Cambio del modelo asistencial en una unidad de uroginecología de un hospital de tercer nivel: impacto de la pandemia por COVID-19 en la presencialidad / Update of the care model in a urogynaecology unit of a tertiary hospital: impact of the COVID-19 pandemic on face-to-face care

La pandemia por la COVID-19 generó un cambio de forma brusca en la práctica asistencial habitual de nuestra unidad de uroginecología, y a raíz de esta situación se ideó un nuevo modelo asistencial para adaptarnos a la nueva etapa epidemiológica. Se acordó, como eje central del nuevo modelo, la disminución de la presencialidad hospitalaria, ofreciendo la misma calidad asistencial mediante la introducción de la telemedicina.Para conseguir tal fin, se elaboró un modelo con tres tipos de visitas nuevas: primera visita médica telemática, visitas de seguimiento de tratamientos conservadores y farmacológicos telemáticas, y creación de visita pack (pack STUI, el pack posparto y el pack postalta) que incluye visitas y pruebas diagnósticas uroginecológicas que se realizan todas el mismo día.El pack STUI va dirigido a todas las pacientes con síntomas del tracto urinario inferior, asociados o no a prolapso de órganos pélvicos. Consta de dos visitas (enfermería y médica), y dos pruebas diagnósticas avanzadas (urodinamia y ecografía de suelo pélvico).El pack posparto va dirigido a mujeres con síntomas de incontinencia urinaria, incontinencia anal, prolapso y/o alteraciones de la sexualidad tras el parto. También incluye mujeres asintomáticas con antecedente de trauma perineal obstétrico. Consta de una visita médica, una ecografía de suelo pélvico y una visita por la fisioterapeuta.El pack postalta se realiza al mes de la cirugía e incluye dos pruebas (ecografía de suelo pélvico y flujometría) y una visita médica.Los tratamientos de fisioterapia y otras visitas que por motivos médicos lo requirieran, han mantenido su presencialidad.(AU)

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.(AU)

Aplicabilidad clínica de la ecografía de suelo pélvico en las mujeres con disfunciones miccionales / Clinical applicability of pelvic floor ultrasound in women with urinary dysfunction

Las disfunciones miccionales más frecuentes son la incontinencia urinaria de esfuerzo (IUE), la incontinencia urinaria de urgencia y la dificultad miccional. Son un problema de salud que afecta a la calidad de vida y, a pesar de su alta prevalencia, su etiopatología y fisiopatología sigue sin estar bien establecida. La ecografía de suelo pélvico (ESP) tiene un papel importante para ayudarnos a comprender conceptos de la fisiopatología de estas disfunciones y el manejo clínico de la paciente.La ESP nos permite evaluar la movilidad uretral, la longitud de la uretra y la presencia de embudización del cuello vesical, todos ellos parámetros importantes a considerar, especialmente en aquellas pacientes que se someterán a una cirugía correctora de la IUE. Mediante la ESP evaluamos de forma rutinaria las paredes vesicales y la morfología uretral con el fin de descartar una enfermedad orgánica asociada. La ESP también nos permite evaluar el residuo posmiccional, importante en todas las pacientes con disfunciones miccionales. Finalmente, la ESP es de gran utilidad en la evaluación de las pacientes con antecedente de cirugía antiinconinencia con una banda suburetral libre de tensión (BSLT), permitiendo valorar los parámetros estáticos y dinámicos de la BSLT (en Valsalva), que se correlacionan con la sintomatología descrita por las pacientes.La ESP es una prueba subespecializada que se debe realizar por personal entrenado, y que cada vez va adquiriendo más protagonismo en las unidades de uroginecología. Se espera en un futuro disponer de una terminología estandarizada y de una aplicabilidad más extendida.

Stress urinary incontinence (SUI), urge urinary incontinence, and voiding dysfunction are the most frequent urinary dysfunctions. These dysfunctions affect the patient's quality of life and despite their high prevalence, their aetiopathology and pathophysiology are still not well established. Pelvic floor ultrasound (PFUS) helps us to understand the pathophysiology of these dysfunctions and the clinical evaluation and treatment of patients.PFUS allows us to assess urethral mobility, urethral length, and bladder neck funnelling, all of which are important parameters to be considered in patients undergoing SUI surgery. The evaluation of bladder walls and urethral morphology could be routinely performed by PFUS to assess other pathologies. PFUS also allows us to evaluate the post void residual volume which is especially important in patients with voiding dysfunction. Finally, PFUS is useful in the assessment of the mid urethral slings used for the surgical treatment of SUI. We can evaluate the static and dynamic (with Valsalva) parameters which correlate with the patient's symptoms.PFUS should be performed by trained professionals, and it is expected that in the near future its use will be more extended.

[Update of the care model in a urogynaecology unit of a tertiary hospital: impact of the COVID-19 pandemic on face-to-face care]. / Cambio del modelo asistencial en una unidad de uroginecología de un hospital de tercer nivel: impacto de la pandemia por COVID-19 en la presencialidad.

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.

Residuo posmiccional y síntomas de disfunción de vaciado en mujeres con prolapso de órganos pélvicos antes y después de la cirugía vaginal. Estudio de cohortes multicéntrico / Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study

OBJETIVOS: El presente trabajo evalúa el impacto de la cirugía vaginal del prolapso de órganos pélvicos (POP) en los síntomas de disfunción de vaciado (DV) y en el residuo posmiccional (RPM) un año después de la intervención. MATERIAL Y MÉTODOS: Estudio epidemiológico, longitudinal y prospectivo. Un total de 39 unidades de ginecología incluyeron mujeres con POP sintomático de grado 2 o superior según la clasificación Pelvic Organ Prolapse Quantification (POP-Q) que iban a ser sometidas a cirugía del prolapso por vía vaginal (estudio CIRPOP-IUE). Se recogieron variables sociodemográficas y clínicas antes y después de la intervención. En ambas visitas, las pacientes cumplimentaron los cuestionarios Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) y Pelvic Floor Distress Inventory (PFDI-20). El RPM se midió por sondaje vesical inmediatamente después de una micción espontánea. RESULTADOS: El 50% de las mujeres refirieron síntomas de DV antes de la intervención. El RPM se midió en 277 mujeres de las cuales en 116 (41,87%) fue > 50 ml y en 42/277 (15,2%) fue > 100 ml. Un año tras la intervención, se observó una reducción objetiva y subjetiva de los síntomas de DV. El RPM medio se redujo de forma estadísticamente significativa, pasando de una media (DE) de 66,4 (68,9) ml a 48,3 (51,3) ml. También disminuyó el número de pacientes que reportaron dificultad de vaciado y sensación de vaciado incompleto en los cuestionarios EPIQ y PFDI-20. CONCLUSIONES: En general, se observó una mejora de la función miccional tanto a través de la disminución de los síntomas específicos de DV como de la reducción del volumen medio del RPM

OBJECTIVES: The present study evaluates the impact of vaginal surgery for pelvic organ prolapse (POP) on voiding dysfunction (VD) symptoms and post-void residual (PVR) one year after the intervention. MATERIAL AND METHODS: Epidemiological, longitudinal, prospective study. Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who would undergo surgery for vaginal prolapse (CIRPOP-IUE study). Sociodemographic and clinical variables were collected before and after the intervention. At both visits, patients completed the 'Epidemiology of Prolapse and Incontinence Questionnaire' (EPIQ) and 'Pelvic Floor Distress Inventory' (PFDI-20) questionnaire. PVR volume was measured by bladder catheterization immediately after spontaneous urination. RESULTS: VD symptoms were present in 50% cases before the intervention. PVR was measured in 277 women of which 116 (41.87%) were > 50 ml and 42/277 (15.2%) were > 100 ml. Objective and subjective reduction in VD symptoms was observed one year after the intervention. Mean PVR volume was reduced with statistical significance, from a mean (SD) of 66.4 (68.9) ml to 48.3 (51.3) ml. The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased. CONCLUSIONS: In general, improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume

Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study. / Residuo posmiccional y síntomas de disfunción de vaciado en mujeres con prolapso de órganos pélvicos antes y después de la cirugía vaginal. Estudio de cohortes multicéntrico.

