Emily K. Saks

Anatomic outcomes of vaginal mesh procedure (Prolift) compared with uterosacral ligament suspension and abdominal sacrocolpopexy for pelvic organ prolapse: a Fellows' Pelvic Research Network study

OBJECTIVE The objective of the study was to compare apical support anatomic outcomes following vaginal mesh procedure (VMP) (Prolift) to uterosacral ligament suspension (USLS) and abdominal sacrocolpopexy (ASC). STUDY DESIGN This multicenter, retrospective chart review compared apical anatomic success (stage 0 or 1 based on point C or D of the Pelvic Organ Prolapse Quantification), level of vaginal apex (point C or D) 3-6 months after prolapse repair at 10 US centers between 2004 and 2007. RESULTS VMP, USLS, and ASC were performed for 206, 231, and 305 subjects respectively. There was no difference in apical success after VMP (98.8%) compared with USLS (99.1%) or ASC (99.3%) (both P = 1.00) 3-6 months after surgery. The average elevation of the vaginal apex was lower after VMP (-6.9 cm) than USLS (-8.05 cm) and ASC (-8.5 cm) (both P < .001) CONCLUSION Patients undergoing VMP have similar apical success compared with USLS and ASC despite lower vaginal apex 3-6 month after surgery.

Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse

To determine whether the presence of obstructive defecatory symptoms is associated with the site and severity of pelvic organ prolapse. Methods: A cross‐sectional study was performed of women with pelvic organ prolapse of grade 2 or greater who had completed a validated questionnaire that surveyed pelvic floor symptoms. Associations between patient characteristics, site and severity of prolapse, and obstructive bowel symptoms were investigated.

Beliefs About Medications as a Predictor of Treatment Adherence in Women with Urinary Incontinence

OBJECTIVE To investigate the association between beliefs about medications and primary adherence in women prescribed anticholinergic medications for urgency urinary incontinence (UUI). METHODS We enrolled 160 women with UUI who were prescribed anticholinergic medications between 2009 and 2010. Validated questionnaires were administered to measure the diagnosis of UUI, its impact on quality of life, and beliefs about medications. Primary adherence, filling of a prescription within 30 days, was measured through pharmacy records. The association between healthcare beliefs and primary adherence was measured using multivariable analysis. RESULTS The incidence of primary adherence to anticholinergic medication was 73%. Of the women, 5% reported belief in the general harm of medicines, 31% reported belief in the general overuse of medicines, and 90% reported belief in the general benefit of medicines. Responses to the Beliefs about Medicines Questionnaire (BMQ) had good internal consistency in women with UUI (Cronbachs alpha 0.59-0.75). On univariable analysis, belief in the general overuse of medicines (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.23-0.99) and belief in the general harm of medicines (OR 0.11, 95% CI 0.02-0.57) were significant negative predictors of primary adherence to anticholinergic medications. A significant relationship between the impact of urinary symptoms on quality of life and primary adherence was not noted (OR 1.02, 95% CI 0.86-1.22). On multivariable analysis, belief in the general overuse of medicines remained a significant negative predictor of primary adherence (OR 0.35, 95% CI 0.16-0.79). CONCLUSIONS Women with UUI who believe that medicines in general are overused are less likely to fill their prescriptions for anticholinergic medications.

Pharmacologic Management of Urinary Incontinence, Voiding Dysfunction, and Overactive Bladder

Most drugs used in the treatment of urinary incontinence and voiding dysfunction in women modulate neuromuscular transmission in the urethra and bladder. Pharmacotherapy is the mainstay of treatment for overactive bladder. Although several different antimuscarinic medications are available for the treatment of overactive bladder, most have similar efficacy and tolerability. Pharmacotherapy has a limited role in the management of stress incontinence and voiding dysfunction in women. Newer drugs that target different mechanisms of action are being developed for the treatment of urinary incontinence and voiding dysfunction in women.

