Long-Term Mesh Exposure 5 Years Following Minimally Invasive Total Hysterectomy and Sacrocolpopexy

INTRODUCTION AND HYPOTHESIS

The objective was to assess long-term mesh complications following total hysterectomy and sacrocolpopexy.

METHODS

In this second extension study, women from a multicenter randomized trial were followed for more than 36 months after surgery. Owing to COVID-19, participants were assessed through either in-person visits or telephone questionnaires. The primary outcome was the incidence of permanent suture or mesh exposure. Secondary outcomes included surgical success and late adverse outcomes.

RESULTS

Out of the 200 initially enrolled participants, 82 women took part in this second extension study. Among them, 46 were in the permanent suture group, and 36 in the delayed absorbable group. The mean follow-up duration was 5.3 years, with the cumulative mesh or suture exposure of 9.9%, involving 18 cases, of which 4 were incident cases. Surgical success after more than 5 years stood at 95%, with few experiencing bothersome bulge symptoms or requiring retreatment. No serious adverse events occurred, including mesh erosion into the bladder or bowel. The most common adverse events were vaginal pain, bleeding, dyspareunia, and stress urinary incontinence, with no significant differences between suture types.

CONCLUSION

The study found that mesh exposure risk gradually increased over time, reaching nearly 10% after more than 5 years post-surgery, regardless of suture type. However, surgical success remained high, and no delayed serious adverse events were reported.

Urinary Incontinence in Primary Care-The Gap Between Recommendations and Real World

IMPORTANCE

Routine screening for urinary incontinence (UI) by primary care providers (PCPs) is recommended.

OBJECTIVES

We aimed to describe the rate of incident UI diagnosed at annual PCP visits, the prevalence of UI in a large primary care population, and estimate the rate of screening for UI during primary care preventive and annual wellness visits. Secondary aims were to describe PCP knowledge and behavior as they relate to UI screening and diagnosis.

STUDY DESIGN

The electronic health record was used to abstract the number of adult female patients seen by PCPs within a regional health system with a diagnosis of UI before our study period and with a new diagnosis over a 2-year period. Additional new diagnoses and screening practices were found on chart review of an additional 824 representative charts. Primary care providers within the health system were surveyed about their screening practices and knowledge about UI.

RESULTS

There were 192,053 women primary care patients seen over 2 years. A total of 5.7% had a UI diagnosis preceding the study period and 3.4% had a UI diagnosis during the study period. A total of 42% of PCPs reported that they screen for UI at least half the time and none were completely satisfied with their ability to screen for UI. Sixteen percent of annual wellness visits had any documentation of screening for UI.

CONCLUSION

In a large primary care population, screening for and detection of UI in women was low.

Relationships Between Urinary and Nonurinary Symptoms in Treatment-Seeking Women in LURN

IMPORTANCE

Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS).

OBJECTIVES

Understand the relationship between physical and psychological factors and LUTS over time.

STUDY DESIGN

Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models.

RESULTS

Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time.

CONCLUSIONS

Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women.

Preferences for Public Health Messaging Related to Bladder Health in Adolescent and Adult Women

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. This article reports an analysis of the "Public Health Messaging" code, which includes participants' views on what information is needed about bladder health, attributes of messaging, and preferred locations and delivery methods. Results: Forty-four focus groups were conducted with 360 participants (ages 11-93 years) organized into six age groups. Across age groups, participants wanted messaging on maintaining bladder health and preventing bladder problems. They offered suggestions for a wide variety of methods to deliver bladder health information. Ideas for delivery methods fell into three broad categories: (1) traditional in-person modes of delivery, which included individual communication with providers in clinical settings and group-based methods in schools and other community settings where adolescent and adult women naturally gather; (2) internet-based website and social media delivery methods; and (3) static (noninteractive) modes of delivery such as pamphlets. Participants recommended the development of multiple delivery methods to be tailored for specific audiences. Conclusions: These findings can inform development of broad ranging public health messaging tailored to audiences of all ages with a goal of engaging adolescent and adult women across the bladder health risk spectrum.

