Urinary Distress Inventory Scores Research Articles

Surgical versus nonsurgical treatment selection patterns among Asian American patients with pelvic floor disorders: a matched cohort study.

The objective was to determine if Asian racial identity was associated with the selection of surgical versus nonsurgical treatments for pelvic floor disorders (PFDs). Secondarily, we aimed to determine if there were other demographic or clinical characteristics associated with treatment selection patterns. This was a retrospective matched cohort study that examined new patient visits (NPVs) of Asian patients at an academic urogynecology practice in Chicago, IL, USA. We included NPVs with primary diagnoses of anal incontinence, mixed urinary incontinence, stress urinary incontinence, overactive bladder, or pelvic organ prolapse. We identified Asian patients with self-identified racial identity recorded in the electronic medical records. Every Asian patient was age matched to white patients in a 1:3 ratio. The primary outcome was surgical versus nonsurgical treatment selection for their primary PFD diagnosis. Comparison of demographic and clinical variables between the two groups and multivariate logistic regression models were performed. A total of 53 Asian patients and 159 white patients were included in this analysis. Asian patients were less likely to be English speaking (92% vs 100%, p=0.004), endorse history of anxiety (17% vs 43%, p<0.001), and report history of any pelvic surgery (15% vs 34%, p=0.009) than white patients. When controlling for race, age, history of anxiety, depression, prior pelvic surgery, sexual activity, Pelvic Organ Prolapse Distress Inventory, Colorectal-Anal Distress Inventory, and Urinary Distress Inventory scores, Asian racial identity (adjusted odds ratio 0.36 [95% CI 0.14-0.85]) was independently associated with decreased likelihood of choosing surgical treatments for PFDs. Asian patients with PFDs were less likely than white patients to undergo surgical treatment for their PFDs despite similar demographic and clinical characteristics.

PD19-12 PATIENT REPORTED OUTCOME MEASURES FOLLOWING HYPERBARIC OXYGEN THERAPY FOR RADIATION CYSTITIS

You have accessJournal of UrologyCME1 Apr 2023PD19-12 PATIENT REPORTED OUTCOME MEASURES FOLLOWING HYPERBARIC OXYGEN THERAPY FOR RADIATION CYSTITIS Rachel A. Moses, Alexandra Hunter, Eileen R. Brandes, Devin R. Cowan, Nicole P. Harlan, Judy R. Rees, Kevin R. Krughoff, William Bihrle, and Jay C. Buckey Rachel A. MosesRachel A. Moses More articles by this author , Alexandra HunterAlexandra Hunter More articles by this author , Eileen R. BrandesEileen R. Brandes More articles by this author , Devin R. CowanDevin R. Cowan More articles by this author , Nicole P. HarlanNicole P. Harlan More articles by this author , Judy R. ReesJudy R. Rees More articles by this author , Kevin R. KrughoffKevin R. Krughoff More articles by this author , William BihrleWilliam Bihrle More articles by this author , and Jay C. BuckeyJay C. Buckey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003285.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies demonstrate reduced bladder bleeding interventions after hyperbaric oxygen therapy (HBOT) for hemorrhagic radiation cystitis. Previously, we demonstrated feasibility of collecting urine-related patient reported outcome measures (PROMs) via the Multicenter Registry for HBOT. The purpose of this study is to evaluate change in urine related PROMs before and after HBOT in a larger, updated cohort. METHODS: Prospectively collected data from 19 sites in the Multicenter Registry for Hyperbaric Oxygen Therapy Consortium were analyzed. Measures included a hematuria scale adapted from the Radiation Therapy Oncology Group (RTOG) radiation cystitis scale and the Urinary Distress Inventory (UDI). Data obtained on the first and last days of HBOT were compared using the Wilcoxon rank sum test. RESULTS: 216 patients were included, 197 had complete RTOG/EROTC hematuria data, 146 had UDI data and 133 had both. Patients were on average 72 (+/-10.3) years old, 58/216 were diabetic, 81/216 were current or former smokers, and 187/216 developed radiation cystitis due to prostate cancer related radiation treatment. Referral for HBOT occurred approximately 7.0+/-5.8yrs following radiation. The average number of treatments was 36+/-11. RTOG/EROTC hematuria scores were significantly improved post HBOT (2.2 pre vs 0.9 post, p=0.001) (Figure 1A). UDI scores were significantly improved, post HBOT (61.5+/-31.5 pre vs 49.1+/-30.9, p<0.01) (Figure 1B). CONCLUSIONS: In a novel, multi-institutional prospective data set, we demonstrate HBOT is associated with improved urine related PROMs for individuals undergoing HBOT for radiation cystitis. Continued expansion of the registry may provide more generalizable results and allow for analysis of factors leading to change in UDI and hematuria scores. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e582 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel A. Moses More articles by this author Alexandra Hunter More articles by this author Eileen R. Brandes More articles by this author Devin R. Cowan More articles by this author Nicole P. Harlan More articles by this author Judy R. Rees More articles by this author Kevin R. Krughoff More articles by this author William Bihrle More articles by this author Jay C. Buckey More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings.

Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement. The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling. Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05). The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups. Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.

Long-Term Follow-Up of Fractional CO2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors.

(1) Background: The objective of this study was to determine the long-term efficacy of fractional CO2 laser therapy in breast cancer survivors. (2) Methods: This was a single-arm study of breast cancer survivors. Participants received three treatments of fractional CO2 laser therapy and returned for a 4 week follow-up. Participants were contacted for follow-up at annual intervals. The Vaginal Assessment Scale (VAS), the Female Sexual Function Index (FSFI), the Female Sexual Distress Scare Revised (FSDS-R), the Urinary Distress Inventory (UDI), and adverse events were collected and reported for the two-year follow-up. The changes in scores were compared between the four-week and two-year and the one-year and two-year follow-ups using paired t-tests. (3) Results: In total, 67 BC survivors were enrolled, 59 completed treatments and the four week follow-up, 39 participated in the one-year follow-up, and 33 participated in the two-year follow-up. After initial improvement in the VAS from baseline to the four week follow-up, there was no statistically significant difference in the VAS score (mean Δ 0.23; 95% CI [−0.05, 0.51], p = 0.150) between the four week follow-up and the two-year follow-up. At the two-year follow-up, the FSFI and FSDS-R scores remained improved from baseline and there was no statistically significant change in the FSFI score (mean Δ −0.83; 95% CI [−3.07, 2.38] p = 0.794) or the FSDS-R score (mean Δ −2.85; 95% CI [−1.88, 7.59] p = 0.227) from the one to two-year follow-up. The UDI scores approached baseline at the two-year follow-up; however, the change between the one- and two-year follow-ups was not statistically significant (mean Δ 4.76; 95% CI [−1.89, 11.41], p = 0.15). (4) Conclusions: Breast cancer survivors treated with fractional CO2 laser therapy have sustained improvement in sexual function two years after treatment completion, suggesting potential long-term benefit.

The Influence of Patients' Goals on Surgical Satisfaction.

The objectives of this study were to describe patients' surgical goals and determine if goal attainment is associated with postoperative satisfaction and regret. Women undergoing surgery for pelvic floor disorders between June and December 2019 were recruited. At their initial visit, patients listed up to 4 surgical goals. Three months after surgery, patients completed the Pelvic Floor Distress Inventory, Patient Global Impression of Improvement, Satisfaction with Decision Scale, and Decision Regret Scale. They were also shown their initial goals and asked, "Did you achieve this goal by having surgery?" Women who achieved all goals were designated "goal achievers," and those who did not achieve even 1 goal were "goal nonachievers" (GNAs). Ninety-nine patients listed a median of 1 (range, 1-4) goals. Goals were categorized as follows: symptom improvement (52%), treatment achievement (23%), lifestyle improvement (17%), and information gathering (6%). Ninety-one percent of patients were goal achievers, and 9% were GNAs. Goal achievers had higher Satisfaction with Decision Scale scores (5.0 [4.7-5.0] vs 4.0 [3.8-4.8], P = 0.002), lower Decision Regret Scale scores (1.0 [1.0-1.4] vs 2.0 [1.1-2.7], P = 0.001), and better Patient Global Impression of Improvement scores (1.0 [1.0-2.0] vs 2.0 [1.0-4.0], P = 0.004). In prolapse surgery patients, postoperative Pelvic Floor Distress Inventory scores were similar; however, GNAs had higher postoperative Urinary Distress Inventory scores (17.0 ± 18.0 vs 45.8 ± 20.8, P = 0.01). Ninety-one percent of women achieved their presurgical goals, the most common being symptom relief. Goal achievers have higher satisfaction and less regret; however, those with worsening or de novo urinary symptoms are more likely to be GNAs and be unsatisfied.

Changes in Morphology of the Urethral Rhabdosphincter Postpartum.

