The impact of dispositional optimism on symptoms and treatment choices in patients with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: The objective of this study is to evaluate dispositional optimism, pelvic floor disorder symptoms, and treatment decisions. METHODS: Scores of the Life Orientation Test-Revised were used to categorize women seeking clinical treatment for pelvic floor disorders as pessimists (scores in lowest third) or optimists (scores in highest third). Participants also listed their treatment goals and quantified pelvic floor symptom severity by completing the Pelvic Floor Distress Inventory (PFDI-20). We compared symptoms, goals, and treatment choices between optimists and pessimists. RESULTS: Three hundred sixteen patients were included, 31% pessimists and 38% optimists. Pessimists reported more goals and different types of treatment goals. Pessimists were also more likely to elect surgical treatment over more conservative treatment methods, although this trend did not reach statistical significance. Among patients with prolapse (≥stage 2), PFDI-20 prolapse subscale scores were inversely correlated with level of optimism, with pessimists reporting a higher level of bother than optimists. CONCLUSIONS: In our study, pessimists reported more treatment goals, were more bothered by prolapse symptoms, and tended to be more likely to choose surgical treatments for their pelvic floor disorders than optimistic women.

AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome.

PURPOSE: To provide a clinical framework for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. MATERIALS AND METHODS: A systematic review of the literature using the MEDLINE® database (search dates 1/1/83-7/22/09) was conducted to identify peer reviewed publications relevant to the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Insufficient evidence-based data were retrieved regarding diagnosis and, therefore, this portion of the Guideline is based on Clinical Principles and Expert Opinion statements. The review yielded an evidence base of 86 treatment articles after application of inclusion/exclusion criteria. These publications were used to create the majority of the treatment portion of the Guideline. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). Additional treatment information is provided as Clinical Principles and Expert Opinion when insufficient evidence existed. See text and algorithm for definitions, and detailed diagnostic management, and treatment frameworks. RESULTS: The evidence-based guideline statements are provided for diagnosis and overall management of interstitial cystitis/bladder pain syndrome as well as for various treatments. The panel identified first through sixth line treatments as well as developed guideline statements on treatments that should not be offered. CONCLUSIONS: Interstitial cystitis/bladder pain syndrome is best identified and managed through use of a logical algorithm such as is presented in this Guideline. In the algorithm the panel identifies an overall management strategy for the interstitial cystitis/bladder pain syndrome patient. Diagnosis and treatment methodologies can be expected to change as the evidence base grows in the future.

Demographic and clinical predictors of treatment failure one year after midurethral sling surgery.

OBJECTIVE: To identify clinical and demographic factors predictive of midurethral sling failure. METHODS: Overall treatment failure was defined by one or more of the following objective outcomes: a positive stress test, positive 24-hour pad test or retreatment for stress urinary incontinence (SUI); subjective outcomes: self reported SUI by the Medical, Epidemiologic and Social Aspect of Aging questionnaire, incontinent episodes by 3-day diary, or retreatment for SUI, or a combination of these. Logistic regression models adjusting for sling type and clinical site were used to predict odds of overall treatment failure after univariable analysis. Models were also fit to compare factors associated with objective failure and subjective failure only. RESULTS: Previous UI surgery (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.14-3.47); maximum Q-tip excursion<30° (OR 1.89, 95% CI 1.16-3.05); Medical, Epidemiologic and Social Aspect of Aging questionnaire urge score per 10 points (OR 1.97, 95% CI 1.21-3.21); and pad weight per 10 g (OR 1.06, 95% CI 1.02-1.10) were predictors of overall failure. Having concomitant surgery (OR 0.44, 95% CI 0.22-0.90) was predictive of subjective failure only rather than objective failure. Age per 10 years (OR 1.48, 95% CI 1.14-1.90); Urogenital Distress Inventory score per 10 points (OR 1.09, 95% CI 1.02-1.17); pad weight per 10 g (OR 1.05, 95% CI 1.01-1.10) were predictive of objective failure compared with subjective failure only. Associations of risk factors and failure were similar independent of sling type (retropubic or transobturator). CONCLUSION: Twelve months after surgery, risk factors for overall and objective treatment failure were similar in women undergoing retropubic and transobturator sling procedures. This information may assist in counseling patients regarding efficacy of sling procedures and in setting expectations for women at increased odds for treatment failure. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00325039. LEVEL OF EVIDENCE: II.

