RESUMO
OBJECTIVES: The primary aim of this study was to determine if results from clean catch urine specimens agree with results from catheterized specimens in a urogynecology patient population. The secondary aim was to identify clinical scenarios in which catheterized specimens are preferred over clean catch specimens. METHODS: Both a midstream clean catch and a catheterized specimen were obtained for each participant. Dipstick urinalysis was performed. If either specimen was positive for nitrites, leukocyte esterase, or blood then both were sent for urine culture.Kappa statistics were calculated to measure agreement between the paired specimen data for the total sample and for stratified samples. We agreed to accept clean catch results as preferable to catheterized results if the κ statistic was 0.7 or greater. RESULTS: Three hundred forty-two participants were enrolled. For all participants, the agreement between the paired samples was strong for nitrite (κ = 0.884), moderate for blood and colony count (both κ = 0.656), weak for culture species (κ = 0.566), and minimal for leukocyte esterase (κ = 0.382). When data were stratified for menopause, vaginal estrogen use, body mass index, and prolapse, there were no clinical scenarios in which the κ values were consistently greater than our accepted value of 0.7. CONCLUSIONS: Our data indicate that catheterized urine specimens should be used in the evaluation of urinary tract infection or microscopic hematuria in the typical patient presenting to a urogynecology office who is often menopausal, overweight, and may have prolapse.
Assuntos
Infecções Urinárias , Coleta de Urina , Feminino , Hematúria/urina , Humanos , Masculino , Nitritos/urina , Urinálise/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/urina , Urina , Coleta de Urina/métodosRESUMO
INTRODUCTION AND HYPOTHESIS: There is little information on the impact that postoperative instructions have on physical activity to help guide physicians in providing these recommendations after surgery. Our study objective was to evaluate the impact of postoperative instructions on physical activity. We hypothesized that there would be no differential effect of instructions on activity. METHODS: In this randomized controlled trial, patients undergoing prolapse repair were randomized to receive either liberal or restricted postoperative activity instructions between February 2017 and February 2019. Physical activity was measured using the Activities Assessment Scale (AAS) and tri-axial accelerometers measured at baseline and 2 and 6 weeks after surgery. A sample size of 146 patients was planned to compare these activity measurements. AAS scores and accelerometer readings of the two groups were compared using separate variance t tests. RESULTS: A total of 157 women were recruited between February 2017 and February 2019, including 146 patients with completed study data (n = 72 liberal, n = 74 restricted). There was no difference in physical activity at 2 weeks between the liberal and the restricted instruction groups, as measured by AAS scores (70.47 ± 12.83, 69.54 ± 12.22, p = 0.66), total steps (4,582.20 ± 2,164.5, 5,014.47 ± 3,025.46, p = 0.32), active minutes (4.22 ± 6.17, 4.96 ± 9.65, p = 0.25), and 10-min intervals (0.76 ± 1.11, 0.77 ± 0.93, p = 0.95) respectively. Similarly, there was no difference in activity at 6 weeks between the liberal and the restricted instruction groups. as measured by AAS scores (81.86 ± 8.25, 81.31 ± 10.31, p = 0.72), total steps (6,316.25 ± 3,173.53, 6,589.94 ± 3,826.43, p = 0.64), active minutes (8.79 ± 10.5,11.36 ± 18.18, p = 0.98), and 10-min intervals (1.37 ± 1.34, 1.34 ± 1.40, p = 0.89) respectively. CONCLUSION: Postoperative instructions do not have an impact on physical activity measures in patients who have undergone pelvic reconstructive surgery.
