Urogynecologic Disorders Research Articles

Gewichtsreduktion bei Übergewicht und Adipositas und deren Auswirkungen auf Sexualität, Harn- und Analinkontinenz, Descensus genitalis und Lebensqualität

AIM: Many patients presenting with urogynecological disorders or sexual disturbance are also overweight. These factors typically diminish the patients' quality of life and undermine their sense of self-worth. METHODS: The study was conducted as a prospective follow-up investigation and included 125 women whose uro- and proctogynecological symptoms, sexual functioning, and quality of life were evaluated before and 12 months after weight reduction. RESULTS: Following nutritional therapy, the body mass index (BMI) decreased from 31.6 to 29.1. At follow-up after 12 months, 31 women (24.8 %) had maintained the weight loss achieved by nutritional therapy, 86 (68.8 %) showed further weight loss, and 8 (6.4 %) had gained weight again. Ninety (72.0 %) patients with disturbed sexual functioning reported a significant improvement after therapy (improvement of the score by 0.5 points, p = 0.012). Quality of life rated on a scale ranging from 1 - 10 achieved a mean score of 4.34 before therapy and increased significantly by 3.69 points to 8.08 after therapy (p = 0.042). Pre-existing symptoms were improved by nutritional therapy in 100 (80.0 %) patients (p = 0.035). CONCLUSION: The results of the prospective study presented here demonstrate that weight loss significantly improves symptoms and the patient's quality of life.

Urogynecology and the underserved

It is the observation of this author that a majority of US patients who seek and receive care for urogynecologic disorders are Caucasian and have insurance or other means to pay for their care. There are, of course, many exceptions. However, the impression remains that urogynecologic disorders are largely addressed in women who have the luxury of time to do so, access to urogynecologic services and the ability to pay. Unlike cancer, urinary incontinence and prolapse are usually not life threatening. Unlike Obstetrics, the disorder does not have a self-limited course. Urogynecologic conditions only uncommonly warrant urgent attention. However, these disorders have a significant impact on the quality of life of women of all races and social strata. African American women have been found to have greater rates of detrusor overactivity. Latina women have been found to have higher rates of prolapse. There is little or no data on Native American women. Medical insurance coverage is less common among minorities in the US, but quality of life issues undoubtedly transcend one’s race and socioeconomic status. So what can be done to address yet another disparity in our health care system? It begins with the recognition that our profession selects for a certain type of patient. It continues with the willingness to accept patients in to our practice with limited or no resources. Then, we must advocate for them in their efforts to secure public assistance or other health care coverage including charity care within our hospital systems. National organizations should recognize the issue and advocate for public coverage for patients who are otherwise disabled by the effects of their urogynecologic disorders, just as one might be disabled by her “bad back”. Underserved women also have more difficulty finding qualified physicians to address their problems because we are largely driven to practice in high resource settings. With this in mind, we have developed a model for delivery of urogynecologic services in one hospital on the Navajo reservation. This may be applicable to other underserved populations, especially those with public funding. Native women with federal medical coverage who have urinary incontinence or prolapse often have no access to urogynecologic services. They must either suffer or seek referral to facilities which are sometimes hundreds of miles away. Sometimes their referrals are approved, sometimes not. Most of these women do not have the resources to travel back and forth to the referral institution for an initial evaluation, followup visit, pre-operative visits, surgery etc. Once or twice yearly, we visit the reservation to perform surgery on patients with prolapse and/or incontinence. These patients are prescreened according to strict criteria and confirmed as suitable candidates prior to the procedure. These visits serve to both help individual patients and teach the Indian Health Service physicians new techniques. The Indian hospital saves money on referrals and reimburses us for expenses. Over time, we have developed a trusting and professional relationship with the IHS physicians which ultimately nourishes us all. There are many ways that physicians in urogynecology and related fields can address the needs of the medically underserved. It is incumbent on our specialty to devise innovative ways to care for patients of all races and socioeconomic statuses. We must be tireless advocates for these patients until the time when all patients are able to receive equal, high quality care. Int Urogynecol J (2006) 17:429 DOI 10.1007/s00192-006-0182-y

The clinical value of sonographic imaging of the urethrovesical anatomy.

Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functional-morphological documentation. With sonography dynamic images during coughing, Valsalva, pelvic floor contraction and micturition are provided. Ultrasonography of the urethrovesical anatomy improves our thinking of function and anatomy and will therefore have an important place in the diagnosis and treatment of urogynecologic disorders.

Psychosomatic aspects of urinary incontinence.

Psychosomatic aspects of urogynecological disorders may play an important role in their clinical presentation. 72 patients presenting to the urogynecological clinics and a control group of 34 healthy women were included in this study. After informed consent had been obtained, all patients were subjected to (1) a detailed enquiry about personal- and medical history (2) psychological tests (Freiburg's personality inventory, a questionnaire focused on anxiety and anger, and Beck's depression inventory) and (3) routine urodynamic measurement. Patients with stress incontinence had a mean duration of symptoms of 59 months. In 67% there was a combination with clinical urge symptoms. 53% of the patients did not have regular sexual intercourse. Of those who had regular intercourse 23% had incontinence during intercourse and 25% were anorgasmic. 59% of the patients had dysmenorrhea and a negative attitude to their menarche. Urodynamic evaluation showed stress, urge or no incontinence in 39%, 12% and 39%, respectively. Analysis of the psychosomatic tests did not show a specific psychosomatic influence. Negative sexual life correlated with depressive mood, which was not based on the urogynecological problem. There was no causal relationship between personality traits and urogynecological problems. The individual perception of incontinence, however, may depend on or influence personality structure.

PHARMACOLOGIC MANAGEMENT OF PELVIC FLOOR DYSFUNCTION

Pharmacologic therapy is an important part of the treatment armamentarium for urogynecologic disorders. Current and future research will determine the utility of such therapy as medications with fewer side effects and more targeted efficacy are developed.

The Prevalence of Urogynecologic Disorders

Although the field of urogynecology spans a wide range of lower urinary tract disorders, urinary incontinence and urinary infections remain the two most common disorders of the urinary tract encountered by the health care provider practicing obstetrics and gynecology. Both problems have a higher prevalence in the older population, and in addition they both have a predilection for recurrence. Together they account for considerable personal and public expense, as well as untold individual emotional and physical distress. Much remains to be learned before significant measures can be initiated to prevent the problems. Urinary incontinence is particularly challenging because it is a manifestation of so many other disorders or their treatment.