OBJECTIVES: The present study evaluates the impact of vaginal surgery for pelvic organ prolapse (POP) on voiding dysfunction (VD) symptoms and post-void residual (PVR) one year after the intervention. MATERIAL AND METHODS: Epidemiological, longitudinal, prospective study. Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who would undergo surgery for vaginal prolapse (CIRPOP-IUE study). Sociodemographic and clinical variables were collected before and after the intervention. At both visits, patients completed the 'Epidemiology of Prolapse and Incontinence Questionnaire' (EPIQ) and 'Pelvic Floor Distress Inventory' (PFDI-20) questionnaire. PVR volume was measured by bladder catheterization immediately after spontaneous urination. RESULTS: VD symptoms were present in 50% cases before the intervention. PVR was measured in 277 women of which 116 (41.87%) were >50ml and 42/277 (15.2%) were >100ml. Objective and subjective reduction in VD symptoms was observed one year after the intervention. Mean PVR volume was reduced with statistical significance, from a mean (SD) of 66.4 (68.9)ml to 48.3 (51.3)ml. The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased. CONCLUSIONS: In general, improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume.

Cómo la pandemia por COVID-19 ha cambiado la forma de atender a las pacientes en una unidad de uroginecología / How did COVID-19 pandemic change the way we attend the patients in an urogynaecological unit

La actual pandemia ocasionada por el SARS-coronavirus tipo 2 ha generado, en pocas semanas, cambios importantes en el funcionamiento del sistema sanitario y la forma en cómo se realiza la atención a las pacientes. La patología uroginecológica afecta a la calidad de vida, pero sin riesgo vital en la mayoría de casos, por lo que suele ser demorable. Además, afecta a un alto porcentaje de mujeres > 65 años (población de riesgo ante la infección por COVID-19). En este manuscrito se resume la evidencia que existe sobre la efectividad de la telemedicina aplicada en las disfunciones de suelo pélvico, así como recomendaciones de las sociedades científicas uroginecológicas durante el estado de alarma. Describimos el abordaje de las disfunciones de suelo pélvico durante la pandemia por COVID-19 y una propuesta de cómo organizar las agendas para el diagnóstico (visitas y pruebas diagnósticas) y tratamiento (conservador, farmacológico y la cirugía) en el período interpandemia y en el futuro

The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future

[How did COVID-19 pandemic change the way we attend the patients in an urogynaecological unit]. / Cómo la pandemia por COVID-19 ha cambiado la forma de atender a las pacientes en una unidad de uroginecología.

The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future.

Actividad y función sexual en mujeres con prolapso de órganos pélvicos avanzado sometidas a cirugía vaginal clásica. Estudio multicéntrico / Sexual activity and function of women with severe pelvic organ prolapse subjected to a classical vaginal surgery. A multicentre study

Introducción y objetivo: El prolapso de órganos pélvicos (POP) puede asociarse a la disfunción sexual femenina. El presente estudio pretendía determinar el impacto de la cirugía correctora del POP sobre la vida sexual de mujeres con POP avanzado. Materiales y métodos: Se diseñó un estudio de cohortes prospectivo, multicéntrico, incluyendo pacientes con POP sintomático, de grado ≥ ii, sometidas a cirugía vía vaginal con tejidos propios. Se evaluó la actividad y función sexual mediante el PISQ-IR antes y 12 meses tras la cirugía. Resultados: Se incluyeron 355 mujeres, 322 con datos de la visita de seguimiento. La media (DE) de edad fue de 64,8 (9,9) años. Basalmente, 170 mujeres eran sexualmente activas y 185 no. Veintinueve mujeres (16,8%) pasaron a ser sexualmente activas y 20 (12,8%) dejaron de serlo tras la cirugía. Un 42,3% reportaron no tener relaciones sexuales debido a problemas de vejiga, intestino o POP, antes de la cirugía y solo un 11,4% después de la cirugía. El 25,3% de las mujeres refería no tener actividad sexual por dolor en la visita basal, mientras que tras la cirugía este porcentaje era del 8,5%. Se observó una mejora estadísticamente significativa en 5 de 6 escalas del PISQ-IR en mujeres sexualmente activas. Conclusiones: El POP sintomático se asocia a la disfunción sexual femenina. El tratamiento quirúrgico del POP parece tener un impacto positivo sobre la vida sexual de mujeres tanto inactivas como activas