Assuntos
Prolapso de Órgão Pélvico , Procedimentos de Cirurgia Plástica , Exercício Físico , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Período Pós-OperatórioRESUMO
OBJECTIVE: Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research. METHOD: Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017. RESULTS: Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3). CONCLUSIONS: Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Prolapso de Órgão Pélvico/psicologia , Qualidade de Vida/psicologia , Imagem Corporal/psicologia , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Angústia Psicológica , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologiaRESUMO
INTRODUCTION AND HYPOTHESIS: The urogynecology subspecialty relies on appropriate referrals from their referral base. We sought to provide guidance for optimizing appropriate referrals to urogynecology by comparing pre-referral characteristics between appropriate and inappropriate referrals. METHODS: This retrospective cohort study examined predictors of appropriate urogynecology referrals. Appropriateness categorization was based upon pelvic floor disorder (PFD) symptoms and signs provided by the referring provider. Patients with both a PFD symptom and sign were considered "appropriate." Patients with neither a PFD symptom nor sign were considered "inappropriate." PFD symptoms were: vaginal bulge, voiding or defecatory dysfunction. PFD signs were: vaginal vault prolapse, urethral hypermobility, mesh/sling exposure, elevated post-void residual, positive standing stress test, abnormal urinalysis or urine culture-proven infection. Continuous and categorical data were analyzed with ANOVA and chi-square test, respectively. A logistic regression model to predict appropriateness was developed from variables identified from the bivariate analysis. RESULTS: Bivariate predictors of an appropriate referral for 1716 study subjects were older age, prior overactive bladder medication use, MD/DO referrer source and OBGYN, urogynecology or urology referrer specialty. Our logistic regression model correctly classified referrals as appropriate in 93.6% of cases. CONCLUSIONS: Age, anti-cholinergic medication use, referrer source and specialty are pre-initial visit predictors of urogynecology referral appropriateness. The predictor-generated model was successful in predicting referral appropriateness. Potential bias from information transfer issues, lack of pre-referral evaluation and referring provider unfamiliarity with urogynecology are possible reasons for inappropriate referrals and potential areas for improvement.
Assuntos
Distúrbios do Assoalho Pélvico , Prolapso de Órgão Pélvico , Bexiga Urinária Hiperativa , Idoso , Feminino , Humanos , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
OBJECTIVE: We sought to describe the readability of Web sites arising from the most common Google search terms related to pelvic organ prolapse, bladder control, and bowel control. METHODS: Google was queried to capture the top 100 search results for the keywords in each disease group. For the top 20 results of each keyword, we analyzed the text for readability using 4 readability formulas: Dale-Chall, Gunning-Fog, Simple Measure of Gobbledygook (SMOG), and Flesch-Kincaid Grade Level.Readability scores were compared using 1-way analysis of variance (α = 0.05), and the Tukey test was performed to characterize any significant differences. The χ tests were used to compare results above and below the eighth grade reading level. Spearman correlations were used to compare the reliability of the different readability formulas. RESULTS: We evaluated 2731 unique Web sites for readability, of which 2334 (85%) had a SMOG score at or above an eighth grade reading level. The mean SMOG score was 9.7 ± 2.1. Web sites in the bladder control keyword group had statistically higher SMOG scores than those in the bowel control and pelvic organ prolapse groups, with means of 9.9 ± 2.0, 9.4 ± 2.1, and 9.6 ± 2.0, respectively. The SMOG was found to be the most reliable. CONCLUSIONS: The vast majority of urogynecologic information available to patients on the Internet is written at or above an eighth grade reading level despite longstanding recommendations to the contrary. Clinicians should advise patients that the information they find online may be difficult to understand.
