Renee Bassaly

Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis

Introduction and hypothesisThe objectives of this study are to investigate myofascial pain in patients with interstitial cystitis (IC) and to correlate myofascial exam findings with validated questionnaires.MethodsA retrospective chart review was performed on 186 patients with a diagnosis of IC from April 2007 to December 2008. Demographics, history and physical examination, and validated pelvic floor dysfunction questionnaire scores were extracted. The data was evaluated with SPSS for Windows using Spearmans rho, Mann–Whitney, and Kruskal–Wallis statistical analyses.ResultsMyofascial pain was demonstrated in 78.3% of IC patients with at least one myofascial trigger point, and 67.9% of patients had numerous areas of trigger points. Mild correlations were seen with trigger points and scores from the PUF, PFDI-20, and PFIQ-7 questionnaires.ConclusionsMyofascial pain is prevalent among IC patients and positively correlated with pelvic floor dysfunction scores. These findings support evaluation of pelvic floor myofascial pain in IC patients and suggest a possible benefit from pelvic floor therapy.

Dietary consumption triggers in interstitial cystitis/bladder pain syndrome patients.

Objectives: The aim of this study was to survey interstitial cystitis/bladder pain syndrome (IC/BPS) patients with a Web-based questionnaire to determine which consumables (foods, drinks, supplements/spices, and general food categories) truly exacerbate IC/BPS symptoms. Methods: The Interstitial Cystitis Association posted a Web link on its Web site offering its members participation in the Web-based questionnaire from April 2009 to February 2010. Members were asked questions on the effect of 344 different foods, drinks, supplements, condiments/spices, and general food categories on urinary frequency, urgency, and/or pelvic pain symptoms. Members were asked to score symptoms related to consumables on a symptom Likert scale of 0 to 5. Questions on ethnicity, education, symptom duration, seasonal allergies, irritable bowel syndrome, and specific diets were included. Results: There were 598 complete responses to the questionnaire, and 95.8% of the participants answered that certain foods and beverages affected their IC/BPS symptoms. Most items had no effect on symptoms. Items that made symptoms worse were citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C. Only calcium glycerophosphate (Prelief; AK Pharma, Inc, Pleasantville, NJ) and sodium bicarbonate (baking soda) had a trend toward improvement in symptoms. Conclusions: Interstitial cystitis diets do not have to be overly restrictive. It is recommended that patients with IC/BPS avoid citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C. The use of calcium glycerophosphate and/or sodium bicarbonate before consumption of these trigger consumables may also help reduce sensitivity.

Cost analysis of open versus robotic-assisted sacrocolpopexy.

Objective This study aimed to report on the costs, operative times, and length of stay for robotic and open sacrocolpopexy. Study Design This retrospective study compares consecutive open and robotic sacrocolpopexies that were performed beyond the surgical learning curve. Hospital direct costs, operative times, and length of stay were compared for the 2 groups. Robot cost and maintenance were included. Statistical significance was considered at P < 0.05. Results The study comprised 91 open and 73 robotic sacrocolpopexies. Both groups were similar clinically. Median operative times for open and robotic approaches were 166 and 212 minutes (P < 0.001), respectively, and length of stay was 3 versus 2 days (P < 0.001). Of the women in the robotic group, 48% had length of stay less than 24 hours versus 1% in the open group. Median robotic and open procedure direct costs were

Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse

6668 and

Evaluation of patient preparedness for surgery: a randomized controlled trial

7804 (P = 0.002), respectively. Readmission rates at 30 days postoperatively were similar. Conclusions Robotic sacrocolpopexy costs less but takes slightly longer to perform than the open procedure.

Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain.

OBJECTIVE We describe a new parameter based on magnetic resonance 3-dimensional (3D) reconstructions proposed to evaluate levator ani muscle (LAM) laxity in women with pelvic organ prolapse (POP). STUDY DESIGN This is an institutional review board-approved, retrospective chart review of 35 women with POP, stages I-IV. The 3D Slicer software package was used to perform 2-dimensional and 3D measurements and the levator ani subtended volume (LASV) was described. Basically, the LASV represents the volume contained by LAM between 2 planes, which coincides with pubococcygeal line and H line. Correlations among measurements, ordinal POP stages, POP Quantification (POPQ) individual measurements, and validated questionnaires were performed. RESULTS The LASV differentiated major (III and IV) from minor (I and II) POPQ stages, which positively correlated to POP stages and POPQ individual measurements. CONCLUSION The LASV is a promising parameter to evaluate the LAM laxity.

