RESUMO
INTRODUCTION AND HYPOTHESIS: The quality of information related to pelvic floor disorders is varied and understudied. Using a validated instrument we evaluated the quality of selected websites addressing treatment options for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). METHODS: English-language, patient-focused professional, governmental, and consumer websites related to POP and SUI were identified using the International Urogynecology Association (IUGA) list of continence societies worldwide, search terms, and provider nomination. Websites were evaluated by 10 providers at an academic medical center, representing urogynecology (6), urology (3), and general gynecology (1). Quality assessment utilized the DISCERN instrument, a validated instrument consisting of 16 questions addressing the quality of consumer health information. RESULTS: Websites of 13 organizations met inclusion criteria and were assessed, 12 relating to SUI and 8 to POP. The websites with the highest mean total DISCERN score for POP were those of the IUGA, the American Society of Colon and Rectal Surgeons, and the American Urogynecologic Association, and for SUI, the National Association For Continence, the American Urological Association, and the IUGA. High correlations were obtained for the total DISCERN score and the overall quality scores for POP (0.76) and SUI (0.82). The most commonly omitted components of the DISCERN instrument were a clear statement of the content objectives, references or sources of the content, and a discussion of what patients could expect if they opted for no intervention. CONCLUSIONS: Available English-language professional websites written to inform patients about management choices for SUI and POP miss key components of quality patient information.
Assuntos
Internet , Educação de Pacientes como Assunto , Prolapso de Órgão Pélvico , Incontinência Urinária por Estresse , Tomada de Decisões , Humanos , Prolapso de Órgão Pélvico/terapia , Incontinência Urinária por Estresse/terapiaRESUMO
Flexible silicone vaginal support pessaries offer a low-risk, effective option for treatment of symptoms of pelvic organ prolapse. This first article in a three-part series summarizes clinical recommendations and current evidence related to pessary indications, choice, and fitting.
Assuntos
Prolapso de Órgão Pélvico , Pessários , Ajuste de Prótese/enfermagem , Especialidades de Enfermagem/métodos , Educação Continuada em Enfermagem , Feminino , Humanos , Prolapso de Órgão Pélvico/enfermagem , Prolapso de Órgão Pélvico/prevenção & controle , Prolapso de Órgão Pélvico/terapia , Ajuste de Prótese/métodos , VaginaRESUMO
Successful use of vaginal support pessaries requires provider and patient understanding of expected symptom-relief, potential complications, self-care options, and evaluation and treatment of pessary-related problems. This second article in a three-part series summarizes clinical recommendations and evidence related to pessary management.
Assuntos
Prolapso de Órgão Pélvico , Pessários/efeitos adversos , Especialidades de Enfermagem/métodos , Doenças Vaginais , Continuidade da Assistência ao Paciente , Educação Continuada em Enfermagem , Feminino , Humanos , Prolapso de Órgão Pélvico/enfermagem , Prolapso de Órgão Pélvico/prevenção & controle , Prolapso de Órgão Pélvico/terapia , Doenças Vaginais/tratamento farmacológico , Doenças Vaginais/enfermagem , Doenças Vaginais/patologiaRESUMO
In this final article in a series of three, components of pessary fitting, provision, and follow up are reviewed from a business perspective related to supplies, patient flow, billing, and coding.
Assuntos
Comércio/organização & administração , Profissionais de Enfermagem/organização & administração , Administração de Consultório/organização & administração , Pessários/provisão & distribuição , Ajuste de Prótese/enfermagem , Especialidades de Enfermagem/organização & administração , Idoso , Comércio/economia , Educação Continuada em Enfermagem , Feminino , Humanos , Profissionais de Enfermagem/economia , Administração de Consultório/economia , Pessários/economia , Ajuste de Prótese/economia , Especialidades de Enfermagem/economiaRESUMO
OBJECTIVE: The objective of the study was to determine the efficacy of the pubovaginal Mersilene mesh sling (PVMMS) for complicated urodynamic stress incontinence (USI). STUDY DESIGN: Between 1990 and 2008, patients with USI plus an at-risk diagnosis underwent a PVMMS by a single surgeon. They were followed up with urodynamics (UDE) and Pelvic Floor Distress Inventory-short form 20 (PFDI-20). Stratification was in an at-risk hierarchy: intrinsic sphincter deficiency (ISD) greater than recurrent USI (RUSI) greater than USI with chronically increased intraabdominal pressure (CI-IAP). A cough stress test determined objective cure. PFDI question 17 assessed subjective cure. RESULTS: Three hundred six patients with ISD (43.5%), RUSI (26.8%), and CI-IAP (29.7%) had objective cure rates of 89.2% in the short term, 86.7% in the intermediate term, and 91.2% in the long term. A group of 48 patients with both short- and long-term UDEs showed cures of 100% and 91.7%. Long-term objective cure rates were: ISD, 90.5% (n = 21); RUSI, 84.2%, (n = 19); CI-IAP, 100% (n = 17). The mean score of postoperative PFDI question 17 was 0.57 (n = 119). Mean symptom improvement was -2.98 (n = 52; P < .0001). CONCLUSION: We demonstrated PVMMS to be subjectively and objectively effective in long-term treatment of complicated forms of USI.
