A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery
|
|
- Ezra Campbell
- 5 years ago
- Views:
Transcription
1 DOI: /j x Urogynaecology A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery S Srikrishna, D Robinson, L Cardozo Department of Urogynaecology, King s College Hospital, London UK Correspondence: Dr S Srikrishna, Department of Urogynaecology, King s College Hospital, Denmark Hill London SE5 9RS, UK. sushmasrikrishna@hotmail.com Accepted 15 July Objective To compare patient goal achievement in prolapse and continence surgery with objective/subjective outcomes; secondarily, to compare patient goal achievement with overall satisfaction and with that of the surgeon. Design Prospective longitudinal observational study, over 2 years. Setting Tertiary urogynaecology centre. Population Women with prolapse or stress incontinence due for surgery. Methods Patients and surgeons listed five goals that they hoped to achieve following surgery. Objective assessment was with Pelvic Organ Prolapse Quantification System (POP-Q) and videocystourethrography (VCU). Quality of life (QoL) was assessed with a Prolapse QoL questionnaire (PQoL), Kings Health questionnaire (KHQ) and Golombok Rust Inventory of Sexual Satisfaction (GRISS) and satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I). Main outcome measures Goal achievement was measured on a 100-mm visual analogue scale (VAS); objective cure of prolapse by POP-Q and of stress incontinence by VCU; QoL was assessed by KHQ, PQoL and GRISS; and satisfaction by PGI-I. Results Complete data were available for 112 women. POP-Q scores significantly improved (P < 0.05); objective cure of incontinence (from VCU) was 88.8%. All QoL questionnaires and PGI-I scores showed significant improvement (P < 0.01). Mean goal achievement was 85.1% for patients and 89.6% for surgeons. Patient goal achievement for prolapse surgery was observed sooner and correlated more with other measures of success than continence surgery. Continence-related goals based on symptom relief were achieved more than those based on body image and sexuality. Surgeons reported a high achievement rate in anatomical restoration and functional improvement goals. Conclusions Patient goal achievement correlates significantly with other measures of success as well as with overall satisfaction. Surgeons and women have varying expectations of the outcome of surgery. Nearly 90% of goals are still achieved 2 years following surgery. Keywords Global indices, goal attainment scaling, patient-centred goals, pelvic organ prolapse, quality of life, stress urinary incontinence. Please cite this paper as: Srikrishna S, Robinson D, Cardozo L. A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery. BJOG 2010;117: Introduction Urogenital prolapse and stress urinary incontinence, although not life threatening, remain important causes of morbidity in women. Their adverse effect on quality of life has been extensively documented. 1,2 Surgical intervention is one treatment option for these women and the lifetime risk of having surgery for pelvic floor dysfunction is 11%, with 29.2% requiring repeat surgery. 3 Traditionally, objective outcome measures have been considered to be more robust and consequently these have been employed in many studies. Despite this, there is no consensus of opinion regarding which method of outcome assessment should be considered more important, 4 although previous guidelines regarding outcome assessment have been published. 5,6 In addition, there is often a dichotomy of opinion when comparing clinician s evaluation with that of women; previous work has demonstrated that clini ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
2 Postoperative patient and surgeon goal achievement cians tend to underestimate the effects of pelvic floor dysfunction on women s lives 7,8 but be more optimistic when evaluating the outcome of pelvic floor surgery. 9 Until relatively recently there has been a paucity of data regarding women s expectations following treatment for urogenital prolapse or incontinence. Expectations regarding outcome are shaped by previous personal experiences, those of friends and relatives and also by the attitude and experience of the clinicians caring for these women. A woman s expectations for surgery may be particularly important when surgery is being performed simply to improve quality of life. 10,11 Consequently the concept of cure is relative. Achieving anatomical restoration of the urogenital tract or being symptomatically dry following continence surgery may not be regarded as a cure if new symptoms related to urinary, sexual and bowel dysfunction are experienced following surgery. As women s views have been recognised as increasingly important, an alternative way of examining women s expectations of treatment using patient-orientated goals 12 has evolved. There are few studies in the existing surgical literature focusing on women s expectations for surgery Although long-term follow-up studies have revealed that goal achievement is related to general quality of life (QoL) measures, 13 there are few data comparing these two measures of outcome and satisfaction. The aim of this study was to compare patient-centred outcomes in women undergoing continence and pelvic reconstructive surgery with objective outcome measures. The secondary aim was to compare overall satisfaction of women with achievement of these goals and with that of the operating surgeon. Methods This was part of an ongoing large prospective longitudinal observational study investigating long-term cure following pelvic floor surgery using both subjective and objective outcome assessment tools. Women complaining of symptomatic urogenital prolapse or stress urinary incontinence, who were on the waiting list for pelvic floor surgery were recruited from a tertiary referral urogynaecology centre, over a 2-year period. All patients fully understood the nature and purpose of the study and written informed consent was obtained before study entry. Ethical approval for this study was obtained from the Kings College Hospital Ethics committee. Inclusion criteria included women over the age of 18 years, on the list for planned urogenital prolapse repair with or without a concomitant continence procedure. The surgeries for prolapse included abdominal or vaginal hysterectomy and pelvic floor repair with or without vault suspension whereas those for incontinence included tension-free vaginal tape, tension-free vaginal tape-obturator (Gynecare Inc., Johnson and Johnson, Somerville, NJ, USA) and open modified Burch colposuspension. The operating surgeons involved were the two consultant urogynaecologists, the urogynaecology subspecialty trainee and the specialist registrars working with the urogynaecology unit. At their initial assessment in the urogynaecology outpatients clinic, all women had been extensively counselled with regard to their planned surgery. This included a full discussion of the purpose, risks, benefits, alternatives and complications of the planned surgery. Women were also given written information leaflets with general information about what to expect around the time of surgery, including plans for pain management, and expected bladder and bowel care. If a woman s expectations from surgery appeared unrealistic in the physician s opinion (such as cure of urgency/urge incontinence following continence surgery or cure of back ache/constipation post prolapse surgery), these were clarified and a further discussion regarding realistic expectations from surgery was documented. Women with urogenital prolapse were objectively assessed preoperatively by clinical examination using the Pelvic Organ Prolapse Quantification System (POP-Q). 14 All women underwent preoperative videocystourethrography (VCU) to detect the presence of urodynamic stress incontinence and rule out underlying detrusor overactivity or voiding dysfunction. The impact of urogenital prolapse and urinary incontinence on women s QoL was assessed using the Prolapse QoL questionnaire (PQoL) and Kings Health questionnaire (KHQ), respectively. These are reliable, validated diseasespecific questionnaires that assess the severity of symptoms of prolapse or of urinary incontinence, respectively, and also their impact on the QoL of affected women. The scoring system of these questionnaires has been previously reported. 2,15 All sexually active women also completed the female scale of the Golombok Rust Inventory of sexual satisfaction (GRISS), 16 which is a short 28-item questionnaire for assessing the existence and severity of sexual problems. All participating women were asked to list up to five personal goals they hoped to achieve following surgery. These goals were documented verbatim with no further attempt being made by the investigator at this stage to counsel women on whether or not these goals appeared unrealistic. This methodology is based on the technique of Goal Attainment Scaling (GAS), which is a measurement technique that was originally developed in the 1960s 17 as part of community mental health evaluation, and since then has had proven utility in assessing the treatment of complex conditions such as interstitial cystitis/painful bladder syndrome 18 and rehabilitation. 19,20 As GAS has the ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology 1505