Introduction and objective: Pelvic organ prolapse (POP) is related with female sexual dysfunction. The present study aimed to determine the impact of POP corrective surgery on the sexual life of women with advanced POP. Materials and methods: A prospective, multicentre cohort study was designed, including patients with grade ≥ II, symptomatic POP, who underwent vaginal surgery with traditional procedures. Sexual activity and function were assessed by PISQ-IR before surgery and 12 months after. Results: We included 355 women; 322 had data from the follow-up visit. The mean (SD) age was 64.8 (9.9) years. At baseline, 170 women were sexually active and 185 were not. After surgery, 29 women (16.8%) became sexually active and 20 (12.8%) ceased sexual activity. Before surgery, 42.3% reported not having sexual intercourse due to bladder, bowel or POP problems; and 11.4% after surgery. At baseline visit, 25.3% had no sexual activity due to pain, however, at follow-up visits, this percentage was 8.5%. A statistically significant improvement was observed in 5 out of 6 scales of the PISQ-IR in sexually active women. Conclusions: Symptomatic POP is associated with female sexual dysfunction. Surgical intervention seems to have a positive impact on sexual life among sexually inactive and active women

Sexual activity and function of women with severe pelvic organ prolapse subjected to a classical vaginal surgery. A Multicentre study. / Actividad y función sexual en mujeres con prolapso de órganos pélvicos avanzado sometidas a cirugía vaginal clásica. Estudio multicéntrico.

INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) is related with female sexual dysfunction. The present study aimed to determine the impact of POP corrective surgery on the sexual life of women with advanced POP. MATERIALS AND METHODS: A prospective, multicentre cohort study was designed, including patients with grade≥II, symptomatic POP, who underwent vaginal surgery with traditional procedures. Sexual activity and function were assessed by PISQ-IR before surgery and 12 months after. RESULTS: We included 355 women; 322 had data from the follow-up visit. The mean (SD) age was 64.8 (9.9) years. At baseline, 170 women were sexually active and 185 were not. After surgery, 29 women (16.8%) became sexually active and 20 (12.8%) ceased sexual activity. Before surgery, 42.3% reported not having sexual intercourse due to bladder, bowel or POP problems; and 11.4% after surgery. At baseline visit, 25.3% had no sexual activity due to pain, however, at follow-up visits, this percentage was 8.5%. A statistically significant improvement was observed in 5 out of 6 scales of the PISQ-IR in sexually active women. CONCLUSIONS: Symptomatic POP is associated with female sexual dysfunction. Surgical intervention seems to have a positive impact on sexual life among sexually inactive and active women.

Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury.

OBJECTIVE: To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). METHODS: External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. RESULTS: Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (κ = 0.01), fair for 2D-TPUS (κ = 0.30) and good for 3D-TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (κ = 0.41) and 2D-TPUS (κ = 0.52) and good for 3D-TPUS (κ = 0.66). Good intraobserver (3D-EAUS, κ = 0.73; 3D-TPUS, κ = 0.78) and interobserver (3D-EAUS, κ = 0.68; 3D-TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). CONCLUSIONS: 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

La incontinencia urinaria en consultas de ginecología. ¿Todas las mujeres con síntomas desean tratarse? / Urinary incontinence in gynaecological consultations. Do all women with symptoms wish to be treated?

Objetivo: Determinar la prevalencia y gravedad de los síntomas de incontinencia urinaria (IU) en mujeres que acuden a consultas de atención primaria de ginecología, así como la proporción con síntomas de IU que desean ser estudiadas y tratadas. Materiales y métodos: Estudio multicéntrico, observacional, descriptivo transversal en mujeres que consultaron por cualquier motivo (excepto IU, embarazo y puerperio), a 8 consultas especializadas en salud sexual y reproductiva de las 4 provincias catalanas. Se utilizó el cuestionario ICQ-UI-SF para la detección de los síntomas de IU. A las mujeres con síntomas de IU (ICI-Q-SF > 0) se les preguntó si deseaban recibir atención específica por su problema de IU. A las que contestaron que no se les preguntó por qué. Resultados: Se incluyeron 2.840 mujeres, de las cuales un 41,8% afirmó tener pérdidas de orina, sobre todo sintomatología leve o moderada. Un 53,62% de las mujeres con IU respondió que no deseaba ser tratadas: un 75% con sintomatología leve, un 45% moderada y solo un 16% y un 5% con sintomatología grave o muy grave, respectivamente. Un 53% de mujeres no deseaba tratamiento porque la IU no era un problema importante para ellas. Conclusiones: Casi la mitad de las mujeres que acuden a una consulta especializada en salud sexual y reproductiva por cualquier motivo refieren síntomas de IU, sobre todo leve y moderada. Más de la mitad de las pacientes con síntomas de IU no desean iniciar un proceso de diagnóstico y tratamiento de su problema. La severidad de los síntomas se asocia a la voluntad de ser tratadas

