Introduction and hypothesis
To evaluate an association between hysterectomy and urinary incontinence (UI) in postmenopausal women.
Methods
Women (aged 50–79) with uteri (
N
= 53,569) and without ...uteri (
N
= 38,524) who enrolled in the Women’s Health Initiative (WHI) Observational Study between 1993 and 1996 were included in this secondary analysis. Baseline (BL) and 3-year demographic, health/physical forms and personal habit questionnaires were used. Statistical analyses included univariate and logistic regression methods.
Results
The baseline UI rate was 66.5 %, with 27.3 % of participants having stress urinary incontinence (SUI), 23 % having urge UI (UUI), and 12.4 % having mixed UI (MUI). 41.8 % of women had undergone hysterectomy, with 88.1 % having had the procedure before age 54. Controlling for health/physical variables, hysterectomy was associated with UI at BL (OR 1.25, 95 % CI 1.19, 1.32) and over the 3-year study period (OR 1.23, 95 % CI 1.11, 1.36). Excluding women with UI at BL, a higher incidence of UUI and SUI episodes was found in hysterectomy at year 3. Among women who had undergone hysterectomy, those with bilateral oophorectomy (BSO) did not have increased odds of developing UI at BL or over the 3-year study period. Hormone use was not associated with a change in UI incidence (estrogen + progesterone,
p
= 0.17; unopposed estrogen,
p
= 0.41).
Conclusions
Risk of UI is increased in postmenopausal women who had undergone hysterectomy compared with women with uteri.
OBJECTIVEThe aim of this study was to characterize clinical success, impact on quality of life, and durability up to 1 year in women with fecal incontinence (FI) responsive to an initial test period ...with a trial vaginal bowel control system.
METHODSThis was a prospective open-label study in subjects with FI and successfully fit who underwent an initial 2-week trial period. Those achieving 50% or greater reduction in FI episodes were provided the long-term system. Primary outcome was success at 3 months defined as 50% or greater reduction in baseline FI episodes, also assessed at 6 and 12 months. Secondary outcomes included symptom impact measured with Fecal Incontinence Quality of Life scale, symptom severity by the St Mark’s (Vaizey) questionnaire, Patient Global Impression of Improvement, and satisfaction. Adverse events were collected. Primary analysis was intention to treat (ITT).
RESULTSSeventy-three subjects with baseline mean of 14.1 ± 12.15 FI episodes over 2 weeks entered the treatment period. Success rate at 3 months was 72.6% (53/73, P < 0.0001); per-protocol, 84.1% (53/63, P < 0.0001). Significant improvement in all Fecal Incontinence Quality of Life subscales and St Mark’s questionnaire meeting minimally important differences was noted. Satisfaction was 91.7%, 89.7%, and 94.4% at 3, 6, and 12 months, respectively; 77.4%, 77.6%, and 79.6% were very much/much better on the Patient Global Impression of Improvement at 3, 6, and 12 months, respectively. Most common adverse event was vaginal wall injury, with most adverse events (90/134, 67%) occurring during fitting period.
CONCLUSIONSIn women with successful fitting and initial treatment response, durable efficacy was seen at 3, 6, and 12 months by objective and subjective measures, with favorable safety.
Objective The purpose of this study was to develop and test a unique, new pelvic floor surgery complication scale and compare it with an existing validated measure. Study Design Surgeons from 2 ...clinical trials networks rated complications based on perceived patient bother, severity, and duration of disability to develop a Pelvic Floor Complication Scale (PFCS). PFCS scores were calculated for subjects in 2 multicenter pelvic floor surgical trials. The PFCS and modified Clavien-Dindo scores were evaluated for associations with length of hospitalization, satisfaction, and quality-of-life measures (Health Utilities Index, Short Form-36, Urogenital Distress Inventory, and Incontinence Impact Questionnaire). Results We calculated PFCS scores for 977 subjects. Higher PFCS and Clavien-Dindo scores similarly were associated with longer length of hospitalization ( P < .01), lower satisfaction ( P < .01), lower Health Utilities Index scores ( P = .02), lower Short Form-36 scores ( P = .02), higher Urogenital Distress Inventory scores ( P < .01), and Incontinence Impact Questionnaire scores ( P < .01) at 3 months. No associations were present at 1 year. Conclusion The PFCS compares favorably to the validated modified Clavien-Dindo instrument.