Assuntos
Polietilenotereftalatos , Slings Suburetrais , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Little is known about how frail, elderly women in assisted living and long-term care facilities view pelvic floor dysfunctions and treatments. Twenty-five residents reflect on these issues, and quality of life.
Assuntos
Atitude Frente a Saúde , Idoso Fragilizado , Diafragma da Pelve , Instituições Residenciais , Incontinência Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Assistência de Longa Duração , Massachusetts , Avaliação das Necessidades , Qualidade de VidaRESUMO
INTRODUCTION: Support pessaries are an important, low-risk treatment option for women with vaginal prolapse but evidence to inform optimal practice is lacking. Currently, gynecologists, urologists, and urogynecologists recommend silicone vaginal support pessaries as first-line treatment for symptomatic vaginal prolapse in women of all ages. It is unknown how many providers who are not physicians prescribe and care for women using pessaries. For this study we attempted to collect opinions of expert nurse providers who fit pessaries on topics related to pessary care and management in an effort to develop consensus to guide practice. METHODS: A 4-round modified Delphi technique was utilized and included one series of online surveys, 2 rounds of anonymous online questionnaires, and one series of face-to-face meetings at conferences. Respondents were invited to participate in all opportunities to provide opinion. For the first 3 rounds respondents were asked to rate statements on a 3-point scale, (agree, disagree, neutral) and provide written comments for those statements with which they did not agree. The goal of additional rounds was 80% agreement between participants, including no less than 6 nurse pessary experts. RESULTS: Greater than 80% consensus was achieved for 22 statements related to patient and provider education, terminology for documentation, pessary management, and follow-up care. Use of vaginal estrogen, antimicrobials, and prevention and management of mechanical injury were areas where no consensus was reached. DISCUSSION: Expert pessary providers were able to develop consensus recommendations to inform provider education and clinical care where the evidence base remains sparse. Areas where consensus was not achieved inform the future pessary-related research agenda needed to identify optimal cost-effective pessary care and educational methods for new pessary providers.
Assuntos
Consenso , Prolapso de Órgão Pélvico/terapia , Pessários , Guias de Prática Clínica como Assunto , Padrões de Prática em Enfermagem , Prolapso Uterino/terapia , Vagina/patologia , Técnica Delphi , Feminino , Ginecologia/métodos , Humanos , Profissionais de Enfermagem , Enfermeiras e Enfermeiros , Prolapso , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Our purposes were to describe pessary-care practices and education of a sample of nurse providers in the United States and identify a cohort of high-volume providers. METHODS: An e-mail survey was sent to members of 3 related nursing professional organizations. Questions addressed general pessary care within the respondent's practice and specific pessary care choices of responding direct providers. Data were managed using REDCap electronic data capture tools. RESULTS: Of 323 respondents, 279 (86.4%) reported pessary care occurred in their office settings, 84.5% of which were urban or suburban, and 65.4% were private practices. Responders were evenly distributed through 4 regions of the United States and represented a variety of specialties. Physicians and advanced practice registered nurses provided the majority of care (up to 80%), along with registered and licensed practical nurses and medical assistants. Care routines varied, most often including 3-month-interval follow-up with speculum-assisted vaginal examinations and no routine use of vaginal products (eg, moisturizers, acidifiers, antimicrobials, or vaginal estrogens). On-the-job mentoring was the primary knowledge source (64%). Comparison of practice patterns suggested possible variation by region and certification. CONCLUSIONS: This exploratory study provides data related to the pessary-care practices of nurse providers in the United States. The range of responses emphasizes a need for evidence-based guidelines for optimal care, based on patient outcomes, satisfaction, and costs of care. Findings also illustrate a need for effective, evidence-based educational programs and clinical mentorship options with experienced providers. A cohort of expert providers was identified to continue work toward these goals.