Objective: To determine the prevalence and symptom severity of urinary incontinence (UI) in women who attend primary care gynaecological consultations, as well as the proportion of women with UI symptoms who wish to be studied and treated. Materials and methods: A multicentre, observational, descriptive cross-sectional study was conducted of women who visit the 8 specialised consultations for sexual and reproductive health (SRH) in the 4 Catalan provinces for any reason (except UI, pregnancy and postpartum). We employed the ICQ-UI-SF questionnaire to detect UI symptoms. Women with UI symptoms (ICI-Q-SF > 0) were asked whether they wanted specific care for their UI problem. Those who answered 'no' were asked why. Results: The study included 2840 women, 41.8% of whom reported urine losses, especially mild to moderate symptoms. Some 53.62% of the women with UI responded that they did not wish to be treated. Of these, 75% had mild symptoms, 45% had moderate symptoms, and only 16% and 5% had severe or very severe symptoms, respectively. Fifty-three percent of the women did not want treatment because the UI was not a significant problem for them. Conclusions: Almost half of the women who attended a specialised consultation for SRH for any reason reported UI symptoms, especially mild and moderate. More than half of the patients with UI symptoms did not want to start a diagnostic and treatment process for their problem. Symptom severity is associated with the willingness to be treated

Urinary incontinence in gynaecological consultations. Do all women with symptoms wish to be treated?

OBJECTIVE: To determine the prevalence and symptom severity of urinary incontinence (UI) in women who attend primary care gynaecological consultations, as well as the proportion of women with UI symptoms who wish to be studied and treated. MATERIALS AND METHODS: A multicentre, observational, descriptive cross-sectional study was conducted of women who visit the 8 specialised consultations for sexual and reproductive health (SRH) in the 4 Catalan provinces for any reason (except UI, pregnancy and postpartum). We employed the ICQ-UI-SF questionnaire to detect UI symptoms. Women with UI symptoms (ICI-Q-SF>0) were asked whether they wanted specific care for their UI problem. Those who answered "no" were asked why. RESULTS: The study included 2840 women, 41.8% of whom reported urine losses, especially mild to moderate symptoms. Some 53.62% of the women with UI responded that they did not wish to be treated. Of these, 75% had mild symptoms, 45% had moderate symptoms, and only 16% and 5% had severe or very severe symptoms, respectively. Fifty-three percent of the women did not want treatment because the UI was not a significant problem for them. CONCLUSIONS: Almost half of the women who attended a specialised consultation for SRH for any reason reported UI symptoms, especially mild and moderate. More than half of the patients with UI symptoms did not want to start a diagnostic and treatment process for their problem. Symptom severity is associated with the willingness to be treated.

Los cuestionarios en la evaluación de la actividad y función sexual en mujeres con incontinencia urinaria y prolapso de órganos pélvicos / Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse

Contexto: La integración del cuidado de la salud sexual en la práctica clínica es importante. En las mujeres con enfermedad del suelo pélvico se da más importancia a la evaluación de los defectos anatómicos, a la función urinaria y anorrectal que a la función sexual. Métodos: Se realizó una revisión y un análisis manual de las publicaciones relacionadas con la evaluación de la salud sexual en uroginecología, en Medline utilizando términos de búsqueda previamente definidos. Se incluyeron solo artículos publicados en inglés y en español. Resultados: Solo el 50% de las mujeres que consultan por un problema uroginecológico son sexualmente activas, de ellas el 60% refieren algún tipo de disfunción sexual. Los cuestionarios y las escalas de sexualidad facilitan la discusión entre la mujer y el profesional de la salud en los diversos aspectos de su vida sexual, su utilización rutinaria puede facilitar el diagnóstico de la disfunciones sexuales y un mejor control de los resultados de los tratamientos. El Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) y el PISQ-IR (IUGA-revised) son los únicos cuestionarios de función sexual femenina validados que han sido desarrollados específicamente para evaluar la función sexual en mujeres con incontinencia urinaria y/o prolapso de órganos pélvicos. El PISQ-IR, además, permite evaluar el impacto en la función sexual en mujeres que no son sexualmente activas, así como en mujeres con incontinencia anal y está diseñado para su validación internacional. Conclusiones: La evaluación de la función sexual mediante cuestionarios específicos facilita la identificación de las disfunciones sexuales asociadas a la enfermedad del suelo pélvico. La inclusión de cuestionarios de sexualidad como medida de resultados permite analizar el impacto de los tratamientos aplicados en la vida sexual de las mujeres con problemas uroginecológicos

Context: Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function. Methods: Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included. Results: Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed. Conclusions: The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

OBJECTIVES: To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP). METHODS: This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered. RESULTS: One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). CONCLUSIONS: Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse.