Levator Ani Muscle Defects in Patients With Surgical Failure

BACKGROUND: Patient preparedness for pelvic reconstructive surgery has important implications for patient satisfaction and the perception of improvement after surgery. The ideal method in which to optimally prepare patients for surgery has not been determined. OBJECTIVE: The objective of the study was to evaluate the impact of a preoperative patient education video on patient preparedness prior to sacrocolpopexy as measured by a preoperative preparedness questionnaire. STUDY DESIGN: We performed a single‐blind, randomized, stratified clinical trial at a single academic center evaluating the use of a preoperative patient education video as an adjunct to preoperative counseling on patient preparedness. Eligible patients presenting for their preoperative appointment prior to undergoing pelvic reconstructive surgery were randomized to watch a preoperative video vs usual care. Preoperative questionnaires assessing patient preparedness, understanding, perception of time, and actual time spent with a health care team were administered at the end of this visit. The primary outcome was patient preparedness for pelvic reconstructive surgery as measured by a preoperative preparedness questionnaire. Secondary outcomes included actual time spent during the physician‐patient encounter, perception of time spent with the health care team, and identification of patient factors associated with patient preparedness. RESULTS: Of the total 100 recruited patients, 52 were randomized to the video group and 48 to the usual‐care group. The use of the video did not increase overall patient preparedness (71.1% with video vs 68.8% usual care, P = .79) prior to surgery. The use of the video did not decrease the amount of time spent during the physician‐patient encounter (16.9 ± 5.6 min vs 17.1 ± 5.4 min, P = .87). There was a significant association between patient preparedness and perception that the health care team spent sufficient time with the patient (89.5% vs 10.5%; P < .001), but no association was observed between preparedness and actual time spent (17.4 ± 5.4 min vs16.5 ± 5.5 min, P = .47). Those with a history of a previous surgery (82.1% vs 33.3%, P = .002) and those with more significant apical prolapse (0.6 ± 4.6 vs –1.6 ± 3.9, P = .05) were more likely to report feeling prepared for surgery. CONCLUSION: The majority of patients undergoing pelvic surgery at our institution felt prepared prior to undergoing surgery. The use of preoperative education video did not increase overall patient preparedness for surgery. Greater preparedness was associated with patient perception of how much time the health care team spent with the patient but not actual time spent.

Estimated levator ani subtended volume: a novel assay for predicting surgical failure after uterosacral ligament suspension

Purpose To report the effects of combined onabotulinumtoxinA (Botox) injections and myofascial release physical therapy on myofascial pelvic pain (MFPP) by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient self-reported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain. Materials and Methods This was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10) reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no. Results Fifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005), and fewer trigger points (44% vs. 100%, p<0.001). Fifty-eight percent of patients (95% confidence interval, 44–72) noted an improvement in self-reported pain. Patients most likely to report no improvement in pain had chronic bowel disorders, while those most likely to report an improvement in pain had a history of past incontinence sling (p=0.03). Posttreatment complications included: constipation (8%), worsening urinary retention (2%), and urinary tract infection (4%). Conclusions Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.

Technical preferences of surgeons performing a sacrocolpopexy procedure.

Introduction The objective of the study was to use a well-described system of measuring levator ani (LA) muscle defects from magnetic resonance images to evaluate whether major defects are correlated to an increased risk of surgical failure. Methods A retrospective cohort study performed on patients who underwent laparoscopic uterosacral ligament suspension from 2010 to 2012. Surgical failure was defined as a composite score of anatomic bulge beyond the hymen with sensation of bulge or repeat treatment of prolapse via pessary or surgery by 1-year follow-up. Levator ani muscle defects were graded by a score of 0 (no defect), 1 (<50% muscle bulk missing), 2 (>50% muscle bulk missing), or 3 (complete loss of muscle). Total score is the sum from both graded sides, with 0 classified as having no defect, 1 to 3 classified as having minor defects, and 4 to 6 classified as having major defects. Dichotomous values of LA major defects were compared against dichotomous values of surgical outcomes via a contingency table. Fisher exact test was then performed to correlate major defects to surgical success/failure. P value of less than 0.05 was considered statistically significant. Results Sixty-six women met the inclusion criteria. Thirteen (19.6%) patients met the criteria for surgical failure at 1 year. Of the 13, 54% (7) had a major defect, and 46% (6) had a minor or no defect (odds ratio, 1.31; 95% confidence interval, 0.39–4.41; P = 0.762). Conclusions We did not find a statistical correlation to surgical failure after a laparoscopic uterosacral ligament suspension with LA muscle defects on preoperative magnetic resonance images within this specific patient population.