3 Srikrishna et al. ability to assess change brought about by any intervention, it can be used as an outcome assessment tool following surgery for pelvic floor dysfunction. However, GAS has only recently been implemented in urogynaecology to evaluate treatment outcomes, This technique was also applied to evaluate surgeon s goals. All the operating surgeons were similarly asked to list up to five goals that they hoped to achieve by operating on each woman participating in the study. Women were reviewed at 6 weeks, 3 months, 6 months, 1 year and 2 years postoperatively. At each review, objective assessment of prolapse was carried out using the POP-Q system. Objective cure of incontinence was determined by repeat VCU at 6 months for all women undergoing continence surgery. Patient and surgeon goal achievement was measured on a Visual Analogue Scale (VAS). This is an instrument that measures a characteristic such as goal achievement, which is believed to range across a continuum of values. Goal achievement may be at any point on a spectrum that appears continuous from not at all achieved to completely achieved. In our study, we used a horizontal line, 100 mm in length, anchored by word descriptors at each end (Figure 1). The woman or the surgeon marked on the line the point that they felt represented their perception of individual goal fulfilment. The VAS score was determined by measuring in millimetres from the left hand end of the line to the point that the patient marked and converting this into a percentage. Each woman completed a VAS documenting the degree of goal fulfilment as well as The Patient Global Impression Not met at all Figure 1. Visual analogue scale. Met completely of Improvement questionnaire (PGI-I). This condition-specific global instrument has previously been validated for use in female patients with urinary incontinence 21 and more recently also for women with urogenital prolapse. 22 The operating surgeons also scored the extent to which their surgical goals had been met, using a VAS at every follow up visit. Patient goals were categorised as being related primarily to symptom relief, return to physical activity, social activities, sexual function and body image. Surgical goals were categorised as being related to anatomical correction, functional improvement, avoidance of new bladder/bowel symptoms, improvement of sexual function, long-term cure and improvement in QoL. Goals were also classified as unrealistic if it was deemed that they had no association with planned surgery (Table 1). Statistical analysis was performed with spss (V. 17, Chicago IL, USA). Paired t test was used for POP-Q measurement and Wilcoxon Signed Rank for PGI-I and QoL scores. Relationships between noncategorical variables were investigated with the Spearman rank correlation coefficient. Results In total, 201 women were recruited into the study. A strict per protocol analysis was followed whereby only those women who had attended every postoperative visit and completed all questionnaires were included. Patients who did not fulfil these stringent criteria were still followed up clinically but these data were not included in the analysis. Therefore, completed data sets were available for 112 (56%) women (mean age 64.2 years, range years). Seventy-nine patients underwent surgery for urogenital prolapse, 19 underwent continence surgery and 14 underwent combined surgery (see Table S1). Objective assessment using POP-Q showed a statistically significant Table 1. Goal categorisation of patient goals for prolapse surgery and continence surgery Category Goal examples Goals for prolapse surgery Physical activity Join a gym, exercise, exercise to lose weight, go for long walks, do the gardening, do the housework, return to professional occupation Go out with my friends/family, go dancing, go ten-pin bowling, travel with friends/family, visit social club Have normal sex again, have a tighter vagina, sex to feel comfortable again, improve sexual pleasure Get rid of bulge, discomfort, dragging sensation, not need to digitate to defaecate or void Social activity Sexual function Symptom relief Goals for continence surgery Physical activity Not leak during exercise/at the gym/during sport/while walking/sudden movements/gardening/running for the bus Social activity Not leak during holidays/travelling/cinema/theatre/dancing. Being able to wear white clothes, visit friends/family Body image Restore/improve self esteem/confidence. Feel womanly again/not feel like old smelly woman Sexual function Not leak/smell during sex, sex to feel comfortable again, improve sexual pleasure 1506 ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
4 Postoperative patient and surgeon goal achievement improvement at 6 weeks, which was maintained at the 2-year review (P < 0.05) (Figure 2). Objective cure of urodynamic stress incontinence on postoperative VCU at 6 months follow-up was 88.8%. All three QoL questionnaires showed an overall significant improvement from preoperative scores to the 2-year review (P < 0.01) (Figures 3 and 4). The PGI-I scores showed a significant improvement from the 6-week score (1.63) to the 2-year follow up (1.51). Women reported a total of 437 goals and surgeons a total of 508 goals. All women and surgeons expressed at least one goal, although surgeons were more likely to document multiple goals (see Table S2) The mean goal achievement for surgeons at 2 years was 89.6%. Surgeons reported a higher achievement rate in anatomical restoration and functional improvement; although lower rates were recorded for goals regarding QoL, sexual function, avoidance of new lower urinary tract symptoms and achieving a long-term cure (Table 2). The mean patient goal achievement at 2 years was 85.1%. Most women with prolapse achieved the majority of their goals by 12 weeks. Women who underwent continence surgery showed higher goal achievement for symptom relief but lower achievement in goals related to body image, confidence, restoration of sexual function and sexuality (Table 3). Goal achievement for prolapse surgery compared better with subjective and objective measures of success than continence surgery. There was significant inverse correlation between goal achievement at 2 years with ordinal scores on the POP-Q, QoL scores as well as women s overall satisfaction with their postoperative condition (Table 4). Goal achievement for continence surgery correlated significantly with KHQ scores and overall satisfaction on PGI-I but not with sexual function scores as measured on GRISS Preop 6 weeks 3 months 6 months 1 year 2 years Figure 3. Quality of Life scores. Discussion KHQ PQoL Our study examines the expectations that women and surgeons have from pelvic floor surgery and the degree to which those expectations are achieved. Previous work suggests that achievement of their own goals is the primary reason why women undergo pelvic floor reconstructive surgery. These goals are highly subjective and personally important to each woman, and despite preoperative counselling sometimes remain unrealistic. Surgeons tend to express more similar goals as a group compared with woman. Surgical goals are often based on objective measures and these are usually achieved to a greater extent. Patient-centred goals for women undergoing prolapse surgery were predominantly based on resolution of symptoms and resumption of physical activity, followed by improvement in sexual function and social activities. In addition, the actual physical presence of a bulge in the vagina was the most commonly cited reason for curtailment of activities as well as sexual dysfunction. This may explain why reduction of the prolapse and restoration of normal anatomy significantly correlated with QoL improve Preop 6 weeks 3 months 6 months 1 year 2 year GH PB TVL Aa Ba C D Bp Ap Ordinal stage Figure 2. Pelvic Organ Prolapse Quantification System scores. ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology 1507
