Exploratory mixed methods study on care-seeking behaviors of Asian Americans with pelvic floor symptoms.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate whether younger age was associated with noncare-seeking behavior among Asian Americans with pelvic floor symptoms, and secondarily, to explore multilevel factors that may contribute to noncare-seeking behavior in this population. METHODS: We performed a concurrent mixed methods study and heterogeneously sampled Asian Americans with urinary incontinence, urgency-frequency, vaginal bulge, or anal incontinence. We stratified the participants into two groups, care seekers vs noncare seekers. Using Anderson's model as the main framework, we administered validated questionnaires and conducted semi-structured interviews to explore factors associated with care-seeking behaviors. RESULTS: Seventy-eight surveys and 20 interviews were completed and analyzed. Most participants reported urinary leakage (67%), followed by urinary urgency-frequency (50%), anal incontinence (18%), and vaginal bulge (17%). The mean age of the study cohort was 46.1 ± 16.2 years. We found noncare seekers to be younger and with an increased proportion of lifetime spent in the USA than care seekers. When controlling for age, proportion of lifetime spent in the USA, symptom severity, and individual-level resources, both younger age and increased proportion of lifetime spent in USA remained independently associated with noncare-seeking behavior. From qualitative data, we found that noncare seekers often experienced anti-Asian racism across workplace, neighborhoods, and health care settings. Additionally, noncare seekers also reported symptom minimization and decreased self-efficacy when coping with their pelvic floor symptoms. CONCLUSIONS: We found that one's age and proportion of lifetime spent in the USA may affect the extent of exposure to anti-Asian racism that is associated with symptom minimization, increased perceived barrier, and noncare-seeking behavior.

Measurement of transurethral bladder neck displacement during tension-free vaginal tape procedure.

INTRODUCTION AND HYPOTHESIS: The rigid catheter guide is used during the tension-free vaginal tape (TVT) procedure to direct the bladder neck away from the retropubic passage of the sling arm. Our aim was to measure, using transperineal ultrasound, the amount of bladder neck displacement by the rigid catheter guide during TVT placement. METHODS: This is a prospective cohort of 28 patients undergoing the TVT procedure, with or without concomitant pelvic organ prolapse repair. Spearman's correlation was used to analyze the bladder neck displacement from the midline. RESULTS: The median right-sided bladder neck displacement distance was 1.4 cm (0.6-2.0), and the median left-sided bladder neck displacement distance was 1.4 cm (0.8-2.0). The overall perforation rate was 14% (4/28). CONCLUSIONS: Bladder neck displacement with the Mandarin guide results in ~1.4 cm of lateral movement.

Obliterative procedures for pelvic organ prolapse.

Colpocleisis is an effective surgical treatment for pelvic organ prolapse in elderly women who do not wish to preserve the vagina for sexual intercourse. Colpocleisis provides good relief of pelvic floor symptoms without significant morbidity. The morbidity and mortality associated with the surgery is largely related to the health status of this elderly segment of the population. Stress incontinence can be addressed with a concomitant procedure such as a midurethral synthetic sling. Overall patient satisfaction with this obliterative procedure is greater than 90%. As the population ages, this procedure stands to become an increasingly popular treatment option.

Anatomic outcomes of vaginal mesh procedure (Prolift) compared with uterosacral ligament suspension and abdominal sacrocolpopexy for pelvic organ prolapse: a Fellows' Pelvic Research Network study.

OBJECTIVE: The objective of the study was to compare apical support anatomic outcomes following vaginal mesh procedure (VMP) (Prolift) to uterosacral ligament suspension (USLS) and abdominal sacrocolpopexy (ASC). STUDY DESIGN: This multicenter, retrospective chart review compared apical anatomic success (stage 0 or 1 based on point C or D of the Pelvic Organ Prolapse Quantification), level of vaginal apex (point C or D) 3-6 months after prolapse repair at 10 US centers between 2004 and 2007. RESULTS: VMP, USLS, and ASC were performed for 206, 231, and 305 subjects respectively. There was no difference in apical success after VMP (98.8%) compared with USLS (99.1%) or ASC (99.3%) (both P = 1.00) 3-6 months after surgery. The average elevation of the vaginal apex was lower after VMP (-6.9 cm) than USLS (-8.05 cm) and ASC (-8.5 cm) (both P < .001) CONCLUSION: Patients undergoing VMP have similar apical success compared with USLS and ASC despite lower vaginal apex 3-6 month after surgery.

Observations relating to urinary sensation during detrusor overactivity.

AIMS: To describe the temporal relationship between increases in lower urinary tract (LUT) sensation and changes in detrusor and/or urethral pressures measured in real time. METHODS: We reviewed 33 multichannel urodynamic tracings that included a continuous recording of LUT sensation and that demonstrated detrusor overactivity incontinence (DOI) or detrusor overactivity (DO). Four physicians reviewed each urodynamic tracing and reached agreement about the temporal relationship between LUT sensation and detrusor contraction. RESULTS: Median age was 60 (36-82) years. Fourteen (42%) had urodynamic diagnoses of mixed incontinence, 18 (55%) had DOI, and 1 (3%) had DO without DOI. We reviewed 119 episodes of detrusor overactivity from the 33 recordings. We found no difference in change in sensation level when comparing DO episodes with DOI episodes or between different urodynamic diagnoses (P > 0.5). There was no dominant temporal pattern seen for the whole group (P = 0.84), that is, there was no evidence that the change in sensation level was more likely to occur before, during, or after DO/DOI episodes. When evaluating the changes in the urethral pressure, the most common pattern seen was an increase in sensation level after a fall in urethral pressure, but no dominant pattern was seen. CONCLUSIONS: Our findings suggest that increased LUT sensation during DO/DOI is not reliably caused by measurable alterations in bladder or urethral pressure.

Urinary retention is uncommon after colpocleisis with concomitant mid-urethral sling.

The purpose of this study was to evaluate the effect of colpocleisis and concomitant mid-urethral sling on voiding function. This is an IRB-approved, retrospective case series of women who underwent a colpocleisis with concomitant synthetic mid-urethral sling for treatment of stress urinary incontinence (SUI) between January 2005 and September 2007. Thirty-eight women with pelvic organ prolapse and SUI symptoms were included. Thirty percent had a post-void residual (PVR) greater than 100 ml preoperatively. PVRs were normal in all but two women after surgery. Median prolapse and urinary subscales of the pelvic floor distress inventory improved significantly after surgery [75 (50-100) vs. 0 (0-38), p < 0.0001 and 44 (8-100) vs. 0 (0-50), p < .0001, respectively]. Colpocleisis with concomitant mid-urethral sling improves urinary symptoms without causing significant urinary retention. This combination may be offered to elderly women with SUI who are undergoing colpocleisis regardless of preoperative PVR.