The aim of the study was to determine the effect of pregnancy on urethral rhabdosphincter cross-sectional area (CSA) and any association of CSA to urinary symptoms. Nulliparous women planning pregnancy (N = 135) underwent standardized evaluations (symptom and quality of life [QOL] questionnaires, magnetic resonance imaging, ultrasonography, and neurophysiologic testing) between January 2008 and December 2013 (V1). The participants who became pregnant and gave birth underwent the same evaluations at 6 weeks (V2) and 6 months postpartum (V3). Participants who had magnetic resonance imaging data from both V1 and V3 were selected. We measured urethral rhabdosphincter CSA from high-resolution axial MRIs in a masked fashion. The mean CSA for each participant was calculated. The change from V1 to V3 was assessed. Sixty-eight women were evaluated. There was a significant decrease of 0.05 cm2 (interquartile range, -0.03 to 0.16 cm2; P = 0.002) in the median sphincter CSA between V1 and V3. There was a significant increase in the median Urinary Distress Inventory (UDI) subscore of the Pelvic Floor Distress Inventory (PFDI) from V1 to V3 (median increase of 0 [IQR, 0 to 8.3]; P = 0.033), but this was not significantly correlated with the change in the urethral CSA (Spearman correlation, 0.199; P = 0.107). Increasing fetal weight was correlated with a decrease in CSA postpartum after vaginal birth (Spearman correlation, -0.340; P = 0.017). There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life.

Assessment of lower urinary tract symptoms during pregnancy: an observational cross-sectional study from Palestine

BackgroundWomen frequently complain of lower urinary tract symptoms (LUTS) during pregnancy due to multiple physiological and potentially pathological changes. Still, there is limited data on the characteristics of LUTS for pregnant women in Palestine. Therefore, this study was designed to assess LUTS among pregnant women in Palestine, in addition to identifying factors that exacerbate LUTS during pregnancy.MethodsWe devised a cross-sectional, questionnaire-based study that used the Urinary Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ) tools to assess LUTS during pregnancy in an antenatal care clinic setting. Multiple linear regressions were conducted to determine variables that significantly related to LUTS (UDI-6 and IIQ-7 scores as dependent variables).ResultsThe study recruited 306 pregnant women. Regarding LUTS findings, the participants scored a mean of 31.9 ± 24.9 out of 100 points (6.7 ± 5.2 out of 21) for the IIQ-7 scale and a mean of 31.2 ± 19.2 out of 100 points (5.6 ± 3.4 out of 18) for the UDI-6 scale. Regression analysis showed that older women (p = 0.031), women with a higher body mass index (p < 0.001), and women in the third trimester of pregnancy (p = 0.023), were independently associated with high UDI score. Multiple linear regression analysis showed that obese and overweight patients (p = 0.006) and multiparity (p = 0.026) were independently associated with high IIQ score.ConclusionsHigh body mass index is independently associated with both UDI and IIQ scores for LUTS. Several strategies should be arranged to raise the awareness of females of childbearing age in Palestine regarding LUTS during pregnancy and factors which may exacerbate LUTS, such as obesity and multiparity. Thus, preventive measures should be implemented, such as serial assessment of LUTS during antenatal care to respond timely to this frequent problem.

Bladder bacterial diversity differs in continent and incontinent women: a cross-sectional study