CONTEXT: Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function. METHODS: Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included. RESULTS: Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed. CONCLUSIONS: The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem.

Evaluating the results of stress urinary incontinence surgery with objective and subjective outcome measures.

OBJECTIVE: To assess the outcomes of stress urinary incontinence (SUI) surgery using objective and subjective measures in women with pure SUI and mixed urinary incontinence (MUI). The degree of correlation between the different outcome measures was also evaluated for both groups. STUDY DESIGN: A multicentre prospective cohort study of women who underwent surgery for SUI. A standardized cough stress test was used as the objective outcome measure, and specific items of the Epidemiology of Prolapse and Incontinence Questionnaire were used as the subjective outcome measure. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Patient Global Impression of Improvement (PGI-I) questionnaires were used for global assessment. Kappa test was used to measure the degree of correlation between the outcome measures. RESULTS: The participants were categorized into two groups before surgery: pure SUI (n=116) and MUI (n=161). Six months after surgery, the cure rate of the SUI component was high in both groups according to the objective and subjective outcome measures. Global assessment showed lower cure rates. The degree of agreement between objective and subjective outcome measures was moderate (kappa 0.541, p<0.001) for women with pure SUI, and fair (kappa 0.377, p<0.001) for women with MUI. Correlation between the change in ICIQ-UI SF score (pre to post surgery) and the degree of satisfaction (PGI-I) was significant (p<0.01) for both the pure SUI group (0.43) and the MUI group (0.48). CONCLUSIONS: Both objective and subjective cure rates are high for women with pure SUI and MUI following SUI surgery in Spain. The degree of agreement between different outcome measures varies.

A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).

INTRODUCTION AND HYPOTHESIS: The objective of this study was to create a valid, reliable, and responsive sexual function measure in women with pelvic floor disorders (PFDs) for both sexually active (SA) and inactive (NSA) women. METHODS: Expert review identified concept gaps and generated items evaluated with cognitive interviews. Women underwent Pelvic Organ Prolapse Quantification (POPQ) exams and completed the Incontinence Severity Index (ISI), a prolapse question from the Epidemiology of Prolapse and Incontinence Questionnaire (ISI scores), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Female Sexual Function Index (FSFI). Principle components and orthogonal varimax rotation and principle factor analysis with oblique rotation identified item grouping. Cronbach's alpha measured internal consistency. Factor correlations evaluated criterion validation. Change scores compared to change scores in other measures evaluated responsiveness among women who underwent surgery. RESULTS: A total of 589 women gave baseline data, 200 returned surveys after treatment, and 147 provided test-retest data. For SA women, 3 subscales each in 2 domains (21 items) and for NSA women 2 subscales in each of 2 domains (12 items) emerged with robust psychometric properties. Cronbach's alpha ranged from .63 to .91. For SA women, correlations were in the anticipated direction with PFDI-20, ISI, and FSFI scores, POPQ, and EPIQ question #35 (all p < .05). PFDI-20, ISI, and FSFI subscale change scores correlated with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association-revised (PISQ-IR) factor change scores and with mean change scores in women who underwent surgery (all p < .05). For NSA women, PISQ-IR scores correlated with PFDI-20, ISI scores, and with EPIQ question #35 (all p < .05). No items demonstrated differences between test and retest (all p ≥ .05), indicating stability over time. CONCLUSIONS: The PISQ-IR is a valid, reliable, and responsive measure of sexual function.

Impacto del tratamiento de la vejiga hiperactiva en las comorbilidades asociadas / Impact of Overactive Bladder Treatment on Associated Comorbidities