Assuntos
Prolapso de Órgão Pélvico/enfermagem , Pessários/estatística & dados numéricos , Padrões de Prática em Enfermagem , Feminino , Humanos , Profissionais de Enfermagem , Inquéritos e Questionários , Estados Unidos , VaginaRESUMO
Data analysis in qualitative research is a creative process. As the instrument of data analysis, the researcher explores and reflects on the meaning of the data. In most qualitative traditions, the data analysis phase overlaps the data collection phase. As data analysis proceeds, the researcher moves back and forth between data analysis and data collection in order to create and explain the findings. Using data from the authors' research, common techniques of data analysis in qualitative research are presented.
Assuntos
Interpretação Estatística de Dados , Pesquisa Qualitativa , Humanos , Pesquisa em Enfermagem/métodosRESUMO
Case and grounded theory are two methods of qualitative research. Both methods have their roots in sociology and are focused on understanding, explaining, and/or predicting human behavior. They are ideal methods for nursing research, as they are useful for exploring human responses to health problems. The theoretical underpinnings, methodologies, strategies for data collection, requirements for trustworthiness, and examples of research using case and grounded theory are described.
Assuntos
Pesquisa Metodológica em Enfermagem/métodos , Registros de Enfermagem , Pesquisa Qualitativa , Projetos de Pesquisa , Antropologia Cultural , Coleta de Dados/métodos , Interpretação Estatística de Dados , Humanos , Modelos de Enfermagem , Pesquisa Metodológica em Enfermagem/normas , Reprodutibilidade dos Testes , Sociologia MédicaRESUMO
INTRODUCTION: Vaginal prolapse can be debilitating, due to pelvic organ prolapse and herniation of the bladder, uterus, intestines and/or support tissues in the vaginal opening. However, there is little published information that documents women's experiences in the months and years after surgery to correct prolapse. OBJECTIVE: This phenomenologic study aimed to increase understanding of the specific experiences that patients report after vaginal closure surgery. METHOD: Participants were recruited via a mailing to surgical patients from a large urogynecologic practice. Semi-structured interviews were tape-recorded and transcribed for analysis. RESULTS: Six women participated in the study. After analyzing the results, five major themes emerged: awareness and confusion, feeling alone in silence, trusting recommendation, acceptance of changed sexuality, and still coping. CONCLUSIONS: This small study shows that vaginal closure affects an intimate body part and can impact self-image, but the women did not regret their changed sexuality. The larger issues for these women were ones of communication, information, and isolation, particularly during their followup care.
Assuntos
Adaptação Psicológica , Atitude Frente a Saúde , Prolapso Uterino/psicologia , Prolapso Uterino/cirurgia , Mulheres/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Conscientização , Barreiras de Comunicação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Solidão/psicologia , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Pesquisa Metodológica em Enfermagem , Assistência Perioperatória/enfermagem , Assistência Perioperatória/psicologia , Pessários , Pesquisa Qualitativa , Qualidade de Vida , Recuperação de Função Fisiológica , Sexualidade/psicologia , Vergonha , Inquéritos e Questionários , Confiança , Prolapso Uterino/enfermagemRESUMO
OBJECTIVES: This study aimed to assess correct performance of pelvic muscle exercises (PMEs) in women presenting for urogynecologic care who express prior PME knowledge and to identify optimal instruction. METHODS: New patients referred to urogynecology clinic reporting knowledge of PME or Kegels were asked to complete a questionnaire concerning knowledge, prior instruction, and current use of PME. During examination, the participants were asked to perform their PME or Kegel. Initial levator strength was documented by Oxford Scale. Randomized-order instructions were then given to educate women who contracted incorrectly. The participants completed a postexamination questionnaire. Analyses described percentage of women who were able to perform a correct contraction on initial attempt and factors associated with correct performance. Standard statistical methods were used to assess factors associated with correct PME performance and initial strength. RESULTS: Two hundred fifty eligible participants completed the questionnaires. Sixty (24%) participants were unable to correctly perform a PME initially. Of the 83 participants reporting current practice of PME, 23% performed them incorrectly. Prior instruction (odds ratio, 3.0; 95% confidence interval, 1.6-5.7; P < 0.01) and prior feedback (odds ratio, 3.5; 95% confidence interval, 1.0-12.0; P < 0.05) were associated with correct PME performance. In women who performed PME incorrectly at the initial assessment, "Squeeze the vaginal muscles you use to hold your urine" resulted in correct PME performance most often. CONCLUSIONS: Women reporting prior knowledge of PME may still perform them incorrectly. Providing instruction and feedback is strongly associated with correct performance and can be easily incorporated into pelvic examination. This may improve PME use and effectiveness to control symptoms of pelvic floor disorders.
