The prevalence of frailty and post-treatment outcomes in elderly women with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: Women seeking treatment for pelvic floor disorders (PFD) may have a high prevalence of frailty, which could potentially impact the risks of treatment. The present study was aimed to assess the prevalence of frailty in patients with PFD and additionally to compare post-treatment complications between frail and non-frail patients. METHODS: This is a prospective observational study conducted in a single secondary referral centre for PFD. Women with PFD and aged ≥ 65 years were eligible for inclusion. Frailty was classified using a validated screening tool, the Groningen Frailty Indicator (GFI). The primary outcome was to determine the prevalence of frailty in elderly women with symptoms of pelvic floor disorders. Secondary outcomes were clinical outcomes after treatment between frail and non-frail patients. RESULTS: A total of 263 women were included. The prevalence of frailty was 54.4% (143 women, 95% CI 48.1-60.5) in the studied group of patients. Frail patients had more comorbidities and used more medication compared to non-frail patients. Non-frail patients were more often surgically treated than frail patients. No differences were found in the incidence of postoperative complications. CONCLUSIONS: Our study shows a high prevalence of frailty in elderly women with symptoms of PFD. Further research is required to investigate whether these frail patients face an increased risk of complications and poor clinical outcomes after treatment for PFD.

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries.

INTRODUCTION AND HYPOTHESIS: Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate. METHODS: This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5 years post-OASIs. RESULTS: The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions. CONCLUSIONS: This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs.