OBJECTIVE:
To assess the clinical efficacy of commercially available pelvic muscle training devices on the treatment of pelvic floor disorders.
DATA SOURCES:
We searched MEDLINE, Web of Science, and ...ClinicalTrials.gov through April 2020. We included observational cohort studies and randomized trials. Case reports, case series, and conference poster presentations were excluded. Studies using vaginal weights or cones and those conducted in the peripartum periods were also excluded.
TABULATION, INTEGRATION, AND RESULTS:
A total of 294 studies were screened. Twenty-six studies were included in the qualitative analysis, and 15 studies were eligible for meta-analyses. Study characteristics and quality were recorded for each study. Meta-analysis showed a large positive effect of commercially available pelvic floor training devices on pelvic floor muscle strength by both objective and subjective measures. Meta-analysis of objective measures showed a reduction of 1.2 pads per day (
P
<.01), 1.3 incontinence episodes per day, (
P
<.01) and 11 g on 24-hour pad test (
P
<.01). Meta-analysis of subjective measures showed a reduction in UDI-6 (Urogenital Distress Inventory, Short Form) scores by 25.1 points (
P
<.01) and in IIQ-7 scores (Incontinence Impact Questionnaire, Short Form) by 14.1 points (
P
=.01). There was an increase in I-QOL (Incontinence Quality of Life) scores by 16.8 points (
P
<.01). The minimal important difference was met for the UDI-6 and I-QOL but not for the IIQ-7. We were unable to perform meta-analysis to evaluate whether pelvic floor training devices are as effective as traditional supervised pelvic floor physical therapy.
CONCLUSION:
Commercially available home pelvic floor training devices are effective in increasing strength of pelvic floor muscles and in the treatment of pelvic floor disorders.
Introduction and hypothesis
To evaluate prevalence of pelvic floor disorders, association of endocrine therapy with pelvic floor disorders, and rates of pelvic floor surgery among breast cancer ...survivors compared to matched controls without history of cancer.
Methods
This is a retrospective, cohort study using electronic medical record data from a ten-hospital regional healthcare system. A total of 19,483 women diagnosed with breast cancer between January 2008 and April 2020 were propensity score matched to 19,483 women without a history of cancer. Medical charts were abstracted for ICD-9 and ICD-10 codes for pelvic floor disorders, use of endocrine therapy, and CPT codes for pelvic floor surgeries and procedures.
Results
Overall, the prevalence of pelvic floor disorders was lower among breast cancer survivors (8.8% vs. 22.6%,
p
< 0.001), and mean time to development of pelvic floor disorders among breast cancer survivors was 3 years. Selective estrogen receptor modulators and aromatase inhibitors were associated with pelvic organ prolapse and stress urinary incontinence, while estrogen antagonists were associated with urge urinary incontinence and lower urinary tract symptoms. Women with breast cancer had similar or higher rates of pelvic floor surgery compared to matched controls.
Conclusions
Rates of pelvic floor disorders were lower among breast cancer survivors compared to controls but rates of surgical intervention did not differ and were higher for some conditions among breast cancer survivors. Implications for cancer survivors: Screening for these disorders should be considered as part of routine survivorship care.
To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement ...Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated.
PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines.
Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded.
Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes.
Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties.
PROSPERO, CRD42021278796.
Talcum Powder Toxicosis in Pregnancy Pennycuff, Jon F.; Davenport, Abigail; Ellis, Jane ...
AJP reports,
10/2018, Letnik:
8, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract
Background
Pica is a relatively common phenomenon in pregnancy and typically includes consumption of nontoxic substances such as earth/clay, raw starches, and ice. Occasionally, substances ...may be toxic or have unintended consequences.
Case
A nulliparous woman presented to our facility complaining of numerous, vague symptoms that are common in pregnancy. She had multiple work-ups and an admission to our antepartum unit without clear etiology of her symptoms. Ultimately, she was diagnosed with talcum powder toxicosis secondary to talc ingestion as a coping mechanism for her anxiety, which was heightened in pregnancy.
Conclusion
This case highlights the importance of screening for mental health disorders, which may be exacerbated during the peripartum period. Patients' coping mechanisms for mental health disorders may have unintended consequences.
Purpose of Review
Over the last decades, much research has been done to discover biomarkers that can be used to better elucidate the pathophysiology of lower urinary tract disorders. Particular ...attention has been paid to the inflammatory response and the development of lower urinary tract disorders. The purpose of this review article is to summarize the current understanding of inflammatory urinary biomarkers’ role in the pathophysiology of overactive bladder. Their utility in clinical evaluation and treatment response as well as methodologic limitations in the research of these biomarkers are also discussed.