Assuntos
Terapia por Exercício , Conhecimentos, Atitudes e Prática em Saúde , Distúrbios do Assoalho Pélvico/terapia , Biorretroalimentação Psicológica , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Contração Muscular/fisiologia , Força Muscular/fisiologia , Educação de Pacientes como Assunto , Distúrbios do Assoalho Pélvico/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aimed to determine risk factors, including postoperative analgesic use, for the development of postoperative urinary retention (PUR) after hysterectomy for routine gynecologic indications using a case-control study design. METHODS: Cases of PUR after hysterectomy were identified from billing data. Cases were those patients requiring recatheterization for inability to void. Controls were similarly identified and matched by age and date of surgery in a 3:1 control-to-case ratio. Chart review was performed to obtain demographic, medical, surgical, anesthetic, and medication data. Cumulative and interval doses of postoperative narcotic were recorded and converted into morphine equivalents. Crude odds ratios (ORs) were determined for potential risk factors for PUR using standard statistical analysis. Conditional logistic regression was used on multivariate models, including cumulative postoperative narcotic use, to determine adjusted ORs for risk factors. RESULTS: Twenty-six cases of PUR were matched with 78 controls. The cases had a higher body mass index (32 vs 28 kg/m2, P = 0.02), had a higher preoperative use of tricyclic antidepressants (TCA; 19.2% vs 1.3%, P = 0.004), were more likely to present preoperative urinary retention associated with fibroids (19.2% vs 0%, P < 0.01), and received a higher cumulative narcotic dose in the postoperative period (109 vs 73.6 mg, P < 0.001). In a multivariate model, preoperative TCA use (OR, 30.1; 95% confidence interval, 1.99-456; P = 0.01) and cumulative narcotic dose (OR, 2.54; 95% confidence interval, 1.44-4.56; P < 0.01) were significantly associated with PUR. CONCLUSIONS: Postoperative urinary retention after hysterectomy is associated with higher postoperative narcotic dose, preoperative TCA use, and preoperative urinary retention.
Assuntos
Analgésicos/efeitos adversos , Histerectomia/efeitos adversos , Retenção Urinária/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Resultado do TratamentoRESUMO
Women commonly experience lower urinary tract symptoms that can severely decrease quality of life. Symptoms are often associated with diagnoses such as urinary incontinence, overactive bladder, and bladder pain syndrome. Expanding evidence supports the effectiveness of many basic nursing interventions, including behavioral management education and optimal use of various pharmacologic agents. The primary focus of this article is pharmacologic treatment of urinary symptoms in women, including new and emerging agents.