5 Srikrishna et al Infrequency Anorgasmia Nonsexuality Vaginismus Preop 6 weeks Avoidance Noncommunication Dissatisfaction Total 3 months 6 months 1 year 2 years Figure 4. Golombok Rust Inventory of Sexual Satisfaction scores. Table 2. Percentage achievement of surgeon s goals at 2 years Surgeon s goals (Numbers expressed) 6 weeks 3 months 6 months 1 year 2 years Functional improvement in prolapse (89) Anatomical restoration (70) Functional improvement in incontinence (32) Improve QoL (67) Long-term cure (9) N/A Avoid new lower urinary tract symptom/bowel symptoms (124) Improve sexual function (26) Table 3. Percentage achievement of patient goals at 2 years Goals (Numbers expressed) 6 weeks 3 months 6 months 1 year 2 years Prolapse goals Physical activity (49) Social activity (21) Symptom relief: [bulge (56), discomfort (35), digitate to defaecate (19)] Sexual function (31) Incontinence goals Symptom relief: [Not need pads (21), not leak (13), not smell (10)] Physical activity (36) Social activity (29) Body image (27) Sexual function(14) Unrealistic goals Sleep at night (7) Relieve overactive bladder symptoms (18) Frequency/urgency etc Relieve backache (12) Relieve constipation (24) ment and goal achievement as early as the 3-month review. These findings are in agreement with other work that reports the significant association between long-term goal attainment with QoL scores. 13,23 However, women with incontinence rated symptom resolution, restoration of physical and social activity along with an improved body image higher than sexual function improvement. Although symptom-based goals were 1508 ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
6 Postoperative patient and surgeon goal achievement Table 4. Correlation of goal achievement POP-Q PQoL KHQ GRISS PGI-I Prolapse goals r = )0.33, P = 0.01 r = )0.61, P = 0.01 r = )0.47, P = 0.01 r = )0.33, P = 0.05 r = )0.71, P = 0.01 Incontinence goals Not applicable Not applicable r = )0.77, P = 0.05 r = )0.29, P = 0.09 r = )0.56, P = 0.05 achieved to a greater extent, achievement of goals based on body image, confidence and sexuality were much lower. In addition, some goals such as not needing pads were not achieved despite resolution of incontinence as a number of women continued to use pads just in case. Women who were incontinent appeared to take much longer to recover confidence in their body image, femininity and sexuality than those with prolapse. We hypothesise that this may be because of the profound negative impact of urinary incontinence on self-esteem, which in turn leads to longterm lack of confidence in their sexuality and body image. Previous work has shown that affected women may feel a sense of shame or humiliation that causes them to distance themselves from sexual relationships. 24 On the other hand, women undergoing surgery for urodynamic stress incontinence have also been shown to have high expectations regarding outcome, including resolution of urgency and frequency. 25 This combination of factors may explain lower goal achievement in this cohort. Unrealistic expectations and goals related to these play an important role in overall postoperative satisfaction of women. The preoperative counselling visit is essential to identify and clarify a woman s expectations. However, women s expectations of goal achievement are so strong that even extensive counselling does not always eliminate unrealistic hopes. Our findings support previous studies that have shown that women hear primarily what interests them. Selective attention and interpretation may explain why women remain dissatisfied despite objective evidence of cure, often stating that no one ever told them and that they were not well prepared for surgery. 10 This once again highlights the importance of clear information leaflets 26 written avoiding medical jargon to reiterate what can and cannot be realistically expected from surgery. Disappointment at not achieving a specific goal, however unrealistic, may overshadow objective cure of stress incontinence and prolapse and therefore does not predict satisfaction. Keeping in mind that patient satisfaction with treatment is directly related to fulfilment of positive expectations, every attempt should be made to keep these expectations realistic and agreed on by patient and physician. To the best of our knowledge, this is the first study to analyse surgeon s goals and the extent to which these are attained. This has provided an overview into the reasoning behind a surgeon s choice of operative intervention and an insight into our motivation for carrying these out. It is reassuring that most surgeons seemed to pay as much importance into improving functional outcomes as they did to anatomic restoration. Improvement of women s QoL, avoidance of surgical complications and durability of cure were also commonly cited as goals, which once again demonstrate a deeper understanding of issues that are ultimately important to the women. Finally, although surgeon s goal achievement continued to be higher than that of women at 2 years, this was only a small difference which suggests that, contrary to popular belief, surgeons may now have a more realistic understanding of not only important goals from a woman s point of view but also of the level of their achievement in addition to their own abilities. Strengths of our study include the prospective design and excellent follow-up rates even at extended follow up of 2 years. Despite following a strict per protocol analysis, whereby only those women who had attended every postoperative visit and completed all questionnaires were included, there was still a 56% follow-up rate at 2 years. All women in this study completed multiple validated indices of bladder, prolapse and sexual function. All objective assessments were also performed using the POP-Q system. As far as we are aware, this is the first study evaluating goals expressed by operating surgeons and how these might differ from patient s goals both in terms of content and extent of achievement. We acknowledge however, that our study has some limitations. As per our study methodology, a strict per protocol analysis was followed whereby only those women who had attended every postoperative visit and completed all questionnaires were included. Women who did not fulfil these stringent criteria were still followed up clinically but these data were not included in the analysis. However, we accept that this perhaps could be a source of potential bias. Our method of categorising the goals of women and surgeons was arbitrary and this may be inherently biased. Although we had multiple surgeons performing the procedures, only a single investigator carried out all the postoperative reviews, which also might be a potential source of bias. Finally, we accept that as some of our results are based on bivariable associations, these may not take into account all the potential confounding variables. We believe that identification of surgeon s goals provides us with deeper insight into our own motivation for opera- ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology 1509
7 Srikrishna et al. tive intervention. In addition, identification of women s preoperative goals may lead to improvement in the delivery of care as unmet expectations have been shown to be an integral part of patient dissatisfaction after surgery 27 and consequently assessment of their achievement may prove an essential measure of surgical success. Conclusion Surgeons and the women they treat choose different goals and have varying expectations of the outcome of surgery for urogenital prolapse and urinary incontinence. However, of the realistic goals approximately 90% are still achieved 2 years following surgery. Disclosure of interests S. Srikrishna has received speaker honoraria from Recordati, Astellas and SEP and is on the advisory board of Astellas. D. Robinson is a consultant for Astellas, Ferring, Gynaecare, Uroplasty, Pfizer, Recordati and Novo-Nordisk; has received speaker honoraria from Astellas, Ferring, Gynaecare, Uroplasty, Pfizer and Recordati and has participated in trials of Astellas and Pfizer. L. Cardozo is a consultant for Astellas, Pfizer, Rottapharm and SEP; has received speaker honorara from Astellas, Pfizer and Rottapharm; has taken part in trials for Astellas and Pfizer; and received a research grant from Pfizer. Contribution to authorship S. Srikrishna was responsible for the conception and design of the study, data acquisition, analysis and interpretation, drafting and revising the manuscript, and final approval of the version to be submitted for publication. D. Robinson was responsible for the conception and design of the study, for supervising the study, for drafting and revising the manuscript and for final approval of the version to be submitted for publication. L. Cardozo was resonsible for supervising the study, revising the manuscript and for final approval of the version to be submitted for publication. Details of ethics approval Ethical approval for this study was obtained from the Kings College Hospital Ethics committee: study number 05WH26. Funding No funding was received for this study. Supporting Information The following supplementary materials are available for this article: Table S1. Demographic data. Table S2. Number of goals expressed by individual patients and surgeons. Additional supporting information may be found in the online version of this article. Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author. j References 1 Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 2005;112: Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 1997;104: Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89: Robinson D, Anders K, Cardozo L, Bidmead J. Outcome measures in urogynaecology: the clinician s perspective. Int Urogynecol J Pelvic Floor Dysfunct 2007;18: Mattiasson A, Djurhuus J, Fonda D, Lose G, Nordling J, Stoher M. Standardisation of outcome studies in patients with lower urinary tract dysfunction: a report on general principles from the standardisation committee of the International Continence Society. Neurourol Urodyn 1998;17: Lose G, Fantl A, Victor A, Walter S, Wells T, Wyman J, et al. Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourol Urodyn 1998;17: Srikrishna S, Robinson D, Cardozo L, Gonzalez J. Is there a discrepancy between patient and physician quality of life assessment? Neurourol Urodyn 2009;28: Srikrishna S, Robinson D, Cardozo L. Is there a difference in patient and physician quality of life evaluation in pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct 2008;19: Black N, Griffiths J, Pope C, Bowling A, Abel P. Impact of surgery for stress incontinence on morbidity: cohort study. BMJ 1997;315: Elkadry EA, Kenton KS, FitzGerald MP, Shott S, Brubaker L. Patientselected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 2003;189: Lowenstein L, FitzGerald MP, Kenton K, Dooley Y, Templehof M, Mueller ER, et al. Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:81 4. Epub Hullfish KL, Bovbjerg VE, Gibson J, Steers WD. Patient centered goals for pelvic floor dysfunction surgery: what is success and is it achieved? Am J Obstet Gynecol 2002;187: Hullfish KL, Bovbjerg VE, Steers WD. Patient centered goals for pelvic floor dysfunction surgery: long-term follow up. Am J Obstet Gynecol 2004;191: Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175: Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S. P-QoL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J 2005;16: ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
8 Postoperative patient and surgeon goal achievement 16 Rust J, Golombok S. The GRISS: a psychometric instrument for the assessment of sexual dysfunction. Arch Sex Behav 1986;15: Kiresuk T, Sherman R. Goal attainment scaling: a general method for evaluating community mental health programs. Commun Ment Health J 1968;4: Payne C, Allee T. Goal achievement provides new insights into interstitial cystitis/painful bladder syndrome symptoms and outcomes. Neurourol Urodyn 2009;28: Becker H, Stuifbergen A, Rogers S, Timmerman G. Goal attainment scaling to measure individual change in intervention studies. Nurs Res 2000;49: Kiresuk T, Lund S, Larsen N. Measurement of goal attainment in clinical and health care programs. Drug Intell Clin Pharm 1982;16: Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 2003;189: Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2010;21: Bovbjerg VE, Trowbridge ER, Barber MD, Martirosian TE, Steers WD, Hullfish KL. Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction. Am J Obstet Gynecol 2009;200: Hägglund D, Wadensten B. Fear of humiliation inhibits women s care-seeking behaviour for long-term urinary incontinence. Scand J Caring Sci 2007;21: Mallett VT, Brubaker L, Stoddard AM, Borello-France D, Tennstedt S, Hall L, et al. The expectations of patients who undergo surgery for stress incontinence. Am J Obstet Gynecol 2008;198: Walker JA. What is the effect of preoperative information on patient satisfaction? Br J Nurs 2007;16: Jones KR, Burney RE, Christy B. Patient expectations for surgery: are they being met? Jt Comm J Qual Improv 2000;26: Journal club Discussion points 1. Background: Discuss patient-reported outcomes, and whether they are associated with clinical or organisational outcomes (complaints, litigation etc), including but not limited to the field of urogynaecology. If you have ever been involved in pelvic floor surgery, recall and discuss your personal goals for the operation(s). Review the literature and explain to your colleagues the Pelvic Organ Prolapse Quantification System. 2. Methods: Describe the technique of Goal Attainment Scaling and compare with Likert scales. If possible, discuss the different statistical methods that would be appropriate for either measure. How could nonparticipants differ from the women eventually included in the study, and how would this influence the study results? 3. Results and implications: Discuss the difference in goal achievement for prolapse, continence symptoms, body image and sexual function, and possible reasons. Explain how the findings of this study will affect your counselling of women before pelvic floor surgery. How are you intending to deal with unrealistic expectations? If you could repeat the study with a larger sample, for which confounding factors would you adjust in the multivariate analyses? j D Siassakos University of Bristol and Southmead Hospital, Bristol, UK jsiasakos@gmail.com ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology 1511
The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence
BJOG: an International Journal of Obstetrics and Gynaecology November 2003, Vol. 110, pp. 983 988 The development of a questionnaire to measure the severity of symptoms and the quality of life before and
More informationExperiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration
DOI: 10.1111/j.1471-0528.2008.01842.x www.blackwellpublishing.com/bjog Urogynaecology Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration S Srikrishna,
More informationAnatomical and Functional Results of Pelvic Organ Prolapse Mesh Repair: A Prospective Study of 105 Cases
International Journal of Clinical Urology 2018; 2(1): 20-24 http://www.sciencepublishinggroup.com/j/ijcu doi: 10.11648/j.ijcu.20180201.14 Anatomical and Functional Results of Pelvic Organ Prolapse Mesh
More informationThe relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration
BJOG: an International Journal of Obstetrics and Gynaecology May 2004, Vol. 111, pp. 468 474 DOI: 1 0. 1111/j.1471-0528.2004.00126.x The relationship between urinary symptom questionnaires and urodynamic
More informationThe effect of physical activity on pelvic organ prolapse
DOI: 10.1111/j.1471-0528.2009.02112.x www.blackwellpublishing.com/bjog Urogynaecology The effect of physical activity on pelvic organ prolapse NS Ali-Ross, ARB Smith, G Hosker The Warrell Unit, St Mary
More informationOriginal article J Bas Res Med Sci 2015; 2(2): The incidence of recurrent pelvic organ prolapse: A cross sectional study
The incidence of recurrent pelvic organ prolapse: A cross sectional study Ashraf Direkvand-Moghadam 1, Ali Delpisheh 2, Azadeh Direkvand-Moghadam 3* 1. Psychosocial Injuries Research Center, Faculty of
More informationSurgical management of stress urinary incontinence in Scotland and Wales: A questionnaire study
International Journal of Surgery (2007) 5, 162e166 www.theijs.com Surgical management of stress urinary incontinence in Scotland and Wales: A questionnaire study Min Yu Lim a, *, Mahesh Perera b, Ian Ramsay
More informationInternational Urogynecological Association (IUGA) Observership Grant. Final Report
International Urogynecological Association (IUGA) 2009-10 Observership Grant Final Report Observership Grant Recipient: Renato Silva Martins 5 th Year Obstetrics and Gynaecology Resident at Coimbra s University
More informationEfficacy and Adverse Effects of Monarc Versus Tension-free Vaginal Tape Obturator: a Retrospective One-year Follow-up Study
Efficacy and Adverse Effects of Monarc Versus Tension-free Vaginal Tape Obturator: a Retrospective One-year Follow-up Study Yvonne KY CHENG MBChB, MRCOG William WK TO MBBS, M Phil, FRCOG, FHKAM (O&G) HX
More informationChildbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England,
DOI: 10.1111/1471-0528.12076 www.bjog.org Urogynaecology Childbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England, 2002 2008 A Pradhan, a DG Tincello, b R Kearney a a Department
More informationCompassionate and effective management
IMPACT OF STRESS URINARY INCONTINENCE ON QUALITY OF LIFE * Paul Abrams, MD, FRCS ABSTRACT Evaluating the impact of stress urinary incontinence (SUI) on quality of life (QOL) is of paramount importance,
More informationKathleen C. Kobashi, MD, FACS Head, Section of Urology and Renal Transplantation Virginia Mason Medical Center, Seattle, WA
Kathleen C. Kobashi, MD, FACS Head, Section of Urology and Renal Transplantation Virginia Mason Medical Center, Seattle, WA Disclosures Advisory Board and/or Speaker Allergan Medtronic Astellas AUA Guidelines
More informationUrodynamics in women. Aims of Urodynamics in women. Why do Urodynamics?