Since the discovery of the bladder microbiome (urobiome), interest has grown in learning whether urobiome characteristics have a role in clinical phenotyping and provide opportunities for novel therapeutic approaches for women with common forms of urinary incontinence. This study aimed to test the hypothesis that the bladder urobiome differs among women in the control cohort and women affected by urinary incontinence by assessing associations between urinary incontinence status and the cultured urobiome. With institutional review board oversight, urine specimens from 309 adult women were collected through transurethral catheterization. These women were categorized into 3 cohorts (continent control, stress urinary incontinence [SUI], and urgency urinary incontinence [UUI]) based on their responses to the validated Pelvic Floor Distress Inventory (PFDI) questionnaire. Among 309 women, 150 were in the continent control cohort, 50 were in the SUI cohort, and 109 were in the UUI cohort. Symptom severity was assessed by subscale scoring with the Urinary Distress Inventory (UDI), subscale of the Pelvic Floor Distress Inventory. Microbes were assessed by expanded quantitative urine culture protocol, which detects the most common bladder microbes (bacteria and yeast). Microbes were identified to the species level by matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Alpha diversity indices were calculated for culture-positive samples and compared across the 3 cohorts. The correlations of UDI scores, alpha diversity indices, and species abundance were estimated. Participants had a mean age of 53 years (range 22-90); most were whites (65%). Women with urinary incontinence were slightly older (control, 47; SUI, 54; UUI, 61). By design, UDI symptom scores differed (control, 8.43 [10.1]; SUI, 97.95 [55.36]; UUI, 93.71 [49.12]; P<.001). Among 309 participants, 216 (70%) had expanded quantitative urine culture-detected bacteria; furthermore, the urinary incontinence cohorts had a higher detection frequency than the control cohort (control, 57%; SUI, 86%; UUI, 81%; P<.001). In addition, the most frequently detected species among the cohorts were as follows: continent control, Lactobacillus iners (12.7%), Streptococcus anginosus (12.7%), L crispatus (10.7%), and L gasseri (10%); SUI, S anginosus (26%), L iners (18%), Staphylococcus epidermidis (18%), and L jensenii (16%); and UUI, S anginosus (30.3%), L gasseri (22%), Aerococcus urinae (18.3%), and Gardnerella vaginalis (17.4%). However, only Actinotignum schaalii (formerly Actinobaculum schaalii), A urinae, A sanguinicola, and Corynebacterium lipophile group were found at significantly higher mean abundances in 1 of the urinary incontinence cohorts when compared with the control cohort (Wilcoxon rank sum test; P<.02), and no individual genus differed significantly between the 2 urinary incontinence cohorts. Both urinary incontinence cohorts had increased alpha diversity similar to continent control cohort with indices of species richness, but not evenness, strongly associated with urinary incontinence. In adult women, the composition of the culturable bladder urobiome is associated with urinary incontinence, regardless of common incontinence subtype. Detection of more unique living microbes was associated with worsening incontinence symptom severity. Culturable species richness was significantly greater in the urinary incontinence cohorts than in the continent control cohort.

The Stress Urinary Incontinence in CrossFit (SUCCeSS) Study.

To evaluate the prevalence and severity of urinary incontinence (UI) in women who participate in CrossFit classes compared with women who participate in non-CrossFit group fitness classes. The authors conducted a cross-sectional study of women who participate in either CrossFit or non-CrossFit group fitness classes using an online survey. Participants provided demographic information and completed the Incontinence Severity Index and Urinary Distress Inventory. Participants were recruited from local CrossFit and non-CrossFit gyms, online via social media, and an electronic CrossFit Newsletter. Associated comorbidities, exercises associated with UI, and coping mechanisms for urinary leakage were also assessed. Four hundred twenty-three women meeting inclusion criteria completed the survey, including 322 CrossFit participants and 101 non-CrossFit participants. We found that CrossFit participants were older than non-CrossFit participants and more likely to self-identify as non-Hispanic white. CrossFit participants more commonly reported UI (84% vs 48%, P = <0.001), higher severity of UI (Urinary Distress Inventory score: 20.8 vs 12.5, P < 0.001), and specifically more stress UI (73% vs 47%, P < 0.001). Weightlifting and jumping movements were the most common exercises associated with UI in CrossFit participants. Age and participation in CrossFit are significant and independent predictors of UI. More than 80% of CrossFit participants reported UI and half of these reported moderate-severe UI, as compared with women who participate in non-CrossFit classes, less than half of whom reported UI with a small minority reporting moderate-severe UI. Exercises most associated with UI were jumping and weightlifting.

The Effect of Aging on Pelvic Floor Pressure Measurements in Nulliparous Women

Aims: To investigate the correlation between age and 3-dimensional pelvic floor manometry parameters, sexual function, and urinary status in old post-menopausal versus young nulliparous women. Methods: This was a cross-sectional study. Two groups of young (18 - 40 years) and old (52 - 85 years) nulliparous volunteers completed Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Female Sexual Function Inventory (FSFI-19) and underwent a 3-dimensional pelvic floor manometry. Results: The study included 9 young participants with a mean age of 28.6, and 10 old participants with a mean age of 61.8. All the older participants were postmenopausal and all the young participants were premenopausal. Mean PFDI-20 score was significantly higher in the older group: 52 ± 12 versus 4 ± 4, p= 0.001. Urinary Distress Inventory score (UDI-6, part of PFDI questionnaire) was higher amongst the older group: 28 ± 26 versus 3 ± 8, p= 0.006. All young participants scored zero in their PFIQ-7 while the older participants averaged 31 out of maximal score of 300. While sexual activity was higher in the younger group (89% versus 60%), sexual function assessed through the FSFI-19, was not significantly different between the two groups. Valsalva pressures obtained from manometry measurements were significantly higher in the older group (mean 230 mm Hg versus 161, p= 0.015). Conclusions: Post-menopausal women have higher pelvic floor and urinary symptoms associated with increased Valsalva pressures as measured by vaginal manometry.