Assuntos
Compreensão , Informação de Saúde ao Consumidor/normas , Incontinência Fecal , Internet/normas , Prolapso de Órgão Pélvico , Incontinência Urinária , Estudos Transversais , Letramento em Saúde , Humanos , Ferramenta de Busca/estatística & dados numéricos , Estatísticas não ParamétricasRESUMO
OBJECTIVES: The aim of this study was to determine the value of posterior compartment surgery during concomitant mesh-augmented apical suspension by comparing obstructed defecatory symptoms after laparoscopic sacrocolpopexy (LSC) with LSC with posterior repair (LSC + PR) and laparoscopic sacrocolpoperineopexy (LSCP) procedures. METHODS: This was a retrospective cohort study of women who underwent LSC, LSC + PR, and LSCP between July 2007 and July 2016 at a tertiary referral center in Indianapolis, Ind. Our primary outcome was differential change in Colorectal-Anal Distress Inventory (CRADI-8) and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores between the groups including patient-specific symptoms of splinting, straining, incomplete emptying, and pain with defecation. Our secondary outcomes were the rates of postoperative persistent, new, and resolved obstructed defecation symptoms. Anatomic outcomes were also compared between the groups as measured by change in Pelvic Organ Prolapse Quantification System points Ap, GH, and PB. RESULTS: A total of 312 women were included in the study (47 LSC, 133 LSC + PR, and 132 LSCP), with a median follow-up time of 366 days. The majority of patients who underwent surgery had stage III pelvic organ prolapse (61%). Baseline demographics were similar between groups, including preoperative CRADI-8 and CRAIQ-7 scores. All surgical groups demonstrated improvement in CRADI-8 and CRAIQ-7 scores postoperatively (P < 0.001). However, despite differential change in Pelvic Organ Prolapse Quantification System points Ap, GH, and PB, there was no change in CRADI-8 and CRAIQ-7 scores or rates of persistent, new, and resolved symptoms of splinting to defecate, incomplete emptying, and pain with defecation between the groups. The only factor that seemed to be differentially improved by the addition of a posterior compartment repair was postoperative straining. There was a greater rate of de novo straining in the LSC group compared with LSCP (P = 0.01) (LSC + PR v LSCP, P = NS, for both). CONCLUSIONS: We cannot recommend posterior compartment surgery as providing any patient-centered benefit beyond improved cosmesis because the addition of perineal body stabilization either before (LSCP) or posterior repair after (LSC + PR) concomitant mesh-augmented apical suspension did not differentially affect bowel symptoms compared with LSC alone.
Assuntos
Constipação Intestinal/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Defecação/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE(S): The aim of this study was to determine if ultralightweight polypropylene mesh reduced the risk of mesh/suture exposure after sacrocolpopexy compared with heavier-weighted polypropylene. METHODS: Bivariate and multivariate analyses were used to interpret data from 133 cases and 261 control subjects to evaluate independent predictors of mesh/suture exposure after sacrocolpopexy from 2003 to 2013. RESULTS: Multivariate logistic regression revealed that prior surgery for incontinence (odds ratio [OR], 2.87; 95% confidence interval [CI], 1.19-6.96), porcine acellular cross-linked collagen matrix with medium-weight polypropylene mesh (OR, 4.95; 95% CI, 1.70-14.42), other polypropylene mesh (OR, 6.73; 95% CI, 1.12-40.63), nonabsorbable braided suture for vaginal mesh attachment (OR, 4.52; 95% CI, 1.53-15.37), and immediate perioperative complications (OR, 3.64; 95% CI, 1.53-13.37) were independent risk factors for mesh/suture exposure. After multivariate analysis, ultralightweight polypropylene mesh was no longer associated with decreased rates of mesh/suture exposure after controlling for known risk factors identified during bivariate analysis (P = 0.423). CONCLUSIONS: Both mesh choice and suture selection remained independent predictors of mesh/suture exposure, with heavier meshes increasing and monofilament suture decreasing rates of mesh/suture exposure. Based on this study, surgeons may consider use of delayed-absorbable, monofilament suture over nonabsorbable braided suture for attachment of vaginal mesh to reduce the risk of mesh/suture exposure when using mesh.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Estudos de Casos e Controles , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Modelos Logísticos , Prolapso de Órgão Pélvico/classificação , Polipropilenos/efeitos adversos , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam. METHODS: Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: "In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?" Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. RESULTS: The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as "not at all" or "somewhat" successful. CONCLUSION: Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Prolapso de Órgão Pélvico/diagnóstico , Procedimentos de Cirurgia Plástica/psicologia , Vagina/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/psicologia , Prolapso de Órgão Pélvico/cirurgia , Estudos Prospectivos , Distribuição Aleatória , Vagina/cirurgia , Gravação em VídeoRESUMO
INTRODUCTION AND HYPOTHESIS: To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery. METHODS: This was a prospective study of all eligible women who were scheduled to undergo reconstructive surgery requiring bladder drainage during the study period November 2013 to March 2015. Women who did not undergo the planned procedure(s) or did not require bladder drainage were excluded. The primary outcome was patient-reported quality of life using catheter-specific instruments including the Catheter-related Quality of Life (CIQOL) instrument, and a modified version of the Intermittent Self-Catheterization Questionnaire (ISC-Q), designed to evaluate aspects of catheter-related quality of life and satisfaction specific to the needs of the individual. RESULTS: A total of 178 women were analyzed, 108 in the transurethral catheter group and 70 in the suprapubic group. Women with suprapubic bladder drainage had higher quality of life and satisfaction scores than women with transurethral bladder drainage as measured by the ISC-Q (68.31 ± 16.87 vs. 54.04 ± 16.95, mean difference 14.27, 95 % CI 9.15 - 19.39). There was no difference in quality of life by the CIQOL. After regression analysis, women with suprapubic bladder drainage were more satisfied with their catheter-specific needs despite longer duration of catheter use, more concurrent continence surgery, and higher trait anxiety. CONCLUSIONS: Differences in catheter-specific quality of life and patient satisfaction scores favoring suprapubic bladder drainage support its continued use in appropriately selected women for treatment of temporary postoperative urinary retention after reconstructive pelvic surgery.