Current role of mesh in vaginal prolapse surgery Richter, Lee A; Carter, Charelle; Gutman, Robert E
Current opinion in obstetrics & gynecology,
10/2014, Letnik:
26, Številka:
5
Journal Article
Recenzirano
This report summarizes the latest literature on transvaginal mesh (TVM) for the treatment of pelvic organ prolapse, with a focus on indications for use and management of complications. We describe ...trends in TVM by reviewing the recent literature and summarizing national meeting presentations.
Vaginal mesh complications are most often managed surgically, and the majority of patients experiencing mesh-related pain have symptom improvement after intervention. New efforts will focus on identifying variables associated with success after intervention for mesh-related complications, to aid reconstructive pelvic surgeons in outcome prediction and patient counselling.
Although the use of TVM has plateaued in recent years, we are seeing an exponential rise in synthetic mesh implant removal. Reconstructive pelvic surgeons advising patients with TVM complications should report that surgical intervention is often necessary, improvement rates of pain-related symptoms after surgery are high, and up to a third may require multiple interventions.
Objective The aims of this secondary analysis of the “Colpopexy And Urinary Reduction Efforts” (CARE) study were to estimate the incidence of postoperative gastrointestinal complications and identify ...risk factors. Study Design We prospectively identified gastrointestinal complications and serious adverse events (SAE) for 12 months after sacrocolpopexy. Two surgeons independently reviewed reports of ileus or small bowel obstruction (SBO). Results Eighteen percent of 322 women (average age 61.3 years) reported “nausea, emesis, bloating, or ileus” during hospitalization and 9.8% at 6 weeks. Nineteen women (5.9%; CI 3.8%, 9.1%) had a possible ileus or SBO that generated SAE reports: 4 (1.2%, CI 0.5%,3.2%) were reoperated for SBO, 11 (3.4%, CI 1.9%,6.1%) were readmitted for medical management, and 4 had a prolonged initial hospitalization. Older age ( P < .001) was a risk factor for ileus or SBO. Conclusion One in 20 women experiences significant gastrointestinal morbidity after sacrocolpopexy. This information will aid preoperative counseling.
Bowel symptoms in women 1 year after sacrocolpopexy Bradley, Catherine S., MD, MSCE; Nygaard, Ingrid E., MD, MS; Brown, Morton B., PhD ...
American journal of obstetrics and gynecology,
12/2007, Letnik:
197, Številka:
6
Journal Article, Conference Proceeding
Recenzirano
Objective The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy. Study Design This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary ...Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II–IV prolapse. In addition to sacrocolpopexy (± Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon’s discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively. Results The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups. Conclusion Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.
Despite large trials designed to guide management on whether to perform a prophylactic continence procedure at the time of pelvic organ prolapse (POP) repair, it remains unclear if a staged or ...interval approach confers advantages in treatment of bothersome stress urinary incontinence (SUI) in women without bothersome SUI before their POP repair.
The objective of this study was to compare success of concomitant versus interval slings for the prevention/treatment of de novo bothersome SUI after POP repair.
This multicenter retrospective cohort with prospective follow-up enrolled women with minimal or no SUI symptoms who underwent minimally invasive apical surgery for stage 2 or higher POP between 2011 and 2018 and had a concomitant sling placed at the time of POP surgery or an interval sling placed. Prospectively, all patients were administered the Urogenital Distress Inventory Short-Form 6, the Patient Global Impression of Improvement, and questions on reoperation/retreatment and complications.