Urodynamics in women Chendrimada Madhu MD, MA, MRCOG Subspecialty Trainee in Urogynaecology Southmead Hospital 2013 Aims of Urodynamics in women n Confirmation of incontinence and its cause n Definition
More informationInterventional procedures guidance Published: 28 June 2017 nice.org.uk/guidance/ipg583
Sacrocolpopexy using mesh to repair vaginal vault prolapse Interventional procedures guidance Published: 28 June 2017 nice.org.uk/guidance/ipg583 Your responsibility This guidance represents the view of
More informationBJUI. Validity and reliability of the patient s perception of intensity of urgency scale in overactive bladder
; 2010 Lower Urinary Tract PATIENT S PERCEPTION OF INTENSITY OF URGENCY SCALE IN OAB CARTWRIGHT ET AL. BJUI Validity and reliability of the patient s perception of intensity of urgency scale in overactive
More information1) What conditions is vaginal mesh used to commonly treat? Vaginal mesh is used to treat two different health issues in women:
Vaginal Mesh Frequently Asked Questions 1) What conditions is vaginal mesh used to commonly treat? Vaginal mesh is used to treat two different health issues in women: a) stress urinary incontinence (SUI)
More informationPredictive factors for overactive bladder symptoms after pelvic organ prolapse surgery
Int Urogynecol J (2010) 21:1143 1149 DOI 10.1007/s00192-010-1152-y ORIGINAL ARTICLE Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery Tiny A. de Boer & Kirsten B. Kluivers
More informationConsultation Guide: Specialised gynaecology surgery and complex urogynaecology conditions service specifications
Consultation Guide: Specialised gynaecology surgery and complex urogynaecology conditions service specifications Consultation guide: Specialised gynaecology surgery and complex urogynaecology conditions
More information2012/13 NHS STANDARD CONTRACT FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH AND LEARNING DISABILITY SERVICES (MULTILATERAL)
E10d 2012/13 NHS STANDARD CONTRACT FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH AND LEARNING DISABILITY SERVICES (MULTILATERAL) SECTION B PART 1 - SERVICE SPECIFICATIONS Service Specification No.
More informationPredicting Treatment Choice for Patients With Pelvic Organ Prolapse
Predicting Treatment Choice for Patients With Pelvic Organ Prolapse Michael Heit, MD, MSPH, Chris Rosenquist, MD, Patrick Culligan, MD, Carol Graham, MD, Miles Murphy, MD, and Susan Shott, PhD OBJECTIVE:
More informationJohn Laughlin 4 th year Cardiff University Medical Student
John Laughlin 4 th year Cardiff University Medical Student Prolapse/incontinence You need to know: Pelvic floor anatomy in relation to uterovaginal support and continence The classification of uterovaginal
More informationProlapse and sexual function in women with benign joint hypermobility syndrome
DOI: 10.1111/1471-0528.12082 www.bjog.org Urogynaecology Prolapse and sexual function in women with benign joint hypermobility syndrome H Mastoroudes, a I Giarenis, a L Cardozo, a S Srikrishna, a M Vella,
More informationTension-free Vaginal Tape for Urodynamic Stress Incontinence
Long-term Results of Tension-free Vaginal Tape Insertion for Urodynamic Stress Incontinence in Chinese Women at Eight-year Follow-up: a Prospective Study YM CHAN MBBS, MRCOG, FHKAM (O&G), DCG, DCH, DFM,
More informationUpdate: The Contiform Intravaginal Device in Four Sizes. for Treatment of Stress Incontinence
Update: The Contiform Intravaginal Device in Four Sizes for Treatment of Stress Incontinence W.A. Allen, H. Leek, A. Izurieta, K. H. Moore Pelvic Floor Unit, St George Hospital Corresponding Author: A/Prof.
More informationA scoring system for the assessment of bowel and lower urinary tract symptoms in women
BJOG: an International Journal of Obstetrics and Gynaecology April 2002, Vol. 109, pp. 424 430 A scoring system for the assessment of bowel and lower urinary tract symptoms in women L. Hiller a, H.D. Bradshaw
More informationShort forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)
American Journal of Obstetrics and Gynecology (2005) 193, 103 13 www.ajog.org Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)
More informationDoes trocar-guided tension-free vaginal mesh (Prolift ) repair provoke prolapse of the unaffected compartments?