Recent Findings
Much of the past research on urinary biomarkers focused on a few molecules, with particular emphasis on neurotrophins. Newer research is beginning to include other signaling molecules such as cytokines and chemokines as well as proteins found in the urothelium. The development of lower urinary tract disorders likely involves a complex interplay between these molecules. However, the inflammatory process appears to play a key role in the pathogenesis of these disorders.
Summary
The role of inflammatory urinary biomarkers in the development of overactive bladder and lower urinary tract disorders and their clinical diagnosis remains unclear. Continued research on these molecules may help better understand the underlying pathophysiology of these disorders. Single urinary biomarkers have not proven sufficient for diagnosis. Instead, future research will likely focus on unique urinary biomarker “finger prints” of multiple molecules to better understand, diagnose, and treat these disorders.
To evaluate trends in annual rates of vaginal birth, cesarean delivery, and obstetric anal sphincter injury at a single institution before and after the designation of obstetric anal sphincter injury ...as a measure of obstetric quality and safety.
This was a retrospective cohort study of women undergoing a singleton vaginal delivery and diagnosed with obstetric anal sphincter injury over a 16-year period. International Classification of Diseases, 9th Revision codes for perineal lacerations were used as identifiers. Trends in annual cesarean delivery, perineal laceration, and obstetric anal sphincter injury rates were assessed in a linear regression model. The data were divided into two time periods (1998-2005 and 2006-2013) based on the year (2006) in which obstetric anal sphincter injury was designated as a quality marker and compared.
A total of 1,366 women had obstetric anal sphincter injury, and 1,360 were included for analysis. There was a 12.1% decline in annual vaginal delivery rates (from 77.1% to 67.8%) and a 40.6% increase in annual cesarean delivery rate (from 22.9% to 32.2%; P<.001). The rate of first-degree and second-degree laceration increased significantly (P=.009), and obstetric anal sphincter injury decreased significantly (P<.001). Operative vaginal birth and episiotomy were associated with obstetric anal sphincter injury in 2006-2013 compared with 1998-2005 (P<.001 and P=.018, respectively).
After the designation of obstetric anal sphincter injury as an institutional quality measure, rates of obstetric anal sphincter injury decreased.
OBJECTIVESObstetric anal sphincter injury (OASIS) is a potentially serious complication of vaginal delivery and can lead to both short-term and long-term sequelae. This study sought to identify ...health care seeking patterns of women who developed pelvic floor symptoms including pelvic pain after OASIS. It also identified demographic and clinical factors associated with seeking subspecialty care from a pelvic floor specialist and demographic and clinical factors associated with seeking care for pelvic pain after OASIS.
METHODSThis study is a retrospective cohort study of 69 women who developed pelvic floor disorders after OASIS.
RESULTSFor women diagnosed with a pelvic floor symptom, the mean time to follow-up was 2.4 years, the mean number of visits until diagnosis was 2.2 visits, and 2.9 visits were needed for treatment. The most common diagnoses were pelvic pain, lower urinary tract symptoms including incontinence, and defecatory dysfunction. Twenty-five percent of the cohort received treatment from a pelvic floor specialist. These women were more likely to be older and have urinary incontinence. Women with pain were more likely to be seen by a primary care provider and have longer time to diagnosis.
CONCLUSIONSThe study showed that multiple visits were needed to both diagnose and treat pelvic floor disorders (PFD) after OASIS. Pelvic pain was the most common primary PFD after OASIS. There should be a high level of suspicion for pelvic floor disorders, especially pain disorders, in women who have sustained a third- or fourth-degree laceration.
Introduction and hypothesis
The aim of this study is to report cognitive dysfunction with commonly used antimuscarinic overactive bladder medications in patients suffering from overactive bladder ...disorder with and without baseline neurologic conditions.
Methods
We conducted an Ovid MEDLINE, Embase, and PsycINFO search from January 1998 to December 2018 using PRISMA guidelines. Eighteen studies met the inclusion criteria, including 5 randomized controlled trials and 13 observational studies.
Results
Cognitive decline was reported with oxybutynin use (5 of 8 studies) and tolterodine use (4 of 7 studies) among patients with and without baseline cognitive impairment. Oxybutynin use was linked to functional, mental, and behavioral decline among patients with Alzheimer’s disease (2 studies). No cognitive decline was detected among patients with and without baseline cognitive impairment taking trospium (6 studies), darifenacin (3 studies), imidafenacin (2 studies), and fesoterodine (1 study). Solifenacin was not associated with cognitive decline (2 studies) but was linked to an increased risk of dementia among patients with diabetes (1 study).
Conclusion
In this review, cognitive decline was reported with oxybutynin and tolterodine use and should be used with caution in adults over 65 years of age. Solifenacin, fesoterodine, and imidafenacin showed mixed results related to central nervous system effect. Trospium and darifenacin were not associated with cognitive decline among patients with and without baseline cognitive impairment.
PDF
