Female urology-future and present (original) (raw)
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Prevalence of Symptomatic Pelvic Floor Disorders in US Women
JAMA, 2008
Context Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect many women. No national prevalence estimates derived from the same population-based sample exists for multiple pelvic floor disorders in women in the United States.
The Standardization of Terminology for Researchers in Female Pelvic Floor Disorders
International Urogynecology Journal, 2001
The lack of standardized terminology in pelvic floor disorders (pelvic organ prolapse, urinary incontinence, and fecal incontinence) is a major obstacle to performing and interpreting research. The National Institutes of Health convened the Terminology Workshop for Researchers in Female Pelvic Floor Disorders to: (1) agree on standard terms for defining conditions and outcomes; (2) make recommendations for minimum data collection for research; and (3) identify high priority issues for future research. Pelvic organ prolapse was defined by physical examination staging using the International Continence Society system. Stress urinary incontinence was defined by symptoms and testing; 'cure' was defined as no stress incontinence symptoms, negative testing, and no new problems due to intervention. Overactive bladder was defined as urinary frequency and urgency, with and without urge incontinence. Detrusor instability was defined by cystometry. For all urinary symptoms, defining 'improvement' after intervention was identified as a high priority. For fecal incontinence, more research is needed before recommendations can be made. A standard terminology for research on pelvic floor disorders is presented and areas of high priority for future research are identified.
International Urogynecology Journal, 2016
Introduction and hypothesis Pelvic floor disorders (PFD), including urinary incontinence, anal incontinence, and pelvic organ prolapse, are common and have a negative effect on the quality of life of women. Treatment is associated with morbidity and may not be totally satisfactory. Prevention of PFDs, when possible, should be a primary goal. The purpose of this paper is to summarise the current literature and give an evidence-based review of the prevention of PFDs Methods A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the prevention of PFDs was drafted, based on a review of the English-language literature. After evaluation by the entire IUGA R&D Committee, revisions were made. The final document represents the IUGA R&D Committee Opinion on the prevention of PFDs. Results This R&D Committee Opinion reviews the literature on the prevention of PFDs and summarises the findings with evidence-based recommendations. Conclusions Pelvic floor disorders have a long latency, and may go through periods of remission, thus making causality difficult to confirm. Nevertheless, prevention strategies targeting modifiable risk factors should be incorporated into clinical practice before the absence of symptomatology.
Pelvic Floor Disorders: Scope of the Problem
Seminars in Colon and Rectal Surgery, 2010
Pelvic floor disorders encompass symptoms, including urinary incontinence, pelvic organ prolapse, and fecal incontinence. Challenges to treating individuals with pelvic floor disorders include under-reporting of symptoms and inconsistent diagnostic criterion. Nearly 1 in 4 individuals in the United States has experienced a pelvic floor disorder. Incontinence disorders are more frequent in women and the prevalence increases with age. Obstetrical trauma is a common factor in the development of pelvic floor dysfunction. Morbidly obese individuals have a higher prevalence of pelvic floor disorders and weight loss may lead to improvement of symptoms. Evaluation and treatment should address the individual's productivity and quality of life in addition to anatomic and functional limitations. Pelvic floor disorders are best treated with a multidisciplinary approach. Semin Colon Rectal Surg 21:2-5
International Urogynecology Journal, 2014
Introduction and hypothesis Little information is available on the recurrent coexistence of pelvic organ prolapse (POP), urinary (UI) and/or anal (AI) incontinence and defecatory dysfunctions and the relationship between these disorders. The purpose of this study is to report the prevalence, bother, and impact on quality of life (QoL) of unreported bowel symptoms in women presenting to a Brazilian tertiary urogynecology clinic. Methods The study was a cross-section survey of 172 patients with symptoms of pelvic floor disorders (PFD). Patients who reported any defecatory and/or continence disorders were included in the study group, and the others were included in the control group. Patients with UI were also compared with those with double incontinence (DI): AI and UI. Univariate analysis was conducted using the Mann-Whitney U test for continuous nonparametric data. Results After the interview, 54.6 % (n=94) of patients presented AI and/or defecatory disorders: 67.0 % constipation, 41.4 % AI, and 34.0 % fecal urgency. Women from the study group scored worse in the QoL questionnaires compared with women from the control group. Among women with UI, 23.21 % had associated AI. Women with DI scored worse in the QoL questionnaires. Conclusion Anal and urinary dysfunctions are usually associated and have a great impact on a woman's QoL. An integrated approach across specialties should lead to improved patient care. Therefore, our study is relevant because it emphasizes the importance of urogynecologists routinely investigating such symptoms. To do so, standardized questionnaires should be included in the evaluation of all these patients.
Pelvic floor disorders in women with premature ovarian insufficiency: a cross-sectional study
Menopause, 2020
Objectives: 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. Methods: 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. Results: The prevalence of self-reported UI was 27.33% and 37.33% for POI and control groups (P > 0.05), respectively. There was no perc...
Symptomatic pelvic floor disorders in community-dwelling older Australian women
Maturitas, 2016
Objectives: To assess the prevalence, and factors associated with, pelvic floor disorders in a representative sample of community-dwelling older Australian women. Methods: 1548 women, aged 65-79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders. Results: Among 1517 women (mean age = 71.5 ± 4.1 SD years), 47.2% (95% CI, 44.7-49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8-38.6%) having UI, 19.8% (95% CI, 17.8-21.9%) having FI, and 6.8% (95% CI, 5.6-8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both. The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8-11.7%) for nulliparous women, to 45.3% (95% CI, 40.3-59.1%) for 1-2 births, and 52.1% (95% CI, 48.3-55.8%) for ≥3 births. Obese women were more likely to have at least one pelvic floor disorder (OR = 1.77; 95% CI, 1.36-2.31, p < 0.01). Conclusion: Pelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem.
International Urogynecology Journal, 2002
The authors report results of a survey of the practice patterns of International Urogynecological Association (IUGA) members in the management of urinary incontinence and pelvic organ prolapse. A questionnaire regarding current urogynecological clinical practice was developed by the Research and Development Committee of IUGA and mailed to all members of IUGA. Age, specialty, and geographic location factors were used for response comparisons. One hundred and fifty-two surveys (30%) were returned, 35% from North America, 51% from Europe/Australia/New Zealand, and 14% from elsewhere. The average age of respondents was 47.2 years (SD = 9.5), 89% were gynecologists and 11% were urologists. Overall, the procedures of choice for stress incontinence (SUI) were tension-free vaginal tape (TVT; 48.8%) and Burch colposuspension (44%). There were significant geographic variations noted. For SUI with low-pressure urethra/intrinsic sphincteric deficiency, TVT was used by 44.6% and suburethral sling by 32.3%. Various materials are used for suburethral slings, including autologous fascia (46.5%), Marlex mesh (27.8%) and cadaveric fascia lata (11.6%). Bulking agent injection therapy is used for ISD by 75% of respondents. Traditional reconstructive procedures are performed by the majority of respondents, including sacrospinous fixation (78%), abdominal sacrocolpopexy (77%), paravaginal repair (65%) and vaginal enterocele repair (93%); 6.5% use defecography in evaluating rectoceles and 44% use the POP-Q. Seventy-two per cent use urodynamic evaluation routinely in prolapse cases with no manifest SUI. Most IUGA members perform commonly accepted procedures for surgical therapy of urinary incontinence and genital prolapse. IUGA members do not frequently use anorectal physiology and fluoroscopic investigations to evaluate rectoceles prior to repair.