1
|
Sarzo C, Nurmahomed N, Ralston C, Igbedioh C, Schizas A, Hainsworth A, Ferrari L. Racial Disparities in Pelvic Floor Disorders. Ann Surg 2024:00000658-990000000-00765. [PMID: 38293824 DOI: 10.1097/sla.0000000000006221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To investigate the impact of racial disparities and Socioeconomic Status (SES) on pelvic floor disorder (PFD) care. SUMMARY BACKGROUND DATA Racial disparities in colorectal PFD remain uninvestigated, despite prior research in urogynecology. METHODS This retrospective study was conducted at Guy's and St. Thomas' Hospital of London in 2023. Patients with colorectal PFD from 2013 to 2018 were evaluated. Patients were classified according to the Index of Multiple Deprivation (IMD) scores and divided into quintiles. The lowest quintile represents the most deprived, whereas the higher quintile represents the least deprived. Assessed variables: patient complaint, symptoms, consultant and biofeedback referrals, investigations, multidisciplinary meeting (MDM) discussions, treatment, and follow-up appointments. RESULTS 2001 patients were considered. A total of 1126 patients were initially analyzed, and 875 patients were excluded owing to incomplete data. Eight ethnic groups were identified in this study. Constipation was the most common compliant across ethnic groups (P=0,03). Diagnostics, MDM discussions, and conservative treatment did not vary between ethnicities. White British and Asian patients were significantly more likely to be seen by a consultant (P=0.001) and undergo surgery (P=0.002). In the second part of the study, the IMD was calculated for 1992 patients who were categorized into quintiles. Diagnostic tests, discussion in MDM, Consultant review, and surgical treatments were significantly lower in the two lowest quintiles (P<0.001, P<0.001, P=0.02, and P=0.02, respectively). Conservative treatment did not vary between the IMD groups. CONCLUSIONS Disparities in the diagnosis and treatment of colorectal PFD exist among ethnic minorities and patients of low SES. This study allows for the replication of service provision frameworks in other affected areas to minimize inequalities.
Collapse
Affiliation(s)
- Carlotta Sarzo
- Pelvic Floor, Guy's and St Thomas Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
2
|
Cuinas K, Ferrari L, Igbedioh C, Solanki D, Williams A, Schizas A, Hainsworth A. Pelvic floor investigations for anal incontinence: Are they useful to predict outcomes from conservative treatment? Neurourol Urodyn 2023. [PMID: 37010063 DOI: 10.1002/nau.25182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
AIMS There are several options for treating anal incontinence (AI), with limited success rate in long-term follow-up. Patients' selection is important to avoid unnecessary investigations and therapies. The aim of this review is to assess the utility of pelvic floor investigations to predict success from conservative treatment in AI. METHODS Baseline demographics, severity scores, and pelvic floor investigations of 490 patients with AI symptoms were retrospectively reviewed. Patient-reported outcomes were used to define success of conservative treatment. RESULTS Bivariate analysis showed that gender, St Mark's incontinence score, Bowel continence and quality of life domains of International Consultation on Incontinence Modular Questionnaire-Bowel symptoms score, Bristol stool chart, anal squeeze pressure, enterocoele, leak of contrast at rest, and dyssynergia in defecography were associated with patient's outcomes from conservative treatment (p < 0.05). Multivariate analysis showed that only the Bowel continence score was an independent predictor of patient's success with treatment. CONCLUSIONS Pelvic floor investigations are of limited value to predict success of conservative treatment and they should be reserved for patients who fail noninvasive management and might require surgical intervention.
Collapse
Affiliation(s)
- Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| |
Collapse
|
3
|
Hainsworth A, Solanki D, Ferrari L, Igbedioh C, Johnston L, Morris SJ, Igualada-Martinez P, Schizas AMP, Williams AB. The association between levator plate integrity and pelvic floor defaecatory dysfunction. Neurourol Urodyn 2023; 42:690-698. [PMID: 36692383 DOI: 10.1002/nau.25119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
AIMS Levator ani deficiency has been implicated in anterior pelvic floor pathology but its association with pelvic floor defaecatory dysfunction is less clear. The aim was to examine the relationship of levator ani deficiency with anatomical abnormalities (rectocoele, intussusception, enterocoele, perineal descent) and patient symptoms (bowel, vagina) in patients with pelvic floor defaecatory dysfunction. METHODS The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]). RESULTS The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency. CONCLUSIONS Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
Collapse
Affiliation(s)
- Alison Hainsworth
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Deepa Solanki
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Linda Ferrari
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carlene Igbedioh
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liam Johnston
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Samantha J Morris
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alexis M P Schizas
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew B Williams
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Ferrari L, Cuinas K, Igbedioh C, Hainsworth A, Solanki D, Williams A, Sahai A, Kelleher C, Schizas A. Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic. Neurourol Urodyn 2023; 42:168-176. [PMID: 36317396 DOI: 10.1002/nau.25063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
Collapse
Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Arun Sahai
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | | | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| |
Collapse
|
6
|
Hainsworth AJ, Solanki D, Morris SJ, Igbedioh C, Schizas AMP, Williams AB. Is there any association between symptoms and findings on imaging in pelvic floor defaecatory dysfunction? A prospective study. Colorectal Dis 2021; 23:237-245. [PMID: 33090672 DOI: 10.1111/codi.15396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022]
Abstract
AIM To compare features on imaging (integrated total pelvic floor ultrasound (transperineal, transvaginal) and defaecation proctography) with bowel, bladder and vaginal symptoms in pelvic floor defaecatory dysfunction. METHOD A prospective observational case series of 216 symptomatic women who underwent symptom severity scoring (bowel, bladder and vaginal), integrated total pelvic floor ultrasound and defaecation proctography. Anatomical (rectocele, intussusception, enterocele, cystocele) and functional (co-ordination, evacuation) features were examined. RESULTS Irrespective of imaging modality, patients with a rectocele had higher International Consultation on Incontinence Modular Questionnaire - Vaginal Symptoms (ICIQ-VS) scores than patients without. On integrated total pelvic floor ultrasound, ICIQ-VS quality of life scores were higher in those with a rectocele. There was a higher International Consultation on Incontinence Modular Questionnaire - Bowel Symptoms (ICIQ-BS) bowel pattern score in those with a rectocele, and a lower ICIQ-BS bowel pattern and sexual impact score in those with intussusception. Poor co-ordination was associated with increased ICIQ-BS bowel control scores and obstructed defaecation symptom scores. On defaecation proctography, ICIQ-VS symptom scores were lower in patients with poor co-ordination. CONCLUSION Patients with a rectocele on either imaging modality may have qualitative vaginal symptoms on assessment. In patients with bowel symptoms but no vaginal symptoms, it is not possible to predict which anatomical abnormalities will be present on imaging.
Collapse
Affiliation(s)
| | - Deepa Solanki
- The Pelvic Floor Unit, Guy's and St Thomas, Hospital, London, UK
| | | | - Carlene Igbedioh
- The Pelvic Floor Unit, Guy's and St Thomas, Hospital, London, UK
| | | | | |
Collapse
|
7
|
McGhee DJM, Royle PL, Counsell CE, Abbas A, Sethi P, Manku L, Narayan A, Clegg K, Bardai A, Brown SHM, Hafeez U, Abdelhafiz AH, McGovern A, Breckenridge A, Seenan P, Samani A, Das S, Khan S, Puffett AJ, Morgan J, Ross G, Cantlay A, Khan N, Bhalla A, Sweeting M, Nimmo CAMD, Fleet J, Igbedioh C, Harari D, Downey CL, Handforth C, Stothard C, Cracknell A, Barnes C, Shaw L, Bainbridge L, Crabtree L, Clark T, Root S, Aitken E, Haroon K, Sudlow M, Hanley K, Welsh S, Hill E, Falconer A, Miller H, Martin B, Tidy E, Pendlebury S, Thompson S, Burnett E, Taylor H, Lonan J, Adler B, McCallion J, Sykes E, Bancroft R, Tullo ES, Young TJ, Clift E, Flavin B, Roberts HC, Sayer AA, Belludi G, Aithal S, Verma A, Singh I, Barne M, Wilkinson I, Sakoane R, Singh N, Wilkinson I, Cottee M, Irani TS, Martinovic O, Abdulla AJJ, Irani TS, Abdulla AJJ, Riglin J, Husk J, Lowe D, Treml J, Vasilakis JN, Buttery A, Reid J, Healy P, Grant-Casey J, Pendry K, Richards J, Singh A, Jarrett D, Hewitt J, Slevin J, Barwell G, Youde J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Robinson D, O'Connell J, Topp JD, Topp JD, Warburton K, Simpson L, Bryce K, Suntharalingam S, Grosser K, D'Silva A, Southern L, Bielawski C, Cook L, Sutton GM, Flanagan L, Storr A, Charlton L, Kerr S, Robinson L, Shaw F, Finch LK, Weerasuriya N, Walker M, Sahota O, Logan P, Brown F, Rossiter F, Baxter M, Mucci E, Brown A, Jackson SHD, de Savary N, Hasan S, Jones H, Birrell J, Hockley J, Hensey N, Meiring R, Athavale N, Simms J, Brown S, West A, Diem P, Simms J, Brown S, West A, Diem P, Davies R, Kings R, Coleman H, Stevens D, Campbell C, Hope S, Morris A, Ong T, Harwood R, Dasgupta D, Mitchell S, Dimmock V, Collin F, Wood E, Green V, Hendrickse-Welsh N, Singh N, Cracknell A, Eccles J, Beezer J, Garside M, Baxter J. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|