Vaginal mesh surgery is efficient to treat pelvic organ prolapse grade 3 in elderly women

Aim. To evaluate the surgical treatment of pelvic organ prolapse grade 3 in elderly women.Materials and Methods. We consecutively recruited 86 elderly women (60 to 75 years old) suffering from pelvic organ prolapse grade 3. Out of them, 56 patients underwent vaginal mesh surgery while 30 refused surgical treatment. After 1 year, we assessed stress urinary incontinence using a cough test and Valsalva maneuver. Pain intensity was measured using the Numeric Rating Scale whereas quality of life was assessed by Pelvic Floor Disability Index (PDFI-20). The primary outcome measure was the prevalence of pelvic organ prolapse symptoms while the secondary outcome measure was the frequency of stress urinary incontinence and low quality of life upon 1 year of follow-up.Results. After 1 year of follow-up, patients who received a surgical treatment were characterized by a statistically significant decrease in both frequency and intensity of complaints and symptoms of pelvic organ prolapse. Pelvic Organ Prolapse Distress Inventory score was 8.3 (4.2-12.5) and 79.2 (79.2-100) in patients with or without surgical treatment respectively. Similar results were showed using Colorectal-Anal Distress Inventory score (6.2 (3.1-6.2) and 68.8 (62.5-71.9) and Urinary Distress Inventory score (8.3 (4.2-8.3) and 83.3 (79.2-87.5), in treated and untreated individuals, respectively. Total Pelvic Floor Disability Index score was 22.8 (11.5-27.0) in women who underwent a vaginal mesh surgery and 227.2 (226.1251.0) in those who did not. All indicated differences were statistically significant.Conclusions. Vaginal mesh surgery is efficient for the treatment of pelvic organ prolapse grade 3 in elderly women.

Fibroid Surgery and Long-Term Improvement in Bladder Symptoms.

Short-term studies have demonstrated improvement in urinary symptoms after fibroid debulking surgery, yet long-term data are lacking. This study assessed the long-term impact of fibroid debulking on urinary symptoms several years postoperatively. This case series prospectively investigated changes in urinary symptoms of women who underwent fibroid debulking surgery by several gynaecological surgeons at one centre (2011-2016). A follow-up demographics questionnaire and the Urinary Distress Inventory (UDI) were administered. Changes in total UDI scores and UDI subscale scores from preoperative baseline to long-term follow-up were calculated. Thirty participants were recruited from the original cohort of 61 women (49% long-term follow-up). There were significant improvements in total UDI scores (P<0.001), obstructive subscale score (P<0.001), and irritative subscale score (P<0.001) 2-7 years postoperatively. Stress subscale scores were not significantly improved even in a subgroup of patients with significant baseline bother (P = 0.101). Six of eight women (75%) were cured of bothersome urge urinary incontinence, and three of eight women (37.5%) were cured of bothersome stress urinary incontinence. Baseline fibroid characteristics or type of surgery did not significantly influence outcomes. There were no significant demographic differences between women with sustained improvements and women with no improvement or worsening symptoms. The results are considered Level III evidence as per the Canadian Task Force on Preventive Health Care Levels of Evidence. Surgical fibroid removal produces long-term improvement in most bladder symptoms except for stress-related symptoms that persist over time. Women with bothersome urinary symptoms should be investigated for fibroids and counselled on potential long-term benefits of debulking surgery.

Assessment of the effect of transobturator tape surgery on women's sexual function using a validated questionnaire.

ObjectiveWomen with pelvic floor disorders and urinary incontinence (UI) are at an increased risk of sexual dysfunction. The purpose of this study was to investigate the effect of surgery for UI on sexual function.MethodsWe retrospectively reviewed the charts of 82 women who underwent mid-urethral transobturator tape (TOT) surgery between March 2010 and December 2014. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were administered pre- and postoperatively.ResultsWe observed a significant increase in the total postoperative PISQ-12 scores compared to the preoperative scores (from 27.1±7.3 to 30.5±6.8, P<0.001). Improved sexual function was confirmed in the physical (13.3±4.5 vs. 15.8±3.5, P<0.001) and partner-related domains (6.7±2.6 vs. 7.4±2.4, P=0.001). Coital incontinence and preoperative urinary distress inventory score were significant factors influencing postoperative sexual function in women undergoing TOT surgery for UI after adjusting for age, body mass index, menopause, and preoperative PISQ-12 score in multivariate regression analysis.ConclusionTOT surgery for UI correction resulted in significant improvement in sexual function.

