Rhiannon Bray

The pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability

OBJECTIVE The contribution of pelvic floor muscle tenderness to chronic pelvic pain (CPP) is well established in the literature. However pelvic floor muscle hyperalgesia (PFMH) is often missed during vaginal examination of women with CPP. To our knowledge criteria for diagnosing PFMH has not been established or validated so far. The aim of this study is to assess the validity and reliability of the PFMH scoring system. STUDY DESIGN Women with and without PFMH were recruited prospectively. Digital pelvic examination was performed to detect any pain. All women were asked to report of any discomfort or pain evoked by digital palpation of the PFMs and to rate the severity of pain/discomfort as none (grade 0), mild (grade I) moderate (grade II) or severe (grade III). All women were also asked to describe the severity of the pain/discomfort using a visual analogue scale (VAS). Following examination a PFMH score was given according to each patients reactions. Intra-observer and inter-observer reliability was assessed. Construct and content validity was also determined. RESULTS 111 (44 symptomatic and 67 controls) were recruited. Intraobserver reliability had ICCs between 0.426 and 0.804. Interobserver reliability had ICCs between 0.724 and 0.917. There was a good correlation between PFMH scores and VAS scores (rho 0.994, p<0.01). Total scores between symptomatic and controls were significantly different (p<0.01 Mann-Whitney U test). CONCLUSION The PFMH scoring system is a simple, reliable, valid and easy screening tool for in the assessment of women with CPP.

A randomised controlled trial comparing immediate versus delayed catheter removal following vaginal prolapse surgery

OBJECTIVE It is unclear if any catheterisation is necessary after vaginal surgery for pelvic organ prolapse. The aim of this study was to determine if indwelling catheterisation is necessary after these procedures. STUDY DESIGN A randomised controlled trial of immediate post-operative removal of catheter compared to a suprapubic catheter (SPC) after vaginal prolapse surgery. In the Suprapubic group the catheter was left on free drainage until a voiding trial was commenced at 48h. Women in the immediate removal group underwent in/out catheterisation only if they had not voided by 8h after surgery to ensure the bladder did not over-distend. RESULTS 55% (n=17) of patients in the immediate removal group did not require catheterisation postoperatively. A further 13 (42%) patients only required one in/out catheterisation 8h post operatively. In the immediate removal group duration of catheterisation was significantly shorter (median 0h, IQR 0-8h, range 0-16h) vs (6days (IQR 2-8days, range 2-19h) p=0.001). The duration of hospital stay (7days (range 3-16) vs. 9 (range 3-27) p=0.014), day of first mobilisation (Day 1, range 0-2, vs. Day 2, range 1-4, p=0.001), and rate of Symptomatic bacturia (16% vs. 52%, p<0.01) were all significantly better with immediate catheter removal. CONCLUSIONS After vaginal surgery for pelvic organ prolapse, the majority of patients do not require extended catheterisation. Early removal of a catheter reduces urinary tract infection and significantly decreases hospital stay. Such a policy should result in improved patient satisfaction and reduced hospital costs.

Prolapse Surgery and Outcome Measures

A number of outcome measures can be used when considering the surgical treatment of pelvic organ prolapse (POP).

Tolterodine ER reduced increased bladder wall thickness in women with overactive bladder. A randomized, placebo-controlled, double-blind, parallel group study

We evaluated the effect of Tolterodine extended release (TER) versus placebo on bladder wall thickness (BWT) using transvaginal ultrasound in women with overactive bladder (OAB).

Urinary metabolic phenotyping of women with lower urinary tract symptoms

Lower urinary tract symptoms (LUTS), including urinary incontinence, urgency and nocturia, affect approximately half of women worldwide. Current diagnostic methods for LUTS are invasive and costly, while available treatments are limited by side effects leading to poor patient compliance. In this study, we aimed to identify urine metabolic signatures associated with LUTS using proton nuclear magnetic resonance (1H NMR) spectroscopy. A total of 214 urine samples were collected from women attending tertiary urogynecology clinics (cases; n = 176) and healthy control women attending general gynecology clinics (n = 36). Despite high variation in the urine metabolome across the cohort, associations between urine metabolic profiles and BMI, parity, overactive bladder syndrome, frequency, straining, and bladder storage were identified using KODAMA (knowledge discovery by accuracy maximization). Four distinct urinary metabotypes were identified, one of which was associated with increased urinary frequency and low BMI. Urine from these patients was characterized by increased levels of isoleucine and decreased levels of hippurate. Our study suggests that metabolic profiling of urine samples from LUTS patients offers the potential to identify differences in underlying etiology, which may permit stratification of patient populations and the design of more personalized treatment strategies.

Urogynecology digest: Presented by Rhiannon Bray

Is percutaneous tibial nerve stimulation a safe and effective long-term treatment for overactive bladder in patients who originally benefited from a 12-week intervention? Kenneth M. Peters, Donna J. Carrico, Leslie S. Wooldridge, Christopher J. Miller, Scott A. MacDiarmid. Percutaneous Tibial Nerve Stimulation for the Long-Term Treatment of Overactive Bladder: 3-Year Results of the STEP Study. J Urol. 2013 Jun;189(6):2194–201.