Epidemiological trends and future care needs for pelvic floor disorders.

PURPOSE OF REVIEW: We sought to provide a review of the recent literature regarding the prevalence and epidemiological trends in pelvic floor disorders (PFDs) including pelvic organ prolapse (POP), urinary incontinence and fecal incontinence. We also examined the current trends in surgical treatment for these disorders and discuss future care needs. RECENT FINDINGS: Approximately, one quarter of all women suffer from at least one or more PFDs. Urinary incontinence represents the most common PFD with an estimated prevalence of 15-17%, whereas fecal incontinence affects, approximately, 9% of adult women. POP is more difficult to assess with prevalence estimates ranging from 3 to 8%. Surgery for PFDs is common as 20% of women undergo stress urinary incontinence or POP surgery over their lifetime. As the aging population grows, the number of women with PFDs will increase substantially and the demand for care for these disorders will continue to grow through the year 2050. SUMMARY: PFDs are a significant public health issue and they negatively impact the lives of millions of adult women. The projected increase in the number of women affected by PFDs over the next 40 years will create increased demand for providers properly trained in Female Pelvic Medicine and Reconstructive Surgery.

Short-term effects of dry needling at a spinal and peripheral site on functional outcome measures, strength, and proprioception among individuals with a lateral ankle sprain.

BACKGROUND: The purpose of the study was to compare the effects of spinal and peripheral dry needling with peripheral dry needling alone, in addition to a strength and proprioception home exercise program, on pain, balance, strength, proprioception, and functional limitations among individuals with a history of a lateral ankle sprain. METHODS: The study design is a single-blinded, repeated measures randomized clinical trial. Thirty-four participants, aged 18-50, with a history of a lateral ankle sprain within the last twelve months were randomly assigned into a peripheral dry needling (PDN) group or a spinal and peripheral dry needling (SPDN) group. Outcome measures included a pain assessment, strength testing, Modified Clinical Test of Sensory Integration and Balance, physical performance on hop tests, Cumberland Ankle Instability Tool and the Foot and Ankle Disability Index assessed at baseline, one week, and at four to six weeks. RESULTS: The mixed model ANOVAs showed significant side by time interaction (p < 0.05) for inverter/dorsiflexion strength and significant improvements in side, time, and side by time (p < 0.05) for the CAIT. CONCLUSION: Trigger point dry needling demonstrated short-term improvements in strength of the inverters/dorsiflexors and the CAIT scores on the involved side at one week and at four to six weeks irrespective of a PDN or SPDN approach. DISCUSSION: These results suggest that improvements in strength and function can be achieved with PDN without additional needling at the corresponding spinal level.

Transfusion Rates and the Utility of Type and Screen for Pelvic Organ Prolapse Surgery.

OBJECTIVES: Limited data exist directly comparing the likelihood of blood transfusion by route of apical pelvic organ prolapse (POP) surgery. In addition, limited evidence is available regarding the risk of not ordering preoperative type and screen (T&S) in apical POP surgery. The objectives of the study are to (1) provide baseline data regarding the current need for preoperative T&S by comparing perioperative blood transfusion rates between 3 routes of apical POP surgery and (2) determine the rate of a positive preoperative antibody screen in women who underwent apical POP surgery. METHODS: This was a retrospective cohort study of women who underwent apical POP surgery by 3 different routes: abdominal (abdominal sacrocolpopexy), robotic (robotic sacrocolpopexy), or vaginal (uterosacral or sacrospinous ligament fixation). RESULTS: Among 610 women who underwent apical POP surgeries between May 2005 and May 2016, 24 women (3.9%) received a perioperative blood transfusion. The rate of transfusion was higher in the abdominal group (11.1%) compared with robotic (0.5%, P < 0.001) and vaginal (0.5%, P < 0.001). In a logistic regression model, abdominal route of POP surgery remained significantly associated with transfusion (odds ratio, 20.7; 95% confidence interval, 2.7-156.6). Among the 572 women who had a preoperative T&S performed, 9 (1.5%) had a positive antibody screen. CONCLUSIONS: Blood transfusion was significantly more common in abdominal compared with robotic and vaginal apical POP surgeries. The rate of a positive antibody screen was low, suggesting that type O blood is low risk if cross-matched blood is not available. Thus, it may be reasonable to not order a preoperative T&S prior to robotic or vaginal apical POP surgery.

Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse.

Understanding and applying the epidemiology and lifetime risk of surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) is necessary to provide quality care to a growing and aging female population. Both SUI and POP are prevalent medical conditions, affecting 15-17% and 3-6% of women respectively. While generally not life-threatening, they represent a significant public health burden as they are associated with a decreased quality of life and significant economic impact. Although treatment is considered elective, for many women, the decision to address SUI or POP is necessary in order to regain a normal lifestyle and the lifetime risk for undergoing surgery to address either stress urinary incontinence or pelvic organ prolapse is 20.5%. This review includes a brief overview of the epidemiology of both disorders, followed by discussion of both landmark and recent literature regarding the lifetime risk of surgery for either disorder. Additionally, we will review re-operation rates, trends in management, and future care needs.