Is There an Association Between Bothersome Urinary Symptoms and Postpartum Depression?

Bothersome urinary symptoms are often present postpartum. The objective of this study was to examine the association between bothersome urinary symptoms and screening positive for postpartum depression. Women presenting at the routine 6-week postpartum visit were screened for risk of depression with the Edinburgh Postnatal Depression Scale. A questionnaire comprising delivery characteristics and demographics, 20-item Postpartum Symptom Inventory (PSI), Urinary Distress Inventory (UDI) short form, Incontinence Impact Questionnaire (IIQ) short form, and history of depression and antidepressant use was completed. Scores were then compared. Data from 104 women were analyzed, with 89% reporting excellent or good health; 73% delivered vaginally; 22% reported a history of depression, and 7% were taking an antidepressant. Twelve percent were classified as at risk of depression. Median UDI score was 5.6 (range, 0-44.4). Median IIQ score was 0 (range, 0-85.7). There was no statistically significant association between bothersome urinary symptoms and the odds of screening positive for depression using either the UDI (adjusted odds ratio [OR], 2.9; 95% confidence interval [CI], 0.7-12.5) or the IIQ (adjusted OR, 0.5; 95% CI, 0.1-2.9). The UDI score was associated with elevated PSI scores as PSI scores increased by 5.4 points if a woman had a UDI score that was greater than zero versus a UDI score of zero, controlling for education level, age, and whether the patient had a cesarean delivery (95% CI, 2.2-8.6; P = 0.001). The UDI score was not associated with antidepressant use (OR, 2.4; 95% CI, 0.5-13.2). The IIQ score had no associations with PSI score (adjusted difference in means, 2.9; 95% CI, -0.9 to 6.8; P = 0.13) or antidepressant use (OR, 1.9; 95% CI, 0.4-9.3). No statistically significant association between bothersome urinary symptoms and the odds of screening positive for increased risk of postpartum depression was found. Future work in this area is needed.

Transurethral Polyacrylamide Hydrogel Injection Therapy in Women Not Eligible for Midurethral Sling Surgery.

This study aims to determine the effects of transurethral polyacrylamide hydrogel injection in patients considered ineligible for midurethral sling surgery. In this prospective observational study, 81 patients received treatment with transurethral polyacrylamide hydrogel injection. Patients were considered ineligible for placement of a midurethral sling based on significant comorbidity (48%), 1 or more previously failed invasive treatments (16%), mixed urinary incontinence (27%), continuous incontinence (5%), or previous pelvic radiation therapy (4%). Longitudinal assessment of subjective treatment outcomes was performed using the validated Urinary Distress Inventory (UDI) and the Pelvic Floor Impact Questionnaire at baseline, 2, and 6 months. To deal with repeated measurements, mixed linear models were used to assess changes in the outcomes over time. There was a significant improvement in the overall UDI score from baseline to month 2 follow-up (FU) (P<0.001). No major differences between the month 2 and 6 FUs were observed. The largest difference in effect was observed for the irritative and stress subscales. Twenty-five patients (33%) requested a second injection at the month 2 FU visit. At month 6 FU, the UDI scores for patients having had only 1 injection were largely unchanged, whereas all UDI domains worsened further for patients having had a second injection at the month 2 visit. After the injection, there were 3 minor adverse events (3.7%) and no serious adverse events. In patients considered ineligible for midurethral sling surgery, transurethral injection with polyacrylamide hydrogel may alleviate urinary incontinence symptoms. Repeat injections did not improve outcomes in this complicated group of patients.

Longitudinal follow-up of levator ani muscle avulsion: does a second delivery affect it?

To evaluate the morphological outcome of levator ani muscle (LAM) avulsion 3-5 years after a first delivery and to assess the effect of a second delivery on this condition. The impact of LAM avulsion on pelvic floor disorders was also studied. Six hundred and sixty-six women who had been assessed for LAM avulsion 8 weeks after their first delivery were invited for a follow-up examination 3-5 years later. Women completed the Pelvic Floor Distress Inventory including the Urinary Distress Inventory (UDI) and Pelvic Organ Prolapse Distress Inventory (POPDI) questionnaires to explore symptoms of pelvic floor disorders, and the pelvic floor was examined using three-dimensional translabial ultrasound and assessed using the pelvic organ prolapse quantification system. Three hundred and ninety-nine women completed the study, of whom 151 were multiparous. Mean interval between first delivery and follow-up was 42.3 ± 7.6 months. Among 69 women who had LAM avulsion 8 weeks after their first delivery, nine (13.0%) had no LAM avulsion at follow-up. One (0.9%) woman had a new LAM avulsion after her second vaginal delivery. A greater proportion of women with LAM avulsion reported symptoms of stress urinary incontinence (SUI) (adjusted odds ratio, 2.09 (95% CI, 1.18-3.70); P = 0.01) and symptoms of prolapse than did women without avulsion; however, this difference did not reach statistical significance (P = 0.61). Women with LAM avulsion had higher UDI and POPDI scores than did women without avulsion (median UDI score, 17.7 (interquartile range (IQR), 5.0-32.4) vs 9.2 (IQR, 0.0-22.1); P = 0.045 and median POPDI score, 20.8 (IQR, 8.8-40.5) vs 10.7 (IQR, 0.0-32.8); P = 0.021). The risk of developing new LAM avulsion after a second vaginal delivery is low (0.9%). Healing of LAM avulsion was observed in 13% of women who had at least one vaginal delivery. At 3-5 years after delivery, women with LAM avulsion reported symptoms of SUI more often than did those without, and had higher UDI and POPDI scores, implying more bothersome symptoms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Cystodistension versus cystoscopy in patients with refractory detrusor overactivity: a randomized controlled trial.

Cystodistension may be offered as a treatment for patients with refractory overactive bladder. The reported efficacy is based on a number of case series. This study was designed to evaluate the efficacy of cystodistension in a randomized trial. This was a randomized study comparing cystoscopy combined with cystodistension with cystoscopy alone. The primary outcome was improvement in the Urgency Perception Scale (UPS) score. Symptoms were assessed using the ICIQ Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the Urinary Distress Inventory (UDI). A total of 77 patients were recruited into the study with 42 randomized into the cystodistension arm and 35 into the cystoscopy-only arm. UPS scores had improved in both the cystodistension (41%) and cystoscopy (44%) arms at 6weeks, but cystodistension provided no added benefit over cystoscopy alone. There was a significant improvement in ICIQ-FLUTS scores in the cystoscopy-only arm at 6weeks (p=0.01), but there was no significant improvement in the cystodistension arm (p=0.09). At 6weeks there were significant improvements in UDI scores in both arms (both p=0.01). Despite statistical improvements at 6 weeks, no clinically therapeutic benefit was maintained by either procedure at 6 months. Cystoscopy produces some short-term improvement in bladder symptoms, but cystodistension does not.

Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial

Introduction and hypothesisThe objective was to evaluate the functional outcome after laparoscopic sacrocolpopexy versus open sacrocolpopexy in women with vault prolapse.MethodsA multicentre randomised controlled trial was carried out at four teaching and two university hospitals in the Netherlands in women with symptomatic vault prolapse requiring surgical treatment. Participants were randomised for laparoscopic or open sacrocolpopexy. Primary outcome was disease-specific quality of life measured using the Urinary Distress Inventory (UDI) questionnaire at 12 months’ follow-up. Secondary outcomes included anatomical outcome and perioperative data. We needed 74 participants to show a difference of 10 points on the prolapse domain of the UDI 12 months after surgery (power of 80%, α error 0.05).ResultsBetween 2007 and 2012, a total of 74 women were randomised. Follow-up after 12 months showed no significant differences in domain scores of the UDI between the two groups. After 12 months, both groups reported a UDI score of 0.0 (IQR: 0–0) for the domain “genital prolapse”, which was the primary outcome. There were no significant differences between the two groups (p = 0.93). The number of severe complications was 4 in the laparoscopic group versus 7 in the open abdominal group (RR 0.57; 95% CI 0.50–2.27). There was less blood loss and a shorter hospital stay after laparoscopy; 2 (IQR 2–3) versus 4 (IQR 3–5) days, which was statistically different. There was no significant difference in anatomical outcome at 12 months.ConclusionOur trial provides evidence to support a laparoscopic approach when performing sacrocolpopexy, as there was less blood loss and hospital stay was shorter, whereas functional and anatomical outcome were not statistically different.