Self-Assessment of Fluid Intake Behavior in Women with Urinary Incontinence

OBJECTIVE To determine if women with urinary incontinence are able to recognize patterns of fluid intake associated with lower urinary tract symptoms. METHODS We performed a cross-sectional study of 256 consecutive women with urinary incontinence at an initial visit to a urogynecology practice. Data from the Questionnaire-Based Voiding Diary, a validated instrument that measures volume of fluid intake, fluid intake behavior, and lower urinary tract symptoms, were abstracted. Carbonated, caffeinated, and total fluid intake volumes were analyzed. Behaviors of excess consumption of caffeinated, carbonated, and total fluid intake as well as restriction of fluid intake were measured. Fluid intake volumes were divided into quartiles and correlated to fluid intake behavior and lower urinary tract symptoms. RESULTS Fluid intake behaviors of drinking excess carbonated and caffeinated beverages were significantly associated with the volume of carbonated (p<0.001) and caffeinated fluid intake (p<0.001). The behavior of drinking excess fluid was significantly associated with the total volume of fluid intake (p=0.019). A significant relationship between quartiles of total fluid intake and increasing number of daily voids (p<0.001) and quartiles of caffeinated fluid intake and increasing severity of urgency urinary incontinence (p=0.038) was noted. A direct statistical association between fluid intake behavior and lower urinary tract symptoms was not noted. CONCLUSIONS Women with urinary incontinence recognize their pattern of fluid intake and fluid intake behavior. The type and volume of fluid intake are significantly associated with symptoms of urinary frequency and urgency urinary incontinence.

Utility preference score measurement in women with fecal incontinence

OBJECTIVE The objective of the study was to evaluate the construct validity of 3 multiattribute health status classification system instruments, and a visual analog scale (VAS) for measuring utility scores for women with fecal incontinence (FI). STUDY DESIGN Utility scores were measured in 200 women with 1 or more of the following diagnoses: fecal or urinary incontinence or pelvic organ prolapse. Pelvic floor symptom severity was measured using the Pelvic Floor Distress Inventory (PFDI-20), and quality of life was assessed with the Pelvic Floor Impact Questionnaire (PFIQ-7). Construct and concurrent validity were evaluated. RESULTS After adjusting for age, comorbidities, urinary incontinence, and prolapse, utility scores were significantly lower for women with FI than women without FI for all health status instruments but not the VAS. All health status instruments had significant correlations with PFDI-20 and PFIQ-7 scores. CONCLUSION The health status instruments provide valid utility scores in women with FI and would be useful in clinical trials and cost-effectiveness research.

Is Pelvic Pain Associated with Defecatory Symptoms in Women with Pelvic Organ Prolapse

To investigate the significance of pelvic pain and its association with defecatory symptoms in women with pelvic organ prolapse (POP).

Increased Fluid Intake Is Associated With Bothersome Bowel Symptoms Among Women With Urinary Incontinence

Objectives To determine the association between the type and volume of fluid intake and bowel symptoms in women with urinary incontinence. We hypothesize that a lower volume of fluid intake would be associated with greater straining with bowel movements in women with urinary incontinence. Methods We performed a cross-sectional study of 256 women presenting with complaints of urinary incontinence from 2009 to 2010. Data on fluid intake, fluid intake behavior, urinary and bowel symptoms were collected using validated questionnaires. The relationship between quartiles of total daily fluid intake and bowel symptoms was analyzed. Results The behavior of restricting fluid intake was reported by 32% of the women. Increasing quartiles of total daily fluid intake was significantly associated with greater bother from straining with bowel movements (P = 0.04). Women with no bother from straining with bowel movements had significantly lower median daily fluid intake (2839 mL) than women with quite a bit of bother (3312 mL; P = 0.01). The association between the volume of fluid intake and straining with bowel movements persisted after controlling for age, body mass index, history of prolapse or incontinence surgery, and stage of prolapse (P < 0.05). There was no association between caffeinated fluid intake and any bowel symptom or between the behavior of restricting fluid intake and any bowel symptom. Conclusion In women with urinary incontinence, higher volume of total fluid intake is reported by women with greater straining with bowel movements. The behavior of fluid restriction is not associated with bothersome bowel symptoms.