Need for Public Health Messaging Related to Bladder Health from Adolescence to Advanced Age

Objective: The purpose of this analysis was to explore adolescent and adult women's interest in public health messaging around bladder health and perceptions of its usefulness. Materials and Methods: Directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health across the life course. This article reports an analysis of the "Public Health Messaging" code, which included participants' desire or need for information about bladder health and recommendations for appropriate priority audiences. Results: Forty-four focus groups were conducted with 360 participants organized into six age groups (11-93 years). There was consensus across age groups that more information about the bladder is wanted and needed throughout the life course, as there is currently a lack of reliable educational resources. Information on bladder health was seen as useful and important because it enables people to anticipate negative changes in bladder health and act to prevent these. Several priority audiences were identified based on their risk of developing symptoms, but participants also saw value in educating the general public regardless of risk status. They also recommended education for parents and teachers who are in positions to control bathroom access. Conclusions: Results indicate a uniform desire for information on women's bladder health and a need for more research to develop individual prevention strategies and public health messaging for women of all ages, as well as guidance for organizations with a role in supporting bladder health.

Satisfaction with a rechargeable sacral neuromodulation system-A secondary analysis of the ARTISAN-SNM study

AIM

To describe factors associated with satisfaction with the Axonics sacral neuromodulation (SNM) System at 1 year.

METHODS

This was a secondary analysis of data collected in the ARTISAN-SNM study-a single arm, prospective, multicenter trial of the Axonics r-SNM System™. ARTISAN-SNM recruited participants with urgency urinary incontinence (UUI) to undergo a single, nonstaged implant of the lead and rechargeable neurostimulator. Participants were considered therapy responders if they had ≥50% reduction in UUI episodes in a 3-day period at 1-month post-implant. Bladder diaries and satisfaction (7-point Likert scale) were assessed at 1 year.

RESULTS

In all, 124 participants (110 "responders" and 14 "non-responders") had complete data at baseline, 1 month and 1 year following implant. Most participants were satisfied with Axonics at 1 year: 68.5% were "very satisfied," 25.8% were "moderately satisfied," and 2.4% were "slightly satisfied." At 1 year, treatment efficacy, as measured by electronic bladder diaries, was significantly associated with satisfaction. Participants who were "very satisfied" had a larger reduction in voids per day (p = .01), leaks per day (p = .004), urgent leaks per day (p = .04), and voids in which the urgency was desperate per day (p = .03) compared to those less satisfied. Twelve of the 14 "non-responders" continued to see improvements in symptom reduction from 1 month to 1 year; 9/14 (64%) were "responders" at 1 year with six reporting being "very satisfied" and one reporting being "moderately satisfied."

CONCLUSION

Satisfaction 1 year after implantation of Axonics SNM is extremely high and correlates with the degree of symptom improvement, which increases over time.

Enhancing behavioral treatment for women with pelvic floor disorders: Study protocol for a pilot randomized controlled trial

Approximately one in four American women report bothersome urinary symptoms (e.g., urgency, frequency), which greatly impact quality of life, including mental health. Bidirectional relationships have been found between urinary symptoms and anxiety, such that urinary symptoms worsen emotional distress (i.e., anxiety and depression), and in turn anxiety can exacerbate these symptoms. Current methods to treat urinary symptoms, such as physical therapy and medications, do not address their emotional impact. As such, our multidisciplinary team is conducting a randomized control trial (RCT) of cognitive-behavior therapy (CBT) using the Unified Protocol (UP) versus supportive therapy in the context of integrated behavioral treatment in the urogynecology context. Women with bothersome urinary symptoms and anxiety are recruited from the Northwestern Medicine Integrated Pelvic Health Program (IPHP) -a transdisciplinary clinic including urogynecologists, urologists, colorectal surgeons, nurses, and physical therapists- and Northwestern Medicine Urology. Participants are randomized to one of two interventions: UP or supportive therapy. All participants attend therapy once per week for 12 weeks. Assessments of urinary symptoms, anxiety, and other indicators of psychological and physical functioning are completed at baseline, mid-treatment, post-treatment, and at 3- and 6-month follow-ups using patient-reported outcomes. The study has been preregistered on clinicaltrails.gov (ID: NCT03623880) and is currently ongoing.

Longitudinal changes in symptom-based female and male LUTS clusters

AIMS

Lower urinary tract symptoms (LUTS) are diverse in type and variable in severity. We examined symptom change within the Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort study identified clusters over time and tested associations with treatments received.

METHODS

Patient-reported LUTS and treatment data were collected at multiple time points between baseline and 12 months from the LURN Observational Cohort study. LUTS severity scores were calculated to summarize changes in symptom reporting over time in previously identified LURN clusters. Repeated measures linear regression models tested adjusted associations between cluster membership and severity scores.