Neuromodulation for Overactive Bladder Symptoms in Women Utilizing Either Motor or Sensory/Motor Provocation With a Minimum Nine-Year Follow-Up.

This study is an evaluation of whether motor provocation compared to mixed sensory/motor provocation for tined lead placement affects its efficacy with quality of life measurements and Likert patient satisfaction. An observational, retrospective cohort study was conducted with the analysis of 128 charts of adult women who, between January 2002 and September 2005, underwent a two-staged approach for sacral neuromodulation by the lead author SPM. Both groups did not differ statistically in their mean preoperative American Anesthesiologist Status Classification Score's of two or less, or frequency, urgency, urgency incontinence daily episodes or Urinary Distress Inventory scores. A seven-point Likert Scale was utilized for post-operative patient satisfaction. Sixty-eight patients (Group 1) received pure motor provocation for tined lead placement under general anesthetic and 60 patients (Group 2) received mixed sensory/motor provocation tined lead placement under intravenous sedation and local anesthetic. Sixty-two of 68 (91%) patients in Group 1 proceeded to Stage Two while 53/60 (88%) in Group 2 proceeded to Stage Two implantation (p = 0.28). Median follow-ups were 124.7 ± 21.5 months for Group 1 and 120.4 ± 19.7 months for Group 2 (p = 0.45). Mean preoperative/postoperative Urinary Distress Inventory short form and number of voids per 24 hours were for Group 1, 15.5 ± 6.6/8.9 ± 4.3 and 16.3 ± 5.3/9.2 ± 3.9 and for Group 2, 16.3 ± 6.4/8.4 ± 3.9 and 17.82 ± 7.17/8.34 ± 4.26 voids/24 hours (p < 0.001). Mean preoperative and postoperative ultrasound post void residual urines were 62.2 ± 29.3 milliliters/46.9 ± 20.6 milliliters (Group 1) and 68.0 ± 26.8 milliliters /42.0 ± 27.8 milliliters (Group 2) (p < 0.01). Mean operative times were 29.5 ± 16.8 minutes (Group 1) and 59.3 ± 25.8 minutes (Group 2) (p < 0.001). Mean Likert patient satisfaction score (1, 2, 3) for Group 1 was 2.6 and 1.8 for Group 2 (p < 0.21). The mean numbers of office visits/year for reprogramming were 1.4 ± 0.7 (Group 1) and 2.8 ± 1.1 (Group 2) (p < 0.001). Women with mixed sensory/motor provocation tined lead placement incurred statistically significant longer operating room times and an increased number of annual reprogramming sessions. Singular motor provocation tined lead placement may, in fact, improve outcomes by significantly decreasing operating room time, improving patient satisfaction, and decreasing mean yearly reprogramming sessions, compared to mixed sensory/motor tined lead placement.

Association of depression and anxiety in underserved women with and without urinary incontinence.

Depression and anxiety are found in increasing rates in those with lower urinary tract disease. The manner in which this association further impacts underserved women has not been fully evaluated. For this study, 429 patients were included from general gynecology and female pelvic medicine and reconstructive surgery clinics between the ages 18 and 80 years at a Los Angeles County teaching hospital. Patients who met the study criteria completed the following questionnaires: the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory, Pelvic Floor Distress Inventory Short From, Pelvic Floor Impact Questionnaire Short Form, and the SF-12 Health Survey. Data analyses included descriptive statistics, tests of mean difference, correlations, and regression models to compare with categories of incontinent and continent women. Of the 429 patients, 71.8% were Hispanic with a mean age of 46.6 years (range, 18-80 years) and median parity of 2.83 (0-17). Among the patients with incontinence, 34.1% reported mild, moderate, or severe depression on the BDI-II compared with 21% patients without incontinence (P = 0.003). In addition, 20.4% of the incontinent group had severe depression (BDI-II, >20), whereas only 8.2% in the continent group had severe depression (P = 0.001). The higher Urinary Distress Inventory scores did correlate with the worsening Patient Health Questionnaire (r = 0.263; P = 0.0001), BDI-II (r = 0.209; P = 0.002), and SF-12 Health Survey mental scores (r = -0.140; P = 0.04). Current findings show that approximately one third of the women reporting incontinence in our sample had depression. Underserved patients seeking medical care for incontinence in publically funded hospitals may have depression and anxiety at rates higher than those reported in the general population.