in which nulliparous women at term with neuraxial analgesia were randomly assigned at complete cervical dilation to immediate pushing or delay for 1 hour. Participants were assessed at baseline (for questionnaire), 6 weeks and 6 months postpartum. Outcome measures were rates and extent of pelvic organ prolapse (POP) based on the Pelvic Organ Prolapse Quantification (POP-Q) system, and patient-reported symptoms of urinary incontinence (UI), fecal incontinence (FI), and POP using validated symptom-specific distress and quality-of-life pelvic floor questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Fecal Incontinence Severity Index (FISI). Rates and severity of POP, and changes in questionnaire scores from baseline at 6 weeks and 6 months were compared between the 2 groups. Of the 2414 subjects randomized, 941 (39.0%) participated in the pelvic floor assessments; 452 immediate and 489 delayed pushing. Baseline characteristics were comparable in the 2 groups. There were no differences in overt perineal lacerations and objective measures of POP at 6 weeks and 6 months (Figure). None of the changes from baseline in the total and subscale scores for the PFDI and PFIQ were significantly different at 6 weeks and 6 months postpartum (Table). The change in FISI score from baseline was statistically higher with immediate pushing at 6 months (0-61 points: 2.91 ± 5.7 vs 1.99 ± 4.5, P=0.01), but this difference was less than the minimal important difference of 4 for this instrument. Among nulliparous women at term with neuraxial analgesia, neither immediate nor delayed pushing in the second stage resulted in significant differences in POP, and patient-reported symptoms of UI and FI at 6 weeks and 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study

BackgroundPelvic floor disorders including urinary incontinence (UI) and pelvic organ prolapse (POP) are common conditions; however, most women with these symptoms do not seek care. Failure to seek care may be related to misconceptions about these conditions. The aim of this study was to assess the baseline knowledge of UI and POP among adult women presenting to primary care clinics, as well as factors associated with knowledge levels.MethodsA survey with questions from previously validated UI and POP knowledge questionnaires (PIKQ-UI and PIKQ-POP, respectively) was self-administered to a cross-sectional group of adult female patients presenting to three primary care clinics: geriatric, community-based, and hospital-based. Participants’ demographics and medical histories were compared using ANOVA or Kruskal-Wallis for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. In order to compare various covariates with knowledge non-proficiency on PIKQ-UI and PIKQ-POP scales, unadjusted and adjusted ORs with 95% CIs were calculated using bivariate analysis and multivariate logistic regression, respectively.ResultsOf 346 participants, knowledge non-proficiency was similar and consistent across clinic sites and reached 72.0% for UI and 53.6% for POP. On multivariate analysis, lower educational attainment, being unaware of UI or POP as medical conditions, and having no history of care-seeking for these conditions were significantly associated with knowledge non-proficiency on UI, POP, or both.ConclusionsKnowledge non-proficiency for UI and POP is common among women presenting for primary care. For UI, healthcare providers should assess patients’ actual understanding of the disease, especially among those with lower educational attainment, to eliminate any possible misconceptions. For POP, the focus should be on increasing awareness of this disease, as many women may have not previously heard of this condition. Simple strategies may increase knowledge in these areas and change care-seeking behaviors.Study registrationNone.

Pelvic floor disorders in women with gynecologic malignancy.

This article serves as an update on issues relating to the intersection of pelvic floor disorders and gynecology oncology. Gynecologic cancer survivors experience pelvic floor disorders (PFDs) at a higher rate than their age-matched peers, often because of shared risk factors and as sequelae of cancer treatment. Concomitant pelvic floor and oncologic surgery can serve as a method to promote quality of life. Studies have demonstrated concomitant surgery to be well tolerated in appropriately selected patients, but only about 2% of oncologic surgeries are coordinated to include the treatment of PFDs. Conversely, women undergoing surgery for PFD have a low, but real risk of occult malignancy. Therefore, preoperative counseling is warranted in select populations. This article will discuss the management of concurrent PFDs and gynecologic malignancies. Healthcare providers should be familiar with screening, management and referral of women with pelvic floor disorders in the gynecologic oncology population.

Concomitant Repair of Pelvic Floor Disorders in Women Undergoing Surgery for Gynecologic Malignancies.