Int Urogynecol J (2010) 21:271 278 DOI 10.1007/s00192-009-1028-1 ORIGINAL ARTICLE Does trocar-guided tension-free vaginal mesh (Prolift ) repair provoke prolapse of the unaffected compartments? Mariëlla
More informationAetiology 1998 Bump & Norton Theoretical model
Kate Lough MSc MCSP Handout IUGA Nice 2015 Physiotherapy and the Provision of Pelvic Floor Muscle Training and Lifestyle Intervention in the Conservative Management of Pelvic Organ Prolapse an evidence
More informationKeywords De novo prolapse, mesh, surgery, untreated compartment,
DOI: 10.1111/j.1471-0528.2011.03231.x www.bjog.org Urogynaecology Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of
More informationLong-Term Durability of the Distal Urethral Polypropylene Sling for the Treatment of Stress Urinary Incontinence: Minimum 11-Year Followup
Long-Term Durability of the Distal Urethral Polypropylene Sling for the Treatment of Stress Urinary Incontinence: Minimum 11-Year Followup Lisa Rogo-Gupta,*, Z. Chad Baxter, Ngoc-Bich Le, Shlomo Raz and
More informationTrials of surgery for stress incontinence thoughts on the Humpty Dumpty principle
BJOG: an International Journal of Obstetrics and Gynaecology October 2002, Vol. 109, pp. 1081 1088 Trials of surgery for stress incontinence thoughts on the Humpty Dumpty principle In Lewis Carroll s Through
More informationInterventional procedures guidance Published: 12 October 2016 nice.org.uk/guidance/ipg566
Single-incision short sling mesh insertion for stress urinary incontinence in women Interventional procedures guidance Published: 12 October 2016 nice.org.uk/guidance/ipg566 Your responsibility This guidance
More informationThe diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth
Int Urogynecol J (8) 19:525 53 DOI.7/s192-7-472-z ORIGINAL ARTICLE The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth Jacobus
More informationCriterion validity, test-retest reliability and sensitivity to change of the St George urinary incontinence score
Original Article THE ST GEORGE URINARY INCONTINENCE SCORE A.L. BLACKWELL et al. Criterion validity, test-retest reliability and sensitivity to change of the St George urinary incontinence score A.L. BLACKWELL,
More informationJMSCR Volume 03 Issue 03 Page March 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Quality of Life among Patients after Vaginal Hysterectomy and Pelvic Floor Repair Operation ABSTRACT Authors S Lovereen 1, F A Suchi 2,
More informationFemale Urology Evaluation of Transobturator Tension-free Vaginal Tapes in Management of Women With Recurrent Stress Urinary Incontinence
Female Urology Evaluation of Transobturator Tension-free Vaginal Tapes in Management of Women With Recurrent Stress Urinary Incontinence Mohamed Abdel-Fattah, Ian Ramsay, Stewart Pringle, Chris Hardwick,
More informationNorthwest Rehabilitation Associates, Inc.
Pelvic Health Patient Intake Form Name: Date: Please answer the following questions as honestly and thoroughly as you can. Your responses will help us better understand your condition and provide the best
More informationBilateral sacrospinous fixation after second recurrence of vaginal vault prolapse:
Bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: efficacy and impact on quality of life and sexuality. Salvatore Giovanni Vitale 1, Diego Rossetti 2, Marco Noventa 3,
More informationTreatment Outcomes of Tension-free Vaginal Tape Insertion
Are the Treatment Outcomes of Tension-free Vaginal Tape Insertion the Same for Patients with Stress Urinary Incontinence with or without Intrinsic Sphincter Deficiency? A Retrospective Study in Hong Kong
More informationPelvic organ prolapse
Page 1 of 11 Pelvic organ prolapse Introduction The aim of this leaflet is to give you information about a pelvic organ prolapse, its causes and available treatments but does not replace advice given by
More informationLevator trauma is associated with pelvic organ prolapse
DOI: 10.1111/j.1471-0528.2008.01751.x www.blackwellpublishing.com/bjog Urogynaecology Levator trauma is associated with pelvic organ prolapse HP Dietz, a JM Simpson b a Department of Obstetrics and Gynaecology,
More informationUse of a visual analog scale for evaluation of bother from pelvic organ prolapse
Ultrasound Obstet Gynecol 2014; 43: 693 697 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13222 Use of a visual analog scale for evaluation of bother from pelvic organ
More informationSubjective Measures of Efficacy: Quality of Life, Patient Satisfaction and Patient-Oriented Goals the Search for Value
european urology supplements 6 (2007) 438 443 available at www.sciencedirect.com journal homepage: www.europeanurology.com Subjective Measures of Efficacy: Quality of Life, Patient Satisfaction and Patient-Oriented
More informationGeneral introduction
General introduction http://hdl.handle.net/1765/103217 General introduction General introduction 1 2 Erasmus Medical Center Rotterdam General introduction 3 Functional pelvic floor disorders Symptoms related
More informationPelvic Floor Disorders Following Hysterectomy for Benign Conditions of Uterus and Endometrial Carcinoma - A Long-term Follow-up Study
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/527 Pelvic Floor Disorders Following Hysterectomy for Benign Conditions of Uterus and Endometrial Carcinoma - A Long-term
More informationThe UK National Prolapse Survey: 10 years on
Int Urogynecol J (2018) 29:795 801 DOI 10.1007/s00192-017-3476-3 ORIGINAL ARTICLE The UK National Prolapse Survey: 10 years on Swati Jha 1 & Alfred Cutner 2 & Paul Moran 3 Received: 28 June 2017 /Accepted:
More informationTVT-O versus Monarc after a 2 4-year follow-up: a prospective comparative study
Int Urogynecol J (2009) 20:1327 1333 DOI 10.1007/s00192-009-0943-5 ORIGINAL ARTICLE TVT-O versus Monarc after a 2 4-year follow-up: a prospective comparative study R. Marijn Houwert & Charlotte Renes-Zijl
More informationAmerican Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology 1 2 3 Recurrence of vaginal prolapse after total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension: comparison between normal-weight
More informationGlasgow Caledonian University
ResearchOnline@GCU Glasgow Caledonian University Feasibility, inter- and intra-rater reliability of physiotherapists measuring prolapse using the pelvic organ prolapse quantification system Stark, Diane;
More informationChildbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse
DOI: 10.1111/1471-0528.12075 www.bjog.org Epidemiology Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse C Glazener, a A Elders, a C MacArthur,
More informationCommonKnowledge. Pacific University. Gina Clark Pacific University. Lauren Murphy Pacific University. Recommended Citation.