Assuntos
Toxinas Botulínicas/uso terapêutico , Doenças da Bexiga Urinária/tratamento farmacológico , Transtornos Urinários/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Acetanilidas/uso terapêutico , Administração Cutânea , Administração Oral , Adulto , Idoso , Cistite Intersticial/diagnóstico , Cistite Intersticial/tratamento farmacológico , Estrogênios/uso terapêutico , Feminino , Humanos , Ácidos Mandélicos/uso terapêutico , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Tiazóis/uso terapêutico , Resultado do Tratamento , Doenças da Bexiga Urinária/diagnóstico , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/diagnóstico , Incontinência Urinária/tratamento farmacológico , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/tratamento farmacológico , Transtornos Urinários/diagnóstico , UrodinâmicaRESUMO
INTRODUCTION: This study aimed to identify risk factors for postpartum urinary retention (PPUR) after cesarean delivery (CD). METHODS: A case-control study design was used. Cases of PPUR after CD were identified using billing codes for CD and "urinary retention" and confirmed by chart review. Matched controls were identified in a 2:1 ratio using an obstetrics database and billing data. Patient demographics, operative, and anesthetic data were collected. Fisher exact tests and Wilcoxon rank sum tests were used to determine differences in medical risk factors, postoperative analgesic use, and catheter management between cases and controls. A modified Poisson conditional multivariate regression with robust error variances was used to estimate the odds ratios (ORs) for significant predictors. RESULTS: Thirty-four confirmed cases of PPUR were matched with 68 controls. The mean ages of cases and controls were 31 and 32 years, respectively. Cases and controls differed in gestational age (P = 0.01), diagnosis of diabetes (P = 0.05), and use of postoperative intravenous and oral narcotics (P < 0.01 and P = 0.03, respectively). In a multivariate model including these factors, increasing gestational age was associated with decreased risk of PPUR [OR, 0.07; 95% confidence interval (CI), 0.01-0.48; P < 0.01], whereas use of postoperative intravenous narcotics (OR, 4.51; 95% CI, 1.09-18.67; P = 0.038) and oral narcotics (OR, 4.99; 95% CI, 1.10-22.65; P = 0.037) were associated with increased risk. CONCLUSIONS: After matching for obstetric factors, use of postoperative narcotic analgesia was associated with increased risk of PPUR. Other operative and anesthetic factors had no association. Multicenter prospective studies are needed to investigate this association.
Assuntos
Cesárea/efeitos adversos , Retenção Urinária/etiologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Estudos de Casos e Controles , Diabetes Gestacional/epidemiologia , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Resultado do Tratamento , Retenção Urinária/epidemiologia , Adulto JovemAssuntos
Terapia por Acupuntura/normas , Medicina Baseada em Evidências/organização & administração , Incontinência Urinária/terapia , Terapia por Acupuntura/métodos , Distribuição por Idade , Fatores Etários , Idoso , Terapia Comportamental , Antagonistas Colinérgicos/efeitos adversos , Terapia de Reposição de Estrogênios , Terapia por Exercício , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve , Projetos de Pesquisa , Segurança , Distribuição por Sexo , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/epidemiologia , Urodinâmica , Saúde da MulherRESUMO
Many factors influence the decision to institute treatment for the common problems of urinary tract symptoms and/or the presence of microorganisms in the urine of women. This article summarizes current evidence related to treatment choice and compares selected treatment practice guidelines. Evidence related to prevention of recurrent infection without the use of antibiotics is included.
Assuntos
Antibacterianos/uso terapêutico , Guias de Prática Clínica como Assunto , Infecções Urinárias/tratamento farmacológico , Antibacterianos/efeitos adversos , Bacteriúria/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fatores de Risco , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controleRESUMO
Pelvic organ prolapse is a common and costly women's health problem. Prevention of prolapse continues to play a role in the debate about the risks and benefits of elective cesarean section, making this an important topic for midwives to understand. While some women appear to be at higher risk for prolapse because of intrinsic anatomic and physiologic factors, others have modifiable risk factors that can be addressed by health care providers. This article discusses the current knowledge related to the etiology of prolapse and related components of pelvic anatomy. Biomechanical principles are then applied to enhance the understanding of prolapse development and prevention. Clinical recommendations are based on current evidence regarding topics such as physical activity during pregnancy, treatment of vaginal atrophy, and optimal pelvic floor muscle exercises.
Assuntos
Diafragma da Pelve/fisiopatologia , Prolapso Uterino/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , GravidezRESUMO
We recorded vaginal pressure in 12 women without risk factors for prolapse during two activity and exercise sessions, compared exercise and cough pressure, and evaluated method reproducibility and patterns of relative pressure. Portable urodynamic equipment, repeated measures descriptive design, and purposeful sampling were used with nonparametric analysis and visual comparison of pressure graphs. Mean participant age was 31.1 years (range 20-51), and mean body mass index was 22.7 (range 18.5-29.3). Mean pressures (in cm H(2)O): cough, 98.0 (48.0-133.7); standing, 24.0 (15.9-28.5); supine exercise, 34.0 (6.3-91.9); exercise machines, 37.0 (20.3-182.3). Repeated measures correlations for selected measures ranged from 0.66 (p Assuntos
Exercício Físico/fisiologia
, Corrida Moderada/fisiologia
, Remoção
, Vagina/fisiologia
, Adolescente
, Adulto
, Tosse
, Feminino
, Humanos
, Remoção/efeitos adversos
, Pessoa de Meia-Idade
, Pressão
, Estatísticas não Paramétricas