RESULTS

Four-hundred seventeen men and 396 women were classified into improved, unchanged, and worsened symptoms between baseline and 12 months (men: 44.1%, 40.5%, and 15.3%; women: 55.8%, 33.1%, 11.1%, respectively). Improvement in LUTS severity scores varied by cluster (estimated adjusted mean change from baseline range: -.04 change in standard deviations of severity scores (ΔSD) to -.67 ΔSD). Prostate surgery was associated with improved severity scores (-.63 ΔSD) in men, while stress incontinence surgery was associated with improved severity scores (-.88 ΔSD) in women.

CONCLUSION

Symptom improvement varied by cluster indicating response to therapy differs amongst subtypes of patients with LUTS. The differential improvement of patients in clusters suggests mechanistic differences between clusters and may aid in selecting more targeted treatments in the future.

Bowel function, sexual function, and symptoms of pelvic organ prolapse in women with and without urinary incontinence

AIMS

Bowel symptoms, pelvic organ prolapse, and sexual dysfunction are common, but their frequency among women with lower urinary tract symptoms (LUTS) has not been well described. Our aims were to describe pelvic floor symptoms among women with and without urinary incontinence (UI) and among subtypes of UI.

METHODS

Women with LUTS seeking care at six U.S. tertiary care centers enrolled in prospective cohort study were studied. At baseline, participants completed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), and PROMIS GI Diarrhea, Constipation, and Fecal Incontinence Scales.

RESULTS

Mean age among the 510 women was 56.4 ± 14.4 years. Women who reported UI (n = 420) had more diarrhea and constipation symptoms (mean scores 49.5 vs 46.2 [P = 0.01] and 51.9 vs 48.4 [P < 0.01], respectively) at baseline. Among sexually active women, mean PISQ-IR subscale scores were lower among those with UI (condition specific: 89.8 vs 96.7, P < 0.01; condition impact: 79.8 vs 92.5, P < 0.01). Women with mixed urinary incontinence (MUI) (n = 240) reported more prolapse symptoms, fecal incontinence, and worse sexual function compared to those with stress urinary incontinence (SUI) and urgency urinary incontinence (UUI).

CONCLUSIONS

Women presenting with LUTS with UI reported significantly worse constipation, diarrhea, fecal incontinence, and sexual function compared to women without UI. In women with UI, sexual function and pelvic organ prolapse (POP) symptoms were worse in those with MUI compared to SUI and UUI.

Reliability and validity of the Tigrigna version of the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7)

INTRODUCTION AND HYPOTHESIS

This study adapted the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) into the Tigrigna language of northern Ethiopia and validated the their reliability and validity through patient interviews.

METHODS

Expert translation, cognitive interviewing, and patient interviews using translated questionnaires were conducted. A subset of women was reinterviewed 1 week later. Intraclass correlation coefficients (ICC), Bland-Altman analysis, and Cronbach's alpha values were assessed. Total and subscale scores were compared between women with and without pelvic floor disorders (PFDs) using the Mann-Whitney U test. Spearman's correlation coefficients were used to compare severity of pelvic organ prolapse (POP) stage according to the POP Quantification (POP-Q) system and PFDI-20 and PFIQ-7 and subscale scores.

RESULTS

Ten women participated in cognitive interviewing and 118 age 49 ± 10 years, mean ± standard deviation (SD) with and without PFDs were interviewed using the translated questionnaires, both of which presented adequate face validity and test-retest reliability [intraclass correlation coefficient (ICC) 0.765-0.969, p < 0.001]. Construct validity was significant between clinical symptoms and full forms (p <0.001) and their subscales (p <0.001), except for the Pelvic Organ Prolapse Impact Questionnaire (POPIQ). Differences between first and second scores on total PFDI-20 and PFIQ-7 and subscales largely fell within 0 ± 1.96 SD. Cronbach's alpha values were 0.891-0.930 for PFDI-20 and 0.909-0.956 for PFIQ-7 (p < 0.001). Analysis of known groups showed differences PFDI-20 and PFIQ-7 scores between women with and without PFDs (p <0.001 for full forms and subscales, except for anal incontinence (AI) and the Urinary Impact Questionnaire (UIQ)/POPIQ.