Assuntos
Satisfação do Paciente , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Bexiga Urinária , Cateterismo Urinário/psicologia , Idoso , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Procedimentos de Cirurgia Plástica , Análise de Regressão , Autocuidado , Inquéritos e Questionários , Bexiga Urinária/cirurgia , Cateterismo Urinário/métodosRESUMO
OBJECTIVE: A growing body of evidence suggests an increased role for apical support in the treatment of pelvic organ prolapse regardless of phenotype. The objective of this study was to determine whether changes in cystocele/rectocele diagnosis and surgical management for the last 30 years reflect this changing paradigm. METHODS: Data from the National Hospital Discharge Survey were mined from 1979 to 2009 for diagnosis and procedure codes. Records were categorized according to predefined combinations of diagnosis and procedure codes and weighted according to the National Hospital Discharge Survey data set. Pearson χ test was used to evaluate the changes in population proportions during the study interval. RESULTS: The proportion of isolated cystocele/rectocele diagnoses decreased from 1979 to 2009 (56.5%, n = 88,548, to 34.8%, n = 31,577). The proportion of isolated apical defect diagnoses increased from 1979 to 2009 (38.4%, n = 60,223, to 60.8%, n = 55,153). There was a decrease in the frequency of isolated cystocele/rectocele repair procedures performed from 1979 to 2009 (96.3%, n = 150,980, to 67.7%, n = 61,444), whereas there was an increase in isolated apical defect repair procedures (2.5%, n = 3929, to 22.5%, n = 20,450). The proportion of cystocele/rectocele plus apical defect procedures also increased (1.2%, n = 1879, to 9.7%, n = 8806). Furthermore, 87.0% of all studied diagnostic groups were managed by cystocele/rectocele repair alone. CONCLUSIONS: Surgeons have responded to the increased contribution of apical support defects to cystocele/rectocele by modifying their diagnostic coding practices. Unfortunately, their surgical choices remain largely rooted in an older paradigm.
Assuntos
Cistocele/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Retocele/cirurgia , Adulto , Idoso , Codificação Clínica/estatística & dados numéricos , Cistocele/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Retocele/diagnóstico , Estudos RetrospectivosRESUMO
OBJECTIVES: To identify patient-reported reasons for selecting obliterative surgery for the purpose of predicting decision regret and satisfaction. METHODS: We created a deidentified database of patients who underwent an obliterative procedure for prolapse from 2006 to 2013. Patients were excluded if they declined study participation, were deceased, or had dementia. Participants completed a survey regarding reasons for selecting obliterative surgery and a modified version of validated questionnaires on decision regret (Decision Regret Scale-Pelvic Floor Disorder) and satisfaction (Satisfaction with Decision Scale-Pelvic Floor Disorder). Parsimonious multivariate linear regression models were constructed to determine if any of the reasons given for choosing obliterative surgery were independent predictors of decision regret and satisfaction after controlling for significant sociodemographic, clinical, and surgical outcome data identified by bivariate analysis. RESULTS: Seventy-seven women completed the surveys. "To follow my doctor's recommendations" and "no longer sexually active," and/or "did not plan to be" as reasons for selecting obliterative surgery made the most difference; however, these reasons were not identified as independent predictors of decision regret or satisfaction after controlling for confounders. The regret linear regression models identified preoperative sexual activity rather than the patient-reported reason "no longer sexually active and/or did not plan to be," as the only independent predictor of more decision regret after obliterative surgery (B coefficient 1.68, P < 0.01). The satisfaction linear regression models identified reoperation for any reason as an independent predictor of lower satisfaction (ß, -0.24; P = 0.04) and the patient-reported reason for choosing obliterative surgery "not interested in pessary" as a predictor of higher satisfaction (ß, 0.30, P = 0.01). CONCLUSIONS: This study advances our knowledge about the obliterative surgical decision making process. Behavioral and educational interventions directed at improving patient and physician communications concerning the dynamics of sexual health issues in an aging population will likely decrease regret when obliterative surgery is chosen. Minimizing reoperation after obliterative surgery through increased experience, knowledge, and improved surgical skills and patient validation when pessary is declined will likely improve satisfaction when obliterative surgery is chosen.