Spousal support decreases the negative impact of pain on mental quality of life in women with interstitial cystitis/painful bladder syndrome.

OBJECTIVE: • To examine whether spousal responses to patient pain would alter the association between pain and patient health-related quality of life (HRQL), depression and disability. METHODS: • Ninety-six women with IC/PBlS (mean age = 50.6 (13.8); mean time since diagnosis = 6.2 years) completed questionnaires on demographics, depressive symptoms (Center for Epidemiological Studies-Depression Scale), disability (Pain Disability Index), HRQL (Medical Outcomes Study Short Form 12) and a measure of perceived spousal responses to their pain (Multidimensional Pain Inventory). • A repeated measures multivariate analysis of variance examined association changes between pain and adjustment variables at high, moderate and low levels of negative, solicitous and distracting spousal responses. RESULTS: • The association between pain and all outcome variables did not vary as a function of levels of solicitous and negative spousal responses. • However, the association between pain and mental HRQL was stronger at lower levels (ß=-1.25) of distracting responses than it was at moderate (ß=-0.66) and higher (ß=-0.06) levels. CONCLUSION: • Distracting spousal responses act to 'buffer' the deleterious effects of pain on mental HRQL for women suffering from IC/PBlS. Spousal support training may be a useful HRQL intervention.

Life impact of urologic pain syndromes.

In order to explore the personal experience of chronic urologic pain we asked patients to journal in their own words their daily symptoms and the effects of those symptoms on home/family life, working life and social life. Journal responses were independently reviewed by three researchers and major themes summarized following an inductive approach. Three major themes were identified concerning symptoms, personal and interpersonal effects of symptoms and related role limitations. Fatigue emerged as a newly recognized symptom that may benefit from treatment. Role limitations are mediated by potentially modifiable personal and interpersonal effects currently not addressed in urologic pain treatment paradigms.

Patients with painful bladder syndrome have altered response to thermal stimuli and catastrophic reaction to painful experiences.

AIMS: To compare cutaneous sensory thresholds, habituation to somatic stimuli, and tendency towards catastrophic reaction to painful stimuli in patients with Painful Bladder Syndrome (PBS) to controls without PBS. METHOD: Thermal and vibratory sensory thresholds were established in 11 PBS patients and 10 controls at C5, T1, T12, and S3 dermatomes. Supra-threshold thermal stimuli were then applied at T12 and S3 for 60 sec while patients periodically rated the intensity of stimuli using a visual analog scale. A Pain Catastrophizing Scale (PCS) questionnaire was also completed by all participants before testing. RESULTS: PBS patients were less sensitive to warm stimuli in the T12 dermatome than asymptomatic controls (thresholds 36.6 +/- 1.10 degrees C vs. 35.3 +/- 1.0 degrees C, P < 0.02) but otherwise had similar thermal and vibratory thresholds. Habituation to supra-threshold stimuli at T12 and S3 dermatomes was more common in controls than PBS subjects (7 (70%) vs. 2 (18%), P < 0.03 and 9 (90%) vs. 3 (27%), P < 0.008, respectively). The PCS score correlated with the duration of PBS symptoms and with thresholds to warm stimuli at T12 dermatome (rho = 0.65, P < 0.03 and rho = 0.5, P < 0.021, respectively). CONCLUSION: Our data suggests that habituation to stimuli may be impaired and that a catastrophic reaction to perceived stimuli may be involved in the sensory experience of PBS patients and facilitate chronic pain. Neurourol. Urodyn. 28:400-404, 2009. (c) 2009 Wiley-Liss, Inc.

Normal preoperative urodynamic testing does not predict voiding dysfunction after Burch colposuspension versus pubovaginal sling.