CONCLUSION

The translated Tigrigna versions of the PFDI-20 and PFIQ-7 questionnaires are reliable, valid, and feasible tools to evaluate symptoms and quality of life (QoL) of Tigrigna-speaking Ethiopian women with PFDs.

Reasons for Seeking Clinical Care for Lower Urinary Tract Symptoms: A Mixed Methods Study

PURPOSE

The primary objective of this study was to evaluate reasons for seeking care among men and women with lower urinary tract symptoms.

MATERIALS AND METHODS

Participants were recruited from urology and urogynecology clinics, and the community. The sample was enriched with persons expected to have abnormal or diminished bladder sensations (eg participants with lower back surgery and participants 65 years old or older). Interviews were performed in person beginning with an open-ended assessment of urinary symptoms and associated bother followed by more directed questions, including reasons for seeking or not seeking treatment. We also examined the relationship between symptom frequency and bother using the LUTS (Lower Urinary Tract Symptoms) Tool.

RESULTS

A total of 88 participants, including 38 men and 50 women, with a mean ± SD age of 52.2 ± 14.3 years provided information about urinary symptoms, including a range of quality of life consequences and coping behaviors. They sought treatment mostly because of new, continuing or bothersome symptoms. Factors associated with not seeking treatment included low symptom severity and concerns about the costs vs the benefits of treatment (eg side effects of medication). Symptom frequency and bother were associated with each other across symptoms assessed by the LUTS Tool.

CONCLUSIONS

In this large qualitative study we obtained useful insights into the impact of lower urinary tract symptoms from the perspective of the person with the symptoms. Removing barriers and misconceptions about the treatment of lower urinary tract symptoms may increase the number of people who seek clinical care and improve the clinical course of men and women who experience lower urinary tract symptoms.

Patient recall 6 weeks after surgical consent for midurethral sling using mesh

INTRODUCTION AND HYPOTHESIS

We aimed to determine patient recall of specific surgical risks and benefits discussed during consent for midurethral sling (MUS) surgery immediately after consent and at 6 weeks follow-up. Specifically we sought to determine whether or not women recalled specific risks related to the placement of mesh.

METHODS

Surgeons consented patients for MUS in their usual fashion during audio recorded consent sessions. After consent and again at 6 weeks postoperatively, women completed a checklist of risks, benefits, alternatives, and general procedural items covered during consent. In addition, women completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Audio files were used to verify specific risks, benefits, alternatives, and procedural items discussed at consent. Recall of specific risks, benefits, and alternatives were correlated with DRS-PFD scores.

RESULTS

Sixty-three women completed checklists immediately post consent and at 6 weeks postoperatively. Six-week recall of benefits, alternatives, and description of the operation did not change. Surgical risk recall as measured by the patient checklist deteriorated from 92 % immediately post consent to 72 % at 6 weeks postoperatively (p < .001). Recall of the risk for mesh erosion declined from 91 to 64 % (p < .001). Recall that mesh was placed during the MUS procedure declined from 98 to 84 % (p = .01). DRS-PFD scores were correlated with poorer surgical risk recall and surgical complications (r = .31, p = .02).

CONCLUSIONS

Recall of MUS surgery risks deteriorated over time. Specifically, women forgot that mesh was placed or might erode. Further investigations into methods and measures of adequate consent that promote recall of long-term surgical risks are needed.

The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing non-surgical therapies for treatment of stress predominant urinary incontinence

AIMS

The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure.

METHODS

Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI and completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach's alpha) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was assessed with 3-month score outcomes and distribution-based measurements.

RESULTS

Four hundred forty-four women (mean age 50) were enrolled with stress (N = 200) and mixed (N = 244) UI; 344 had 3-month data. Baseline QUID Stress and Urge scores (both scaled 0-15, larger values indicating worse UI) were 8.4 +/- 3.2 and 4.5 +/- 3.3, respectively. Internal consistency of QUID Total, Stress, and Urge scores was 0.75, 0.64 and 0.87, respectively. QUID Stress scores correlated moderately with UDI-Stress scores (r = 0.68, P < 0.0001) and diary stress UI episodes (r = 0.41, P < 0.0001). QUID Urge scores correlated moderately with UDI-Irritative scores (r = 0.68, P < 0.0001) and diary urge UI episodes (r = 0.45, P < 0.0001). Three-month QUID Stress and Urge scores improved (4.1 +/- 3.4 and 2.2 +/- 2.7, both P < 0.0001). QUID Stress score effect size (1.3) and standardized response mean (1.2) suggested a large change after therapy.