Pacific University CommonKnowledge PT Critically Appraised Topics School of Physical Therapy 2012 The diagnostic accuracy of patient subjective history compared to the gold standard of urodynamic testing
More informationStress Incontinence. Susannah Elvy Urogynaecology CNS
Stress Incontinence Susannah Elvy Urogynaecology CNS Definitions Prevalence Assessment Investigation Treatment Surgery Men International Continence Society define as the complaint of any involuntary leakage
More informationBen Herbert Alex Wojtowicz
Ben Herbert Alex Wojtowicz 54 year old female presenting with: Dragging sensation Urinary incontinence Some faecal incontinence HPC Since May 14 had noticed a mass protruding from the vagina when going
More informationPaucity of Urogynaecology Research in Africa: time for change
Paucity of Urogynaecology Research in Africa: time for change SASOG 2014 Maki L, Brouard K, Jeffery S Department of Obstetrics and Gynaecology, University of Cape Town Urogynaecology and Pelvic floor reconstruction
More informationTransperineal ultrasound to assess the effect of tension-free vaginal tape position on flow rates
Ultrasound Obstet Gynecol 2010; 36: 379 383 Published online 3 August 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.7640 Transperineal ultrasound to assess the effect of tension-free
More informationAppendix B Protocol for management of obstetric anal sphincter injury THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS
Appendix B Protocol for management of obstetric anal sphincter injury Document Type: THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS PURPOSE & SCOPE To provide a guideline that will assist in
More informationContent. Terminology Anatomy Aetiology Presentation Classification Management
Prolapse Content Terminology Anatomy Aetiology Presentation Classification Management Terminology Prolapse Descent of pelvic organs into the vagina Cystocele ant. vaginal wall involving bladder Uterine
More informationAssociation between ICS POP-Q coordinates and translabial ultrasound findings: implications for definition of normal pelvic organ support
Ultrasound Obstet Gynecol 216; 47: 36368 Published online 29 January 216 in Wiley Online Library (wileyonlinelibrary.com). DOI: 1.12/uog.14872 Association between ICS POP-Q coordinates and translabial
More informationProlapse and Urogynae Incontinence. Lucy Tiffin and Hannah Wheldon-Holmes
Prolapse and Urogynae Incontinence Lucy Tiffin and Hannah Wheldon-Holmes 66 year old woman with incontinence PC: 7 year Hx of urgency, frequency, nocturia (incl. incontinence at night), and stress incontinence
More informationSep \8958 Appell Dmochowski.ppt LMF 1
Surgical Outcomes (How did we get ourselves into this mess?) Roger R. Dmochowski, MD, FACS Department of Urologic Surgery Vanderbilt University School of Medicine Nashville, Tennessee Considerations Evaluation
More informationEffect of Anesthesia on Voiding Function After Tension-Free Vaginal Tape Procedure
Effect of Anesthesia on Voiding Function After Tension-Free Vaginal Tape Procedure M. Murphy, MD, M. H. Heit, MD, MSPH, L. Fouts, MD, C. A. Graham, MD, L. Blackwell, RN, and P. J. Culligan, MD OBJECTIVE:
More informationImprovements in overactive bladder syndrome after polypropylene mesh surgery for cystocele
Australian and New Zealand Journal of Obstetrics and Gynaecology 29; 49: 226 231 DOI: 1.1111/j.1479-828X.29.965.x Blackwell Publishing Asia Original Article Improvements in overactive bladder syndrome
More informationUrinary Incontinence. Lora Keeling and Byron Neale
Urinary Incontinence Lora Keeling and Byron Neale Not life threatening. Introduction But can have a huge impact on quality of life. Two main types of urinary incontinence (UI). Stress UI leakage on effort,
More informationSeventeen years follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence
Int Urogynecol J (2013) 24:1265 1269 DOI 10.1007/s00192-013-2090-2 ORIGINAL ARTICLE: EDITORS CHOICE Seventeen years follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence
More informationVaginal Parity and Pelvic Organ Prolapse
The Journal of Reproductive Medicine Vaginal Parity and Pelvic Organ Prolapse Lieschen H. Quiroz, M.D., Alvaro Muñoz, Ph.D., Stuart H. Shippey, M.D., Robert E. Gutman, M.D., and Victoria L. Handa, M.D.
More informationThe urethral support system during pregnancy and after childbirth Wijma, Jacobus
University of Groningen The urethral support system during pregnancy and after childbirth Wijma, Jacobus IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish
More informationOperative Approach to Stress Incontinence. Goals of presentation. Preoperative evaluation: Urodynamic Testing? Michelle Y. Morrill, M.D.
Operative Approach to Stress Incontinence Goals of presentation Michelle Y. Morrill, M.D. Director of Urogynecology The Permanente Medical Group Kaiser, San Francisco Review preoperative care & evaluation
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SCOPE. Urinary incontinence: the management of urinary incontinence in women
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE 1 Guideline title SCOPE Urinary incontinence: the management of urinary incontinence in women 1.1 Short title Urinary incontinence 2 Background a) The National
More informationProlapse & Urogynaecology. Hester Mannion and Fabi Sica
Prolapse & Urogynaecology Hester Mannion and Fabi Sica Take home messages Prolapse and associated incontinence is very common It has a devastating effect on the QoL of the patient and their partner Strategies
More informationPRE-OPERATIVE URODYNAMIC
PRE-OPERATIVE URODYNAMIC STUDIES: IS THERE VALUE IN PREDICTING POST-OPERATIVE STRESS URINARY INCONTINENCE IN WOMEN UNDERGOING PROLAPSE SURGERY? Dr K Janse van Rensburg Dr JA van Rensburg INTRODUCTION POP
More informationINTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR SURGICAL PROCEDURES TO
AN AMERICAN UROGYNECOLOGIC SOCIETY (AUGS) / INTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR SURGICAL PROCEDURES TO TREAT PELVIC ORGAN PROLAPSE NEED FOR A WORKING
More informationUrodynamic findings in women with insensible incontinence
bs_bs_banner International Journal of Urology (2013) 20, 429 433 doi: 10.1111/j.1442-2042.2012.03146.x Original Article: Clinical Investigation Urodynamic findings in women with insensible Benjamin M Brucker,
More informationSexual Function and Dysfunction
Sexual Function and Dysfunction Angie Rantell Lead Nurse / Nurse Cystoscopist Kings College Hospital, London, UK In the real world Sexual practices are changing! Sexual identities and behaviours change
More informationA Simplified Urinary Incontinence Score for the Evaluation of Treatment Outcomes
Neurourology and Urodynamics 19:127 135 (2000) A Simplified Urinary Incontinence Score for the Evaluation of Treatment Outcomes Asnat Groutz, Jerry G. Blaivas,* and Jarrod E. Rosenthal Weill Medical College,
More informationWORKING TOGETHER FOR THE NHS 20/07/2018
20/07/2018 NHS Improvement and NHS England Wellington House 133-155 Waterloo Road London SE1 8UG 020 3747 0000 www.england.nhs.uk www.improvement.nhs.uk To: Regional Directors, Trust Medical Directors,
More informationThe Management of Female Urinary Incontinence. Part 1: Aetiology and Investigations