PURPOSE: Urodynamic studies have been proposed as a means of identifying patients at risk for voiding dysfunction after surgery for stress urinary incontinence. We determined if preoperative urodynamic findings predict postoperative voiding dysfunction after pubovaginal sling or Burch colposuspension. MATERIALS AND METHODS: Data were analyzed from preoperative, standardized urodynamic studies performed on participants in the Stress Incontinence Treatment Efficacy Trial, in which women with stress urinary incontinence were randomized to undergo pubovaginal sling surgery or Burch colposuspension. Voiding dysfunction was defined as use of any bladder catheter after 6 weeks, or reoperation for takedown of a pubovaginal sling or Burch colposuspension. Urodynamic study parameters examined were post-void residual urine, maximum flow during noninvasive flowmetry, maximum flow during pressure flow study, change in vesical pressure at maximum flow during pressure flow study, change in abdominal pressure at maximum flow during pressure flow study and change in detrusor pressure at maximum flow during pressure flow study. The study excluded women with a preoperative post-void residual urine volume of more than 150 ml or a maximum flow during noninvasive flowmetry of less than 12 ml per second unless advanced pelvic prolapse was also present. RESULTS: Of the 655 women in whom data were analyzed voiding dysfunction developed in 57 including 8 in the Burch colposuspension and 49 in the pubovaginal sling groups. There were 9 patients who could not be categorized and, thus, were excluded from the remainder of the analysis (646). A total of 38 women used a catheter beyond week 6, 3 had a surgical takedown and 16 had both. All 19 women who had surgical takedown were in the pubovaginal sling group. The statistical analysis of urodynamic predictors is based on subsets of the entire cohort, including 579 women with preoperative uroflowmetry, 378 with change in vesical pressure, and 377 with change in abdominal and detrusor pressure values. No preoperative urodynamic study findings were associated with an increased risk of voiding dysfunction in any group. Mean maximum flow during noninvasive flowmetry values were similar among women with voiding dysfunction compared to those without voiding dysfunction in the entire group (23.4 vs 25.7 ml per second, p = 0.16), in the Burch colposuspension group (25.8 vs 25.7 ml per second, p = 0.98) and in the pubovaginal sling group (23.1 vs 25.7 ml per second, p = 0.17). Voiding pressures and degree of abdominal straining were not associated with postoperative voiding dysfunction. CONCLUSIONS: In this carefully selected group preoperative urodynamic studies did not predict postoperative voiding dysfunction or the risk of surgical revision in the pubovaginal sling group. Our findings may be limited by the stringent exclusion criteria and studying a group believed to be at greater risk for voiding dysfunction could alter these findings. Additional analysis using subjective measures to define voiding dysfunction is warranted to further determine the ability of urodynamic studies to stratify the risk of postoperative voiding dysfunction, which appears to be limited in the current study.

Clinically useful measures in women with mixed urinary incontinence.

OBJECTIVE: The purposes of this study were to assess: 1) clinically relevant relationships between urinary diary and quality of life, and 2) reproducibility of validated questionnaires and urinary diaries in women with mixed urinary incontinence symptoms (MUI). STUDY DESIGN: Forty-seven women with MUI completed 7-day diaries, the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire, and Medical, Epidemiological, and Social Aspects of Aging questionnaire 2 weeks apart. RESULTS: The number of urge incontinence episodes predicted incontinence severity on UDI-6 (R(2) = .38, P < .03). Except for the number of stress incontinence episodes, diary variables and questionnaire responses were reproducible (range from Spearman's rho = .7 to rho = .96, P < .001). CONCLUSION: The 6 questions of the UDI-6 adequately represent incontinence severity. With the exception of the number of stress incontinence episodes recorded on the 7-day diary, common incontinence measures are reproducible over 2 weeks.

The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women.

