Hema D. Brazell

Effect of a Decision Aid on Decision Making for the Treatment of Pelvic Organ Prolapse.

Objectives The aim of this study was to evaluate if the addition of a decision aid (DA) decreases decisional conflict in women presenting for the management and treatment of pelvic organ prolapse (POP). Methods Women scheduled for the evaluation and management of POP were randomized into either of 2 groups: standard counseling (SC) alone (n = 51) or SC plus a DA (n = 53). Upon completion of their initial visit, patients filled out a 16-item decisional conflict scale and short form general health survey. Values were assessed for normality and compared between groups. Normally distributed, continuous data were evaluated with a Student t test. A &khgr;2 test was used to compare selected categorical characteristics between groups. Differences in distributions of low and high decisional conflict were assessed with a Mann-Whitney U test. Results One hundred four women were randomized for this analysis. Baseline characteristics, including pelvic prolapse examination measurements, did not significantly differ between groups. The addition of a DA to SC did not significantly lower the level decisional conflict patients faced when deciding on a treatment plan (P = 0.566). There were no significant differences between groups in the following subscores: uncertainty, values clarity, support, effective decision, and informed. In addition, there were no between-group differences in choice of treatment plan (conservative management, pelvic floor physical therapy, pessary, and surgery; P = 0.835). Conclusions In this relatively small sample, the addition of a DA to SC for women with POP does not significantly decrease the level of decisional conflict in making treatment-related decisions.

The impact of pessary use on bowel symptoms: one-year outcomes.

Objectives The literature states that patients with pelvic organ prolapse have a higher prevalence of bothersome bowel symptoms and that surgical correction of prolapse may improve bowel function. There is limited knowledge regarding the impact of pessary use on bowel function in patients with prolapse. The aim of this study was to evaluate if there is a change in bowel symptoms in patients with prolapse treated with a vaginal pessary. Methods Women who presented for pessary insertion completed the validated questionnaires on the bowel symptom severity and on the effect of bowel symptoms on the quality of life at baseline and again at 12 months of continuous pessary use. Inferential statistics comprised Student t test for evaluating differences in continuous Gaussian data between groups and paired t tests were used to evaluate differences among subjects between the baseline and 12 months of use. Results One hundred four women participated in the original study, and 43 had complete data for analysis. Women who completed 12 months of pessary use reported significant improvements in both bowel-related symptoms and bowel-related quality of life (95% confidence interval of the difference 1.6–11.4 and 2.0–14.0, respectively). Patients who completed the 12-month follow-up were significantly older and more likely to have stage 3 or 4 prolapse than noncompleters, but there were no differences in body mass index, race, history of prior prolapse surgery, or menopause status. Conclusions In women with prolapse, the use of a pessary is associated with a decrease in complaints related to bowel symptoms.

Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse.

OBJECTIVE We sought to evaluate the prevalence of pelvic organ prolapse (POP) among a diverse group of women and to determine if race/ethnicity and/or socioeconomic status (SES) are factors in treatment-seeking behavior. STUDY DESIGN All data were collected from the National Institutes of Health-supported Boston Area Community Health Survey. SES was calculated by a 2-factor index that combined household income with years of education. Inferential statistics comprised 1-way analysis of variance, with a post hoc Scheffé test performed to evaluate whether there were differences between individual groups. A χ(2) test was used to evaluate whether distributions were equal among the various questions by race/ethnicity and SES category. RESULTS A total of 3205 women were included in the analysis. Hispanic ethnicity and younger age were associated with POP (P < .002 and P < .001, respectively) as well as with seeking treatment for prolapse (P = .007 and P < .001, respectively). These factors were also associated with subsequent surgical repair (P = .027 and P = .019, respectively). A regression model showed that women were 4.9% more likely to seek treatment for every year younger they were, across the range of age. Although women of a higher SES were more likely to have POP, SES was neither associated with a higher likelihood of seeking treatment nor with the surgical management of prolapse. CONCLUSION Hispanic ethnicity and younger age were associated with seeking treatment for POP. Hispanics were more likely than whites or blacks to proceed with surgical management. There was no correlation of SES with any of the above factors.

Do Patients With Pelvic Organ Prolapse Have an Increased Frequency of Asymptomatic Microscopic Hematuria

OBJECTIVE To determine the prevalence of asymptomatic microscopic hematuria (AMH) in patients with pelvic organ prolapse. METHODS The Urogynecology patient database was reviewed for patients presenting between July 2010 and April 2011 inclusive. We compared the prevalence of AMH in patients with no prolapse with those with prolapse. A post-hoc analysis was performed to evaluate if overall stage of prolapse was related to the presence of AMH. Pearson chi-square analysis was used for categorical variables, and P values<.05 were deemed statistically significant. RESULTS Of the 230 women with evaluable AMH data, 29 (12.6%) had AMH. Baseline patient demographic data did not significantly differ between groups. Women with prolapse had a higher prevalence of AMH compared with women with no prolapse (18.3% vs 5.1%, P=.003). There was a significant difference in the distribution of AMH by stage of prolapse, with AMH more prevalent among women with higher stages of prolapse (P=.007). CONCLUSION Women with prolapse beyond the hymen have a significantly higher prevalence of AMH when compared with women with prolapse at or above the hymen. We suggest an overall rate of AMH in the Urogynecologic population of 12.6%.