Assuntos
Tomada de Decisões , Emoções , Procedimentos Cirúrgicos em Ginecologia/psicologia , Satisfação do Paciente , Prolapso de Órgão Pélvico/psicologia , Vagina/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Prolapso de Órgão Pélvico/cirurgia , Período Pós-Operatório , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to determine if sacral colpopexy has an impact on in vivo vaginal biomechanical properties. STUDY DESIGN: Thirty-five participants who underwent sacral colpopexy were enrolled in this prospective clinical trial. In vivo vaginal biomechanical properties, including elasticity, viscoelasticity, and vaginal stiffness index, as well as symptom severity questionnaires (pelvic floor distress inventory-short form) and Pelvic Organ Prolapse Quantification (POP-Q) examination, were performed preoperatively and 6 weeks postoperatively. RESULTS: Thirty-two participants completed the study. Six weeks after sacral colpopexy participants demonstrated a decrease in prolapse related symptoms (POPDI-6 score, 39.8 vs 9.0, P < .00001) and 97% demonstrated anatomical cure of their prolapse. At 6 weeks follow-up participants demonstrated an increase in elasticity (2.26 vs 3.43, P < .00001), viscoelasticity (1.55 vs 4.08, P < .000001), and vaginal stiffness index (108.65 vs 164.50, P < .01). CONCLUSION: These findings suggest that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.
Assuntos
Fenômenos Biomecânicos , Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso Uterino/diagnóstico , Prolapso Uterino/cirurgia , Idoso , Colposcopia/métodos , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Probabilidade , Estudos Prospectivos , Qualidade de Vida , Medição de Risco , Região Sacrococcígea , Estatísticas não Paramétricas , Telas Cirúrgicas , Resultado do Tratamento , Vagina/fisiologia , Vagina/cirurgiaRESUMO
OBJECTIVE: The purpose of this study was to identify differences in urine proteins between patients with interstitial cystitis (IC) and asymptomatic control (AC) subjects with the use of proteomic techniques. STUDY DESIGN: Nine patients with IC and their age-, race-, and sex-matched AC subjects volunteered a urine specimen. Urine proteins were separated with the use of 2-dimensional polyacrylamide gels. Differing proteins underwent digestion and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Computer-assisted data analysis was used to identify the corresponding protein. Differences in urine protein responses between patients with IC and AC subjects were evaluated by the Mann-Whitney U test to account for the nonnormal frequency distribution of the parameter estimate or chi-square when data were bimodal. RESULTS: Four proteins differed significantly between patients with IC and AC subjects. The AC subjects had a greater concentration of a uromodulin (P = .019) and two kininogens (P = .023, .046). The patients with IC had a greater concentration of inter-alpha-trypsin inhibitor heavy chain H4 (P = .019). CONCLUSION: These urine protein isoforms may be biomarkers for IC.