OBJECTIVE: The purpose of this study was to corroborate the association between obstructive sleep apnea (OSA) and nocturia in a clinical sample of urogynecologic patients and to explore whether night-time urine concentration predicts the presence of OSA. STUDY DESIGN: Patients with nocturia and control subjects underwent a home sleep study, completed validated nocturia questionnaires, and provided evening and morning urine specimens that were analyzed for osmolarity. RESULTS: Twenty-one patients with nocturia (16 of whom also had daytime overactive bladder [OAB] symptoms) and 10 control subjects were studied. OSA was present in 17 of 21 women (81%) with nocturia: 13 women (81%) with OAB, 4 women (80%) with nocturia/no OAB, and 4 control subjects (40%; P < .001). The percentage of rapid eye movement sleep time was correlated inversely with nocturic frequency (rho = -.51; P < .004). The presence of diluted nighttime urine in a patient with nocturia was 88% sensitive for the presence of OSA. CONCLUSION: We should consider a diagnosis of OSA in all patients with nocturia, even those patients with daytime OAB.

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth.

OBJECTIVE: The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL). STUDY DESIGN: Seven hundred fifty-nine primiparous women in the Childbirth and Pelvic Symptoms study were interviewed 6 months postpartum. FI and UI were assessed with validated questionnaires. We measured QOL with SF-12 summary scores, health utility index score (a measure of self-rated overall health), and the modified Manchester Health Questionnaire. RESULTS: Women with FI had worse self-rated health utility index scores (85.1 +/- 9.8 vs 88.0 +/- 11.6, P = .02) and Medical Outcomes Study Short Form Health Survey (SF-12) mental summary scores (46.8 +/- 9.2 vs 51.1 +/- 8.7, P < .0001) than women without FI or flatal incontinence. Women with UI had worse SF-12 mental summary scores (48.3 +/- 9.8 vs 51.6 +/- 7.8, P < .01) and self-rated health utility index scores (84.1 +/- 12.5 vs 88.7 +/- 10.1, P < .01) than women without UI. Women with both FI and UI had the lowest SF-12 mental summary scores (44.5 +/- 9.0). CONCLUSION: Six months after delivery, women experiencing FI or UI reported negative effects on health-related QOL. FI and UI together have a greater impact than either condition alone.

Race and ethnicity do not contribute to differences in preoperative urinary incontinence severity or symptom bother in women who undergo stress incontinence surgery.

OBJECTIVE: The purpose of this study was to determine whether race/ethnicity affects urinary incontinence (UI) severity and bother in women who undergo surgery for stress incontinence. STUDY DESIGN: We used baseline data from participants in the Stress Incontinence Surgical Treatment Efficacy trial. UI severity was measured by the number of leakage episodes during a 3-day urinary diary and by urodynamic evaluation. UI bother was measured with the Urogenital Distress Inventory. Race/ethnicity classification was based on self-report. RESULTS: Of the 654 women, 72 women (11%) were Hispanic; 480 women (73%) were non-Hispanic white; 44 women (6.7%) were non-Hispanic black, and 58 women (8.9%) were of other race/ethnicity. No differences were seen in any UI severity measures. Non-Hispanic white women had the lowest Urogenital Distress Inventory scores on bivariate analysis, which was explained by socioeconomic status, body mass index, and age on multivariate analysis. CONCLUSION: Factors other than racial/ethnic differences underlie variations in UI symptoms and bother in this group of women who sought surgery for stress incontinence.

Lower urinary tract symptoms, quality of life and pelvic organ prolapse: irritative bladder and obstructive voiding symptoms in women planning to undergo abdominal sacrocolpopexy for advanced pelvic organ prolapse.

PURPOSE: We compared lower urinary tract and voiding symptoms in women with and without symptoms of stress urinary incontinence who were planning to undergo abdominal sacrocolpopexy for pelvic organ prolapse. MATERIALS AND METHODS: Subjects without stress urinary incontinence included 293 women in the Colpopexy and Urinary Reduction Efforts Trial. Subjects with stress urinary incontinence included 82 women who met trial inclusion criteria except for having stress urinary incontinence symptoms. We assessed symptoms and quality of life using validated measures. RESULTS: After adjusting for age, race and site subjects with stress urinary incontinence had higher irritative and obstructive symptom subscale scores and reported greater symptom bother, greater impact of colorectal and prolapse symptoms, and poorer physical and mental health. CONCLUSIONS: Women with prolapse and stress urinary incontinence had more lower urinary tract symptoms and reported more functional impact. This is contrary to our hypothesis that women with prolapse and stress urinary incontinence would have fewer irritative, obstructive and voiding symptoms because of the relief valve effect of the less resistant urethra.

Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study.

OBJECTIVE: To identify risk factors for postpartum FI and UI. METHODS: Secondary analysis of data from the CAPS study, which estimated the prevalence of postpartum FI and UI in primiparous women with clinically recognized anal sphincter tears after vaginal delivery, compared with women who delivered vaginally without recognized tears or by cesarean before labor. A total of 921 women were enrolled while in the hospital and 759 (82%) were interviewed by telephone 6 months postpartum. FI was assessed using the FISI and UI using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. FI risk factor analyses were conducted within each group, because of higher prevalence in the tear group. UI analyses were conducted with the groups combined. RESULTS: In women with sphincter tears, FI at 6 months was associated with white race (OR 6.1, 95% CI 1.3-29.4), antenatal UI (OR 2.2, CI 1.1-4.3), 4th versus 3rd degree tear (OR 2.0, CI 1.0-4.0), older age at delivery (OR 1.6 per 5 yr, CI 1.2-2.1), and higher body mass index (BMI) (OR 1.3 per 5 kg/m(2), CI 1.0-1.7). No factors were associated with FI in the vaginal or cesarean control groups. Across all groups, risk factors for postpartum UI were antenatal UI (OR 3.5, CI 2.4-5.2), less education (OR 2.0, CI 1.4-2.8), and higher BMI (OR 1.2 per 5 kg/m(2), CI 1.1-1.4); cesarean delivery was protective (OR 0.5, CI 0.3-0.9). CONCLUSIONS: Postpartum FI and UI are associated with few modifiable risk factors. However, the presence of antenatal UI and high BMI may help clinicians target at-risk women for early intervention.

Urethral and bladder current perception thresholds: normative data in women.

PURPOSE: Given increased evidence of sensory dysfunction in lower urinary tract pathology, we determined normative current perception threshold values in the lower urinary tract of asymptomatic women. MATERIALS AND METHODS: After receiving institutional review board approval women without lower urinary tract symptoms underwent current perception threshold testing of the urethra and bladder using a Neurometer constant current stimulator. Current perception threshold values were determined at 3 frequencies, including 2,000 Hz (corresponding to A-beta fibers), 250 Hz (corresponding to A-delta fibers) and 5 Hz (corresponding to C fibers). RESULTS: A total of 48 women with a mean age of 38 years (range 23 to 67) underwent current perception threshold testing. Normative values were established for the urethra and bladder at 2,000, 250 and 5 Hz. Median urethral current perception thresholds at 2,000, 250 and 5 Hz were 1.2 (IQR 0.76-1.5), 0.45 (IQR 0.33-0.56) and 0.11 mA (IQR 0.07-0.24), respectively. Median bladder current perception thresholds at 2,000, 250 and 5 Hz were 4.1 (IQR 2.0-6.3), 2.3 (IQR 0.87-5.5) and 1.4 mA (IQR 0.22-2.9), respectively. Urethral and bladder current perception thresholds increased significantly with subject age at all 3 frequencies (p<0.0005). Prior pelvic surgery was associated with an increased bladder current perception threshold at all 3 frequencies (p<0.005) but not with the urethral current perception threshold. CONCLUSIONS: We report urethral and bladder current perception thresholds for a large sample of asymptomatic women. These reference values may help elucidate changes in afferent nerve function in women with lower urinary tract dysfunction.

The volume at which women leak first on urodynamic testing is not associated with quality of life, measures of urethral integrity or surgical failure.