CONCLUSION

The QUID has acceptable psychometric characteristics and may be used as a UI outcome measure in clinical trials.

Associated factors and the impact of fecal incontinence in women with urge urinary incontinence: from the Urinary Incontinence Treatment Network's Behavior Enhances Drug Reduction of Incontinence study

OBJECTIVE

The objective of the study was to determine the prevalence, risk factors, and impact on quality-of-life (QOL) that fecal incontinence (FI) symptoms have on women seeking treatment for urge urinary incontinence (UUI).

STUDY DESIGN

Baseline sociodemographic, history, physical examination, and validated questionnaire data were analyzed in 307 women enrolled in the Behavior Enhances Drug Reduction of Incontinence study for associations with FI. FI was defined as loss of liquid/solid stool occurring at least monthly. Multivariable logistic regression models compared women with FI and UUI with women with only UUI.

RESULTS

Prevalence of monthly FI was 18%, liquid stool (12%), and solid stool (6%). In multivariable analysis, FI was associated with vaginal delivery, posterior vaginal wall prolapse, higher body mass index, and UUI symptoms. QOL was worse in women with FI/UUI than isolated UUI.

CONCLUSION

Women seeking treatment for UUI have high rates of monthly FI with a negative impact on QOL.

Obesity and outcomes after sacrocolpopexy

OBJECTIVE

The purpose of this study was to compare outcomes after sacrocolpopexy (SC) between obese and healthy-weight women.

STUDY DESIGN

Baseline and postoperative data were analyzed from the Colpopexy And Urinary Reduction Efforts (CARE) randomized trial of SC with or without Burch colposuspension in stress continent women with stages II-IV prolapse. Outcomes and complications were compared between obese and healthy-weight women.

RESULTS

CARE participants included 74 obese (body mass index >/=30 kg/m(2)), 122 overweight (25-29.9 kg/m(2)), and 125 healthy-weight (18.5-24.9 kg/m(2)) women, and 1 underweight (< 18.5 kg/m(2)) woman. Compared to healthy-weight women, obese women were younger (59.0 +/- 9.9 vs 62.1 +/- 10.3 yrs; P = .04), more likely to have stage II prolapse (25.7% vs 11.2%; P = .01), and had longer operative times (189 +/- 52 vs 169 +/- 58 min; P = .02). Two years after surgery, stress incontinence, prolapse, symptom resolution, and satisfaction did not differ between the obese and healthy-weight groups.

CONCLUSION

Most outcomes and complication rates after SC are similar in obese and healthy-weight women.

Bowel symptoms in women 1 year after sacrocolpopexy

OBJECTIVE

The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy.

STUDY DESIGN

This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II-IV prolapse. In addition to sacrocolpopexy (+/- Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon's discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively.

RESULTS

The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups.

CONCLUSION

Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.

Bowel symptoms in women planning surgery for pelvic organ prolapse

OBJECTIVE

The objective of the study was to measure associations between bowel symptoms and prolapse.

STUDY DESIGN

Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed.

RESULTS

Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. Colorectal-Anal Distress Inventory obstructive subscale scores were higher in stage II women (median 29 [interquartile range 8,92] versus 17 [0,33] and 25 [0,38] for stages III and IV, respectively; adjusted P = .01). The few statistically significant correlations between symptoms and vaginal descent were negative and weak (less than 0.2).

CONCLUSION

Bowel symptoms and questionnaire scores do not increase with prolapse stage in women presenting for sacrocolpopexy.

Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery

OBJECTIVE

The purpose of this study was to assess factors that influence patient satisfaction 1 year after pelvic reconstructive surgery.

STUDY DESIGN

We previously reported the objective success, goals, and expectations of a cohort of 78 patients 3 months after surgery. A second blinded independent physician investigator contacted the same patients by phone to reassess these items 1 year after surgery. Data were analyzed with the Spearman correlation, the Mann-Whitney test, the chi-squared test of association, and the Friedman test.