The aims of this study were to determine the rate and describe 30-day postoperative complications of concomitant pelvic organ prolapse and/or urinary incontinence (POPUI) procedures in women undergoing surgery for a gynecologic malignancy. Women who underwent surgical intervention for a gynecologic malignancy between 2010 and 2014 were identified using postoperative International Classification of Diseases, Ninth Revision codes 179.0 to 184.9 in the American College of Surgeons National Surgical Quality Improvement Program database. Women who underwent POPUI procedures were identified using Current Procedural Terminology codes between 51840 and 58294. Infectious, pulmonary, cardiac, and venous thromboembolism complication rates were calculated. Patient demographics and postoperative complication rates were analyzed using Student t, χ, and Fisher exact tests and compared between women with a gynecologic malignancy who did and did not undergo concomitant POPUI procedures. We identified 23,501 women with a diagnosis of a gynecologic malignancy. The most common included uterine (63%), ovarian (25%), and cervical cancer (8%). Only a small proportion of the women undergoing gynecologic cancer surgery (n = 556 [2.4%]) had concomitant POPUI procedures. The most commonly performed POPUI procedures included anterior and/or posterior colporrhaphy (n = 205 [32%]), laparoscopic colpopexy (n = 181 [28.2%]), and midurethral sling (n = 70 [10.9%]). There were no differences in 30-day reoperation; infectious, pulmonary, and cardiac complications; or venous thromboembolic events between women who did and did not have concomitant POPUI surgery. Using a large national surgical database, only 2.4% of women undergoing gynecologic cancer surgery had a concomitant POPUI procedure. Our data suggest that postoperative complications may not increase when concomitant surgery for POPUI is done at the time of gynecologic cancer surgery.

MP33-01 COST IMPACT OF ELECTIVE CESAREAN DELIVERY ON FUTURE PELVIC FLOOR DISORDERS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-01 COST IMPACT OF ELECTIVE CESAREAN DELIVERY ON FUTURE PELVIC FLOOR DISORDERS Devin Patel, Justin Houman, James Weinberger, Lauren Wood, Jennifer Anger, and Karyn Eilber Devin PatelDevin Patel More articles by this author , Justin HoumanJustin Houman More articles by this author , James WeinbergerJames Weinberger More articles by this author , Lauren WoodLauren Wood More articles by this author , Jennifer AngerJennifer Anger More articles by this author , and Karyn EilberKaryn Eilber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1072AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to analyze the cost impact of Cesarean versus spontaneous vaginal delivery on two common forms of pelvic floor disorders (PFDs): stress urinary incontinence (SUI) and pelvic organ prolapse (POP). METHODS We compared average cost of delivery method to the lifetime risk and cost of PFD in women <65 years of age. In this analysis, direct costs were defined based on reimbursements. Initial cost of maternal care included those incurred at delivery and three months post-partum. Future costs of PFD included those incurred after delivery up to 65 years of age. Costs of maternal care were obtained from MarketScan® databases of reimbursement. A previously reported incremental cost of illness model was used to estimate direct (inpatient and outpatient reimbursement and prescription drugs) and indirect (disability claims and imputed wages for work absence) costs for SUI. Personal costs for SUI (supplies, laundry, dry cleaning) were assumed for one year and estimated based on previous data. The cost of POP was determined by multiplying the number of POP operations by the direct costs per surgery. Previously reported data on incidence of POP and SUI in women following Cesarean and vaginal delivery was used to calculate attributable risk. RESULTS The average estimated cost for vaginal delivery was $7,089 and for Cesarean delivery was $9,905. For SUI, the average direct cost was estimated as $5,642, the average indirect cost as $4,208 and the average personal cost as $750. The average direct cost of POP surgery was $4,658. Following Cesarean delivery, the absolute risk for SUI and POP was estimated as 7% and 5%, respectively. Following vaginal delivery, the absolute risk for SUI and POP was estimated as 13% and 14%, respectively. The average woman undergoing Cesarean delivery would undergo an immediate excess cost of $2,816. The potential savings for SUI and POP in women <65 years of age would be $636 and $419, respectively, for a total of $1,055. CONCLUSIONS Although elective Cesarean is associated with reduced incidence of PFDs, the increased immediate cost of Cesarean delivery does not offset future cost savings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e427-e428 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Devin Patel More articles by this author Justin Houman More articles by this author James Weinberger More articles by this author Lauren Wood More articles by this author Jennifer Anger More articles by this author Karyn Eilber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...