PURPOSE: We determined if the bladder volume at which urodynamic stress incontinence is first detected is related to preoperative quality of life, urethral sphincter assessment or surgical outcome in women undergoing continence surgery. MATERIALS AND METHODS: Charts of consecutive women who underwent a sling or Burch procedure were reviewed. Preoperative and postoperative assessment included the Incontinence Impact Questionnaire and Urogenital Distress Inventory. Urodynamic stress incontinence volume is the bladder volume at which urodynamic stress incontinence was first detected. Women were divided into 4 groups according to urodynamic stress incontinence volume, and compared with respect to maximum urethral closure pressure, Valsalva leak point pressure, Incontinence Impact Questionnaire and Urogenital Distress Inventory. Urodynamic stress incontinence persistence was evaluated only in patients who had sling surgery. RESULTS: A total of 168 women were recruited for the study. Urodynamic stress incontinence volume was 100 ml for 31% of women, 200 ml for 17%, 300 ml for 17% and 400 ml or greater for 35%. Baseline and postoperative Urogenital Distress Inventory, Incontinence Impact Questionnaire, maximal urethral closure pressure and Valsalva leak point pressure did not differ by urodynamic stress incontinence volume. Among the 116 patients who had the sling procedure, urodynamic stress incontinence persistence did not differ by urodynamic stress incontinence volume (p=0.72). CONCLUSIONS: Women who demonstrate urodynamic stress incontinence at lower bladder volumes do not report greater bother from incontinence than women who leak at higher volumes, suggesting leakage severity on urodynamics is not an adequate reflection of incontinence related quality of life.

Quality of life in women with stress urinary incontinence.

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity.

Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears.

OBJECTIVE: To estimate whether endoanal ultrasound findings are more prevalent in primiparous women with a history of anal sphincter tear than in women without this history and whether the findings are associated with fecal incontinence symptoms. METHODS: A total of 251 primiparous women at seven clinical sites underwent standardized ultrasound assessment of the internal and external anal sphincter 6-12 months after delivery. Participants were women in the three cohorts of the Childbirth and Pelvic Symptoms Study: 1) women with clinically evident third- or fourth-degree tear at vaginal delivery (n=106); 2) no tear at vaginal delivery (n=106); and 3) cesarean delivery without labor (n=39). Women completed the Fecal Incontinence Severity Index to assess fecal incontinence symptoms. RESULTS: Thirty-five percent of the sphincter tear group exhibited internal sphincter gaps compared with 3% of vaginal controls (odds ratio [OR] 18.4, 95% confidence interval [CI] 5.5-62.1) and 10% of cesarean controls. External sphincter gaps were identified in 51% of the tear group compared with 31% of vaginal controls (OR 2.3, 95% CI 1.3-4.0) and 28% of cesarean controls. In the tear group, fecal incontinence severity was greater in those with internal sphincter gaps compared with those with no internal sphincter gaps (Fecal Incontinence Severity Index score 6.6+/-8.3 compared with 3.3+/-6.1, P=.02), as well as in those with external sphincter gaps (6.1+/-8.4 compared with 2.7+/-5.0, P=.01), and greatest in those with both internal and external sphincter gaps compared with at least one gap not present (7.2+/-8.1 compared with 3.4+/-6.4, P=.003). CONCLUSION: Anal sphincter gaps detected by ultrasonography are prevalent in postpartum primiparous women with a history of sphincter tear and are associated with fecal incontinence severity. LEVEL OF EVIDENCE: II-2.

Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse.

OBJECTIVE: The purpose of this study was to determine the relationship between the most prolapsed portion of the anterior and posterior vaginal walls and the apex. STUDY DESIGN: After obtaining institutional review board approval, demographic data and pelvic organ prolapse quantification findings from consecutive new patients who were seen at our urogynecologic practice between January 2004 and February 2005 were reviewed. RESULTS: Three hundred twenty-five women were included in this cohort. The support of the vaginal apex (pelvic organ prolapse quantification point C) correlated strongly with the most prolapsed portion of the anterior vaginal wall, Ba (Spearman's rho = 0.835; P < .001) and correlated moderately with the most prolapsed portion of the posterior vaginal wall, Bp (Spearman's rho = 0.556; P < .001). A strong linear relationship was found between C and Ba, which is best modeled by the following regression equation: C = Ba(1.4) - 4.4 (r = .869). CONCLUSION: Anterior vaginal wall prolapse is associated strongly with apical prolapse. Anterior vaginal wall defects that are surgically repaired usually require a concomitant repair of the apex.