The Management of Female Urinary Incontinence Part 1: Aetiology and Investigations Dr Oseka Onuma Gynaecologist and Pelvic Reconstructive Surgeon 4 Robe Terrace Medindie SA 5081 Urinary incontinence has
More informationStudy of correlation between symptoms and signs in women with anterior vaginal wall prolapse
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Bijwe SA et al. Int J Reprod Contracept Obstet Gynecol. 2017 Jul;6(7):3155-3159 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172953
More informationDisease Management. Incontinence Care. Chan Sau Kuen Continence Nurse Consultant United Christian Hospital 14/11/09
Disease Management in Incontinence Care Chan Sau Kuen Continence Nurse Consultant United Christian Hospital 14/11/09 What is incontinence? Definition of Incontinence - Is the compliant of any involuntary
More informationSolifenacin significantly improves all symptoms of overactive bladder syndrome
REVIEW doi: 10.1111/j.1742-1241.2006.01067.x Solifenacin significantly improves all symptoms of overactive bladder syndrome C. R. CHAPPLE, 1 L. CARDOZO, 2 W. D. STEERS, 3 F. E. GOVIER 4 1 Department of
More informationPELVIC PHYSIOTHERAPY EDUCATION GUIDELINE
PELVIC PHYSIOTHERAPY EDUCATION GUIDELINE Initiated at the International Continence Society (ICS) Annual Meeting in San Francisco 2009 Initially Adopted by the ICS Physiotherapy Committee September 2010
More informationDuloxetine in women awaiting surgery
DOI: 1.1111/j.1471-528.6.879.x www.blackwellpublishing.com/bjog Review article H Drutz Ontario Power Generation Building, Toronto, Ontario, Canada Correspondence: Prof. Dr H Drutz, Mount Sinai Hospital,
More informationEndometriosis, pelvic pain, and psychological functioning
FERTILITY AND STERILITY Vol. 63. No.4. April 1995 Copyright 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. Endometriosis, pelvic pain, and psychological functioning
More informationKey Words: urinary incontinence, suburethral slings
Evaluation of Transobturator Tension-Free Vaginal Tapes in the Surgical Management of Mixed Urinary Incontinence: 3-Year Outcomes of a Randomized Controlled Trial Mohamed Abdel-Fattah,*, Laura R. Hopper
More informationAN INTERNATIONAL CONTINENCE SOCIETY (ICS) / INTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR CHILDBIRTH TRAUMA
AN INTERNATIONAL CONTINENCE SOCIETY (ICS) / INTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR CHILDBIRTH TRAUMA NEED FOR A WORKING GROUP ON CHILDBIRTH TRAUMA A: Background
More informationKaranvir Virk M.D. Minimally Invasive & Pelvic Reconstructive Surgery 01/28/2015
Karanvir Virk M.D. Minimally Invasive & Pelvic Reconstructive Surgery 01/28/2015 Disclosures I have none Objectives Identify the basic Anatomy and causes of Pelvic Organ Prolapse Examine office diagnosis
More informationWomen s & Children s Directorate The TVT Operation - a guide for patients
Women s & Children s Directorate The TVT Operation - a guide for patients This leaflet was written for women who are considering having a TVT operation. If you have any questions that aren't answered by
More informationDear Colleagues, EXTENSION OF PAUSE TO THE USE OF VAGINAL MESH
29/03/2019 NHS Improvement and NHS England Wellington House 133-155 Waterloo Road London SE1 8UG 020 3747 0000 www.england.nhs.uk www.improvement.nhs.uk To: Regional Directors, Trust Medical Directors,
More informationRisk Factors of Voiding Dysfunction and Patient Satisfaction After Tension-free Vaginal Tape Procedure
J Korean Med Sci 2005; 20: 1006-10 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Risk Factors of Voiding Dysfunction and Patient Satisfaction After Tension-free Vaginal Tape Procedure
More informationInternational Federation of Gynecology and Obstetrics
International Federation of Gynecology and Obstetrics COMMITTEE FOR UROGYNAECOLOGY AND PELVIC FLOOR MEMBER: TSUNG-HSIEN (CHARLES) SU, CHAIR (TAIWAN) DAVID RICHMOND, CO-CHAIR (UK) CHITTARANJAN PURANDARE,
More informationThe Evidence for Antimuscarinic Agents in Female Mixed Urinary Incontinence
european urology supplements 5 (2006) 849 853 available at www.sciencedirect.com journal homepage: www.europeanurology.com The Evidence for Antimuscarinic Agents in Female Mixed Urinary Incontinence Stefano
More informationMr. GIT KAH ANN. Pakar Klinikal Urologi Hospital Kuala Lumpur.
Mr. GIT KAH ANN Pakar Klinikal Urologi Hospital Kuala Lumpur drgitka@yahoo.com 25 Jan 2007 HIGHLIGHTS Introduction ICS Definition Making a Diagnosis Voiding Chart Investigation Urodynamics Ancillary Investigations
More informationSurgery for stress incontinence:
Surgery for stress incontinence: information for you aashara Published February 2005 by the RCOG Contents Key points About this information What is stress incontinence? Do I need an operation? What operation
More informationFemale Pelvic Prolapse: Considerations on Mesh Surgery and our Experience with Prolift Mesh in 84 Women with Complicated Pelvic Prolapses
Journal of Applied Medical Sciences, vol.5, no. 2, 2016, 19-30 ISSN: 2241-2328 (print version), 2241-2336 (online) Scienpress Ltd, 2016 Female Pelvic Prolapse: Considerations on Mesh Surgery and our Experience
More informationDOEs It MattER? MatERIal and MEtHODs. IntRODuctIOn. K. Jundt 1, s. Wagner 1, v. von Bodungen 1, K. Friese 1, u. M. Peschers 2
112 Eu RO PE an JOuR nal OF MED I cal RE search Eur J Med Res (2010) 15: 112-116 I. Holzapfel Publishers 2010 Occult IncOntInEncE In WOMEn WItH PElvIc ORgan PROlaPsE DOEs It MattER? K. Jundt 1, s. Wagner
More informationCONTINENCE MODULE 1 MIMIMUM STANDARDS FOR THE SPECIALIST ASSESSMENT & CONSERVATIVE MANAGEMENT OF FEMALE LOWER URINARY TRACT SYMPTOMS
CONTINENCE MODULE 1 MIMIMUM STANDARDS FOR THE SPECIALIST ASSESSMENT & CONSERVATIVE MANAGEMENT OF FEMALE LOWER URINARY TRACT SYMPTOMS The minimum standards required to initiate specialised conservative
More informationEffect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder
www.kjurology.org DOI:10.4111/kju.2011.52.6.396 Voiding Dysfunction Effect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder Young Kook Han, Won Ki Lee, Seong Ho Lee, Dae
More informationUrogynaecology. Colm McAlinden
Urogynaecology Colm McAlinden Definitions Urinary incontinence compliant of any involuntary leakage of urine with many different causes Two main types: Stress Urge Definitions Nocturia: More than a single
More informationObliterative surgery for the treatment of pelvic organ prolapse: A patient survey on
Obliterative surgery for the treatment of pelvic organ prolapse: A patient survey on reasons for surgery selection and post-operative decision regret and satisfaction. Michelle M. Takase-Sanchez, MD Indiana
More informationPelvic Support Problems
AP012, April 2010 ACOG publications are protected by copyright and all rights are reserved. ACOG publications may not be reproduced in any form or by any means without written permission from the copyright
More informationFrequency of urinary incontinence with Pelvic organ prolapse and associated factors
ORIGINAL ARTICLE Frequency of urinary incontinence with Pelvic organ prolapse and associated factors Dr. Raheela Mohsin 1, Dr.Ayesha Saba 2, Humera Ismail 3 1 Dr. Raheela Mohsin, Aga Khan University Hospital,
More information