A total of 120 patients had concomitant slings, and 60 had interval slings. There were no differences in the proportion of patients who had intrinsic sphincter deficiency (22% vs 20%), although the concomitant sling group was more likely to have a positive cough stress test result (30% vs 8%, P = 0.006). The interval sling group was more likely to report "yes" to SUI symptoms on Urogenital Distress Inventory Short-Form 6 (3% vs 30%, P = 0.0006) and during their postoperative visit (0% vs 24%, P < 0.0001). There were no differences in surgical complications.
Among women with minimal or no SUI symptoms undergoing prolapse repair, concomitant slings resulted in lower rates of bothersome SUI compared with similar women undergoing interval sling placement.
Objective The purpose of this study was to compare anatomic outcomes and graft-related complications (GRCs) for abdominal sacrocolpopexy (ASC) with Pelvicol (CR BARD, Murray Hill, NJ), autologous ...fascia, and synthetic grafts. Study Design This is a retrospective cohort study of ASC from 2001-2005. We reviewed anatomic outcomes and GRCs. Apical failure was defined as >stage 0. Results Of 259 ASC procedures, Pelvicol was used in 102 procedures (39%); synthetic mesh in 134 procedures (52%), and autologous fascia in 23 procedures (9%). Mean postoperative follow up was 1.1 years. Apical failure by graft group were Pelvicol 10 (11%), synthetics 1 (1%), and autologous 1 (7%; P = .011). All 7 reoperations for apical prolapse were in the Pelvicol group. GRCs occurred in 16% of the cases, with a higher proportion of erosions in the Pelvicol group (11% vs 3% and 4%; P = .045). Reoperations as a result of GRC were similar between groups. Conclusion ASC is more likely to fail with Pelvicol than with synthetic or autologous grafts. The use of Pelvicol did not reduce graft-related complications in this population.
OBJECTIVEThe aim of this article is to summarize the relevant findings that inform the 2017 International Consultation on Incontinence pathway for surgical treatment of pelvic organ prolapse (POP).
...METHODSWe conducted an evidence-based review of the English-language peer-reviewed literature relating to POP surgery published prior to December 2016. Level 1 evidence (randomized controlled trials RCTs or systematic reviews of RCTs) was preferred; however, level 2 (poor-quality RCT, prospective cohort studies) or 3 evidence (case series or retrospective studies) has been included if level 1 data were lacking. The committee evaluated the literature and made recommendations based on the Oxford grading system summarized as followsgrade A recommendation usually depends on consistent level 1 evidence; grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs; grade C recommendation usually depends on level 3 studies or “majority evidence” from level 2/3 studies or Delphi-processed expert opinion; grade D, “no recommendation possible,” would be used where the evidence is inadequate or conflicting.
RESULTSThe recommendations from each chapter of the review are presented and serve to inform an evidence-based pathway for the surgical treatment of prolapse. A Web-based interactive application of the pathway is presented.
CONCLUSIONSThe 2017 International Consultation on Incontinence pathway on surgery for POP is designed as an adjunct to transparent consultation and consent relating to POP surgery. The final decision regarding surgical intervention can be made only after a shared decision-making process between the patient and the clinician that will evaluate a variety of individual factors that cannot be assessed in the pathway.
Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) ...treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors.
This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean SD, 50 10; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores.
Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean SD, 48.8 8.1 vs 50.4 8.5; P = 0.035); Global Mental scores were similar (51.4 8.4 vs 51.9 9.5, P = 0.56). Global Health scores correlated with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire scores (all P's < 0.0001). In multivariable models, menopause was associated with better physical QOL, and constipation, coronary artery disease, pelvic pain, and increased body mass index with worse physical QOL. Age was associated with better mental QOL, and constipation, fecal incontinence, pelvic pain, and coronary artery disease with worse mental QOL.
Women choosing POP surgery versus pessary had similar physical and mental generic QOL.
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