Epidemiological trends and future care needs for pelvic floor disorders

Dieter, Alexis A.; Wilkins, Maggie F.; Wu, Jennifer M.

doi:10.1097/gco.0000000000000200

Cited by 165 publications

(135 citation statements)

References 40 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…In the present study, the groups with cesarean delivery had a higher body mass index, and the women in the ECD group were older than those in the vaginal delivery group. Older age and obesity are known risk factors for PFD and therefore these factors could have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

Colla

Paiva

Ferla

et al. 2018

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

Colla

Paiva

Ferla

et al. 2018

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…1 Even in the best hands, with the best available operations, one in five women has a surgical failure. 2–4 Improved understanding of the pelvic floor biomechanics and how failures in individual structures relate to operative failure has the potential to provide information that can help us improve treatment selections and operative strategies to provide better care to women with prolapse.…”

Section: Objectivesmentioning

confidence: 99%

Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse

Sammarco

Nandikanti

Kobernik

et al. 2017

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Background Pelvic organ prolapse has two components; 1) protrusion of the pelvic organs beyond the hymen and 2) descent of the levator ani. The Pelvic Organ Prolapse Quantification system measures the first component, however, there remains no standard measurement protocol for the second mechanism. Objectives Test the hypotheses that 1) difference in the protrusion area is greater than the area created by levator descent in prolapse patients compared with controls and, 2) Prolapse is more strongly associated with levator hiatus compared to urogenital hiatus. Study Design Mid-sagittal MRI scans from 30 controls, 30 anterior predominant and 30 posterior predominant prolapse patients were assessed. Levator area was defined as the area above the levator ani and below the sacrococcygeal inferior pubic point line. Protrusion area was defined as the protruding vaginal walls below the levator area. The levator hiatus and urogenital hiatus were measured. Bivariate analysis and multiple comparisons were performed. Bivariate logistic regression was performed to assess prolapse as a function of levator hiatus, urogenital hiatus, levator area, and protrusion. Pearson correlation coefficients were calculated. Results The levator area for the anterior (34.0±6.5cm2) and posterior (35.7±8.0cm2) prolapse groups were larger during Valsalva compared to controls (20.9±7.8cm2, p<.0001 for both); similarly, protrusion areas for the anterior (14.3±6.2cm2) and posterior (14.4±5.7cm2) were both larger than controls (5.0±1.8cm2, p<.0001 for both). The levator hiatus length for the anterior (7.2±1cm) and posterior (6.9±1cm) were longer during Valsalva compared to controls (5.2±1.5cm, p<.0001 for both); similarly, urogenital hiatus lengths for the anterior (5.7±1cm) and posterior (6.3±1.1cm) were both longer than controls (3.8±0.8cm, p<.0001 for both). The difference in levator area in prolapse patients compared with controls was greater than the difference in protrusion area (14.0 ± 7.2cm2 v. 9.4 ± 5.9cm2, p<.0002). The urogenital was more strongly associated with prolapse than the levator hiatus (OR: 12.9, 95% CI: (4.1–39.2), OR: 4.3, 95% CI: (2.3–7.5)). Levator hiatus and urogenital hiatus are both correlated with levator and protrusion areas, and all were associated with maximum prolapse size (p≤0.001, for all comparisons). Conclusions In prolapse, the levator area increases more than the protrusion area and both the urogenital hiatus and levator hiatus are larger. The odds of prolapse for an increase in the urogenital hiatus are three times larger than for the levator hiatus, which leads us to reject both the original hypotheses.

show abstract

“…1,2 Postoperative voiding dysfunction is common following these procedures. Historically, after open colposuspenion and bladder neck sling surgeries, suprapubic catheters or indwelling transurethral Foley catheters were routinely placed for several days to weeks until normal voiding function was ensured.…”

mentioning

confidence: 99%

Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery

Meekins

Siddiqui

Amundsen

et al. 2017

Southern Medical Journal

Self Cite

View full text Add to dashboard Cite

Objectives To evaluate the relation between voided volume and void trial “success” to create an algorithm that minimizes the need for postvoid residual volume (PVR) assessment in backfill-assisted void trials. Methods This article is an ancillary analysis of deidentified data from a randomized trial evaluating prophylactic antibiotics after urogynecologic surgery. Void trials were routinely performed after surgery; voided volumes, PVR, and void trial outcomes were collected. The void trial regimen was as follows: the bladder was backfilled with 300 mL of normal saline or until the patient reported the urgency to void, the catheter was removed, and the participant was prompted to void immediately. PVR volume was measured either by sonographic bladder scan or catheterization. Voided volumes were categorized in 25-mL increments from 50 to 225 mL. For each voided volume range, the PVR and void trial outcome data were incorporated to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in terms of ability of voided volume alone to predict a passing void trial result. An algorithm was created using the voided volumes that optimize PPV and NPV. Results The study population included 255 participants. Voided volumes <100 mL and ≥200 mL were identified as optimal thresholds to predict failure and passage of backfill-assisted void trials, respectively. When patients voided <100 mL, 3% passed their void trial (NPV odds ratio 96.7, 95% confidence interval 88.6–99.5). When patients voided ≥200 mL, 97% passed (PPV odds ratio 97.4, 95% confidence interval 93.5–99.3). Conclusions We propose an algorithm for void trials after urogynecologic surgery. After backfilling the bladder if voided volume is ≥200 mL, the void trial is successful and no PVR is needed; if voided volume is between 100 and 199 mL, the void trial is indeterminate and PVR is recommended; and if voided volume is <100 mL, the void trial is unsuccessful and catheterization is needed. Applying this algorithm to our study population would have eliminated the need for PVR in 85% of patients. Calculated PPVs and NPVs depend on the prevalence of voiding dysfunction in the population being studied, and therefore may be unique to our institution.

show abstract

Epidemiological trends and future care needs for pelvic floor disorders

Cited by 165 publications

References 40 publications

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse

Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery

Contact Info

Product

Resources

About