RESULTS

Seventy patients (89%) of the original cohort completed the second assessment. Although group satisfaction and goal achievement were stable (P < .01), 70% of patients reported a change in their satisfaction ratings between 3 months and 1 year (rho = 0.3). Reduced satisfaction between 3 and 12 months after surgery was strongly associated with decreased goal achievement (rho = 0.47; P = .006). Fifty-six percent of patients reported urge incontinence symptoms after surgery (44% de novo and 12% persistent). Urge incontinence was the most common reason for patient dissatisfaction after surgery (P = .04).

CONCLUSION

Symptoms of urge incontinence and reduced achievement of subjective surgical goals are associated with decreased long-term patient satisfaction after reconstructive pelvic surgery.

Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life

OBJECTIVE

The purpose of this study was to estimate the prevalence and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65.

STUDY DESIGN

Consecutive women presenting for general gynecologic care were given a bowel function questionnaire. Women with AI were prompted to complete the Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL).

RESULTS

The cohort was composed of 457 women with a mean age of 39.9 +/- 11 years. AI prevalence was 28.4% (95% CI 24.4-32.8). After logistic regression, IBS (OR 3.22, 1.75-5.93), constipation (OR 2.11, 1.22-3.63), age (OR 1.05, 1.03-1.07), and BMI (OR 1.04, 1.01-1.08) remained significant risk factors. The mean FISI score was 20.4 +/- 12.4. Women with only flatal incontinence scored higher, and women with liquid loss scored lower on all 4 scales of the FIQL.

CONCLUSION

AI is prevalent in women seeking benign gynecologic care, and liquid stool incontinence has the greatest impact upon quality of life.

Localization of the urge to void in patients with painful bladder syndrome

AIMS

Our aim was to describe the location of urinary urgency or bladder discomfort in patients with painful bladder syndrome (PBS) and controls.

METHODS

Patients with symptomatic diagnoses of PBS, overactive bladder (OAB) syndrome, stress urinary incontinence (SUI), and asymptomatic controls were asked to indicate the location of their urinary urge/urgency/discomfort on a body map.

RESULTS

We present results for 30 PBS patients, 25 OAB patients, 15 SUI patients, and 15 asymptomatic controls. In asymptomatic subjects and those with SUI, the urge to void was localized to the suprapubic region only. More than half (53%) of patients with PBS and a minority (20%) of those with OAB localized their urinary urgency/discomfort to both suprapubic and vulvar/urethral locations. Some patients with PBS also localized their urinary discomfort to other body sites including low back, upper and lateral buttocks, lower abdomen, and upper thighs.

CONCLUSIONS

In most patients with PBS and some with OAB, complaints of bladder discomfort or urgency may refer to sensations that are localized at sites other than suprapubic. The etiology of widespread sensation may include an expansion of dermatomes of referral of bladder sensation, and/or the presence of associated somatic abnormalities.

Patient-selected goals: a new perspective on surgical outcome

OBJECTIVE

This study was undertaken to study the relationship between achievement of patient goals, overall satisfaction, and objective outcome measures.

STUDY DESIGN

After Institutional Review Board approval, we prospectively evaluated 78 women undergoing pelvic reconstructive surgery at Loyola University Medical Center. After informed consent for surgery, patients were asked to state their goals for surgery. In a follow-up telephone conversation, these goals were reviewed and negotiated to modify expectations. The same physician investigator contacted women 3 months after surgery to assess goal achievement, overall satisfaction, and their surgical experience. Date were analyzed with Spearman correlation and Mann-Whitney tests.

RESULTS

Of 78 women, 75% indicated that they met most of their goals, and 72% were more than 80% satisfied. Patient satisfaction was moderately correlated to goal achievement (rho=0.57, P<.001). Objective cure, defined as no urodynamic stress incontinence and stage 0 or I prolapse, was not related to satisfaction (P=.14). Dissatisfaction was highly associated with feeling "unprepared for surgery" (P<.001).

CONCLUSION

Objective and subjective outcomes are necessary to predict patient satisfaction.

Sliding hernia of the bladder presenting as suprapubic pain in a female

We report a case of bilateral sliding hernia of the bladder in a 64-year-old woman who presented with suprapubic pain and nocturia and was diagnosed by voiding diary and cystogram.

Uncomplicated erosion of polytetrafluoroethylene grafts into the rectum

Synthetic materials are frequently used in gynecologic surgical procedures to repair pelvic floor hernias and prolapse and to form barriers to adhesion formation. Mesh erosion into the vagina and lower urinary tract are known complications. We report 2 cases of polytetrafluoroethylene mesh erosion into the rectum.