Assuntos
Cistite Intersticial/diagnóstico , Proteínas/análise , Proteômica , Urina/química , Adolescente , Adulto , Idoso , alfa-Globulinas/urina , Biomarcadores/urina , Proteínas Sanguíneas/urina , Cistite Intersticial/urina , Diagnóstico Diferencial , Eletroforese em Gel de Poliacrilamida , Feminino , Glicoproteínas/urina , Humanos , Cininogênios/urina , Masculino , Pessoa de Meia-Idade , Mucoproteínas/urina , Isoformas de Proteínas , Proteínas Secretadas Inibidoras de Proteinases/urina , Qualidade de Vida , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , UromodulinaRESUMO
The objective of this study was to determine if vaginal stiffness index, an in vivo vaginal biomechanical property, is correlated with pelvic floor disorder symptom distress, impact on quality of life, or sexual function as measured by disease-specific quality-of-life scales. Forty-eight women completed validated quality-of-life scales (pelvic floor distress inventory-short form, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaire) and underwent in vivo vaginal biomechanical testing. After bivariate relationships between vaginal stiffness index and demographic, obstetric, and gynecologic variables were explored, multiple linear regression controlling for pelvic organ prolapse quantitative (POP-Q) stage of prolapse was performed. The vaginal stiffness index was inversely correlated with pelvic organ prolapse distress severity (POPDI-6) after controlling for POP-Q stage of prolapse (p = 0.011, r = 0.67, r (2) = 0.450, beta = -2.3). These findings provide initial evidence for the construct validity of in vivo vaginal biomechanical testing for pelvic organ prolapse evaluation because an increasing vaginal stiffness index is correlated with decreasing symptomatic and anatomic severity of disease.
Assuntos
Cistocele/diagnóstico , Qualidade de Vida , Índice de Gravidade de Doença , Prolapso Uterino/diagnóstico , Idoso , Fenômenos Biomecânicos , Estudos Transversais , Cistocele/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso Uterino/fisiopatologia , Vagina/fisiopatologiaRESUMO
AIMS: To assess the construct validity of the incontinence severity index (ISI) by testing its correlation with two health-related quality of life measures, the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7), in women with urodynamic stress incontinence. MATERIALS AND METHODS: A cohort of 170 women with the urodynamic stress incontinence who underwent corrective surgery completed the ISI, IIQ-7, and the UDI-6 both pre- and post-treatment. We correlated the pre- and post-treatment responses between the ISI, the IIQ-7, the UDI-6 and their subscales. We also assessed the sensitivity of the ISI to change by correlating the percent change in score between the three instruments. The results were analyzed using a non-parametric test of correlation, the Spearman's rho. RESULTS: The ISI scores were generally not well correlated with the pre-treatment IIQ-7 and UDI-6 scores (r < 0.40). The post-treatment scores and percent change from pre- to post-treatment of the ISI, however, were highly correlated with that of the IIQ-7 and UDI-6 (r's > 0.70, P < 0.001). The ISI was most highly correlated with the UDI-6 stress symptoms subscale and most poorly correlated with the UDI-6 obstructive/discomfort subscale. CONCLUSIONS: This study provides valuable insight into the construct validity of the ISI. Evidence of its convergent validity is found in the high correlation with the stress symptoms subscales of the UDI-6, while the poorer correlation with the obstructive subscale provides evidence of its divergent validity. These data also suggest that the ISI is highly sensitive to change seen with treatment.
Assuntos
Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/psicologia , Sintomas Afetivos , Idoso , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes , Incontinência Urinária por Estresse/cirurgiaRESUMO
OBJECTIVE: To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. METHODS: Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the chi(2) test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test. RESULTS: One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall). CONCLUSIONS: Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates. LEVEL OF EVIDENCE: I.