Objetivos: Analizar el manejo de pacientes con vejiga hiperactiva (VH) de nuevo diagnóstico y el impacto del tratamiento en las comorbilidades asociadas. Material y métodos: Se reclutaron 1.434 pacientes mayores de 60 años con VH de nuevo diagnóstico y al menos una patología asociada (infecciones urinarias o de piel del área genital, trastornos del sueño, depresión, hipertensión) en 300 consultas de urología/ginecología de España. Inicialmente se recogieron datos sociodemográficos y clínicos y se pautó tratamiento para VH según la práctica clínica habitual; 4-6 meses después se reevaluó la sintomatología. Se realizó un análisis estadístico descriptivo, contrastes por sexos (Chi2/Mann-Whitney) y para la evolución entre visitas (McNemar). Resultados: Se presentan datos de 1.274 pacientes válidos en visita 1 y 1.153 en visita 2. La edad media fue 68,17 (6,19) años y el 71,51% de la muestra fueron mujeres. El 66,41% presentó urgencia miccional, con o sin incontinencia urinaria (IU) de urgencia y el 33,59% urgencia asociada a IU de esfuerzo. Las patologías asociadas más frecuentes fueron trastornos de sueño (56,44%) e infecciones urinarias (53,14%). Las infecciones urinarias y genitales y el tratamiento para la depresión fueron más frecuentes en mujeres; los trastornos del sueño e hipertensión, en varones. Los tratamientos más frecuentemente indicados fueron anticolinérgicos (95,45%) y recomendaciones sobre pautas de estilo de vida (85,32%). En la segunda visita se detectó mejora significativa en los síntomas de las comorbilidades asociadas. Conclusiones: La identificación y tratamiento de los síntomas de VH es importante para reducir el impacto de la enfermedad y de las patologías asociadas (AU)

Objectives: To analyze the management of patients newly diagnosed with overactive bladder (OAB) and to assess the impact of treatment on associated comorbidities. Material and methods: 1,434 patients over 60 years with newly diagnosed OAB and at least one associated comorbidity (urinary tract infections, genital skin infections, sleep disturbances, depression, and hypertension) were recruited in 300 urology/gynecology surgeries in Spain. In the first visit sociodemographic and clinic data were recorded, and treatment for OAB following usual practice was prescribed. 4-6 months later symptoms were reevaluated. A descriptive statistical analysis was performed, variables were compared by gender (Chi2/Mann-Whitney) and between visits (McNemar). Results: Data for 1,274 valid patients in visit 1 and 1,153 in visit 2 are presented. Mean age in the sample was 68.17(6.19) years, 71.51% were women. 66.41% presented urgency, with or without urge urinary incontinence, and 33.59% presented urgency related to stress urinary incontinence. The most frequent associated pathologies were sleep disturbances (56.44%) and urinary tract infections (53.14%). Urinary tract infections and genital skin infections and treatment for depression were more frequent in women; sleep disturbances and hypertension in men. Treatments more frequently prescribed were anticholinergics (95.45%) and guidance for lifestyle changes (85.32%). Statistically significant improvement in symptoms of associated comorbidities was detected in visit 2. Conclusions: Detection and treatment of OAB symptoms is relevant to reduce both the impact of the affection and of associated pathologies (AU)

[Impact of overactive bladder treatment on associated comorbidities]. / Impacto del tratamiento de la vejiga hiperactiva en las comorbilidades asociadas.

OBJECTIVES: To analyze the management of patients newly diagnosed with overactive bladder (OAB) and to assess the impact of treatment on associated comorbidities. MATERIAL AND METHODS: 1,434 patients over 60 years with newly diagnosed OAB and at least one associated comorbidity (urinary tract infections, genital skin infections, sleep disturbances, depression, and hypertension) were recruited in 300 urology/gynecology surgeries in Spain. In the first visit sociodemographic and clinic data were recorded, and treatment for OAB following usual practice was prescribed. 4-6 months later symptoms were reevaluated. A descriptive statistical analysis was performed, variables were compared by gender (Chi(2)/Mann-Whitney) and between visits (McNemar). RESULTS: Data for 1,274 valid patients in visit 1 and 1,153 in visit 2 are presented. Mean age in the sample was 68.17(6.19) years, 71.51% were women. 66.41% presented urgency, with or without urge urinary incontinence, and 33.59% presented urgency related to stress urinary incontinence. The most frequent associated pathologies were sleep disturbances (56.44%) and urinary tract infections (53.14%). Urinary tract infections and genital skin infections and treatment for depression were more frequent in women; sleep disturbances and hypertension in men. Treatments more frequently prescribed were anticholinergics (95.45%) and guidance for lifestyle changes (85.32%). Statistically significant improvement in symptoms of associated comorbidities was detected in visit 2. CONCLUSIONS: Detection and treatment of OAB symptoms is relevant to reduce both the impact of the affection and of associated pathologies.