Racial Differences in Pelvic Organ Prolapse Symptoms Among Women Undergoing Pelvic Reconstructive Surgery for Prolapse

Abstract

Objective The aim of this study was to determine if there is a difference in Pelvic Floor Disability Index Questionnaire (PFDI-20) scores between black and white women seeking surgical management for pelvic organ prolapse (POP). Methods A retrospective cohort study of 232 women who underwent pelvic reconstructive surgery with apical suspension for POP was performed. Demographic and clinical data were collected. All women completed the PFDI-20 and had a Pelvic Organ Prolapse Quantification examination at the initial consultation. Appropriate statistical tests were used to compare black and white women. Multivariable regression models adjusting for demographic and clinical variables were developed to determine the independent relationship between race and POP symptoms. Results In our cohort, 174 (75%) were white and 58 (25%) were black. Compared with white women, black women had higher parity, body mass index, Charlson Comorbidity Index score, and anterior POP stage. White women had higher total PFDI-20 scores corresponding to higher scores on all symptom subscales. After controlling for potential confounders, white race and prior anti-incontinence surgery remained associated with higher total PFDI scores. Higher Urogenital Distress Inventory 6 scores were significantly associated with white race, prior anti-incontinence procedures, and increasing body mass index, whereas higher CRADI-8 scores were associated with prior anti-incontinence surgery and higher POP stages. Conclusions White women appeared to have more overall symptom bother from prolapse, as well as urinary symptoms, as compared with black women, when assessed by validated questionnaire tools in a cohort of patients who underwent prolapse surgery. Further research is required to determine if racial differences in symptoms translate to differences in outcomes.

Existe relação entre etnia e a incidência de prolapsos genitais?

“…De acordo com Shek et al [17], mulheres AD possuem descenso de órgãos pélvicos significativamente maiores, inclusive a descida do colo da bexiga é maior, mesmo em repouso. Segundo Ford et al [20], essas diferenças etiológicas relacionadas a etnia, podem estar associadas à desigualdade socioeconômica, determinantes genéticos do POP e morfologia dos sistemas de suporte uretral. Quando se trata de lesões obstétricas, alguns dados indicam que o fator racial está diretamente ligado à ocorrência destas lesões [20].…”

“…Segundo Ford et al [20], essas diferenças etiológicas relacionadas a etnia, podem estar associadas à desigualdade socioeconômica, determinantes genéticos do POP e morfologia dos sistemas de suporte uretral. Quando se trata de lesões obstétricas, alguns dados indicam que o fator racial está diretamente ligado à ocorrência destas lesões [20]. Encontra-se também casos em que o POP surge por conta de fatores hereditários para parentescos de primeiro grau, envolvendo genes pertencentes à biossíntese de colágeno e elastina [23].…”

“…Neste contexto, estudos sugerem que mulheres AD apontam menor perfil de fibras do tipo I, que estão diretamente relacionadas à sustentação dos órgãos pélvicos, levando, assim, a uma probabilidade maior para o surgimento do POP [17]. Por outro lado, as CC apresentam mais sintomas urinários associados, que podem estar envolvidos na fraqueza muscular, pois apresentam uma menor quantidade de fibras do tipo II, envolvidas na habilidade dos músculos de responderem de forma rápida ao aumento da pressão intra-abdominal, visto que, nesta revisão, as mulheres CC apresentaram maiores escores totais de PFDI-20, escores mais altos do UDI-6 e em geral sintomas de POP associados aos sintomas urinários [20].…”

“…figura 1 representa o fluxograma de pesquisa relatado e, dentre os selecionados, tratava-se de 1 estudo de coorte retrospectivo[20], 1 estudo de coorte prospectivo[14],…”

Health Care Disparities Among Latina Patients Presenting With Pelvic Organ Prolapse

“…9,10 Others have suggested that non-Latina White patients were more likely to have more advanced prolapse at the time of presentation compared with individuals of other races, while another study determined that Black patients presented with higher stages of prolapse when compared with non-Latina White patients. 5,11 Because there are limited data on objective prolapse severity among Latina patients, we sought to determine whether self-identifying Latina patients across 2 diverse hospital sites present with higher objective degrees of pelvic organ prolapse-as measured by overall POP-Q scores and leading edge of prolapse-compared with their non-Latina counterparts at the time of evaluation in a subspecialist clinic. We also sought to identify other characteristics that may be associated with higher degrees of prolapse at the time of initial presentation to a urogynecology clinic.…”