Assuntos
Colposcopia/métodos , Fascia Lata/transplante , Procedimentos Cirúrgicos em Ginecologia/métodos , Polipropilenos , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Adulto , Idoso , Análise de Variância , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Probabilidade , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler , Prolapso Uterino/diagnóstico por imagemRESUMO
OBJECTIVE: To estimate whether the mode of anesthesia (and the resultant ability or inability to perform the cough-stress test) used during the tension-free vaginal tape (TVT) procedure affects postoperative continence. METHODS: A cohort of 170 women who underwent the TVT procedure without any other concomitant surgery completed the short form of the Urogenital Distress Inventory (UDI-6) to assess their continence status preoperatively and postoperatively. Chi-squared, t, and Mann-Whitney U tests were used to determine the association between these data and anesthesia type during univariate analysis. RESULTS: Both anesthesia groups showed significant improvement from their preoperative UDI-6 scores to their postoperative scores. However, when comparing the change from pre- to postoperative UDI-Stress Symptoms subscale scores between the 2 groups, we found a significant difference. Mean improvement in the local group was 58.3 (+/- 33.8) compared with 41.7 (+/- 39.4) in the general group (P = .02). CONCLUSION: Women who undergo TVT show significant improvements in incontinence severity regardless of anesthesia type. However, greater improvements in stress incontinence, as measured by the UDI-Stress Symptoms subscale, are seen when the TVT is placed while using the cough-stress test under local analgesia. LEVEL OF EVIDENCE: II-2.
Assuntos
Tosse , Qualidade de Vida , Telas Cirúrgicas , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Idoso , Análise de Variância , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Cuidados Pós-Operatórios , Probabilidade , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento , Urodinâmica , Procedimentos Cirúrgicos Urológicos/instrumentação , Urologia/métodosRESUMO
OBJECTIVE: To compare the tensile strength of two approaches for uterosacral ligament suturing using a cadaver model. METHODS: In 12 unembalmed cadavers, four polytetrafluoroethylene sutures were placed through the uterosacral ligaments. In each cadaver, two sutures were placed laparoscopically, and two more were placed vaginally. A single, experienced surgeon placed all laparoscopic sutures (n = 23), and another experienced surgeon placed all vaginal sutures (n = 22). A blinded team of investigators measured the distance from each suture to the ipsilateral ischial spine; determined whether any sutures incorporated ureters, viscera, or large vessels; and then passed the sutures through an apical vaginal incision. Using a hand-held tensiometer, progressive tensile load was then applied to these sutures along the axis of the vagina until they either broke or were completely dislodged from the ligaments. RESULTS: The average peak tension required to break or dislodge the sutures was 26.2 +/- 8.8 psi (laparoscopic) and 22.5 +/- 7.4 psi (vaginal) (P =.14, 95% confidence interval [CI] -1.2, 8.6). The average force required for suture breakage (n = 28) was 28 +/- 7 psi, and the average force applied when ligament failure occurred (n = 17) was 18.5 +/- 6 psi (P <.001, 95% CI -13.8, -5.2). The average distance from a laparoscopic or vaginal suture to the ipsilateral ischial spine was 19.1 +/- 7 mm and 17.4 +/- 6 mm, respectively (P =.46, 95% CI -3.0, 6.4). None of the sutures from either technique were found to incorporate a visceral structure, ureter, or great vessel. CONCLUSION: These suturing techniques appear to be equal in tensile strength.
Assuntos
Ligamentos/cirurgia , Sacro/cirurgia , Técnicas de Sutura , Útero/cirurgia , Idoso , Cadáver , Feminino , Humanos , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Resistência à Tração , Vagina/cirurgiaRESUMO
OBJECTIVE: The aim was to determine the minimum meaningful study period required for prospective trials involving sacral colpopexy. STUDY DESIGN: This is a retrospective analysis of 245 patients who underwent sacral colpopexy. Postoperative pelvic organ prolapse quantitation was our objective end point. In an effort to control for selection bias, patients who returned for postoperative examinations were compared with those who did not for clinical and demographic information. A validated prolapse-specific quality of life instrument was used to determine the subjective end points. RESULTS: Objective failure (any postoperative POP-Q point > or = stage II) was found in 37 (15.1%) patients. Of these, 26 (70.3%) occurred within 6 months, and 30 (81.1%) occurred within 1 year. Another 5 objective failures were discovered between 1 and 2 years after surgery for a total of 94.6% of failures occurring within 2 years. There were no clinically significant differences between the groups of women with and without objective postoperative follow-up, indicating minimal selection bias. CONCLUSION: It is reasonable to construct randomized controlled trials involving sacral colpopexy that only include 1- or 2-year follow-up.