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2.
Int Urogynecol J ; 22(11): 1437-43, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21975533

RESUMO

INTRODUCTION AND HYPOTHESIS: This study was conducted to assess national rates in stress urinary incontinence (SUI) surgery in the USA from 1998 to 2007. METHODS: We utilized the 1998-2007 Nationwide Inpatient Sample and assessed women aged 20 years and older who underwent SUI surgery based on the International Classification of Diseases, 9th Revision (ICD-9) procedure and diagnosis codes. RESULTS: The total number of SUI surgeries performed during this 10-year period was 759,821. The annual number of procedures increased from 37,953 in 1998 to 94,910 in 2007. The type of SUI surgery performed also changed (p < 0.001). In 1998, retropubic suspensions represented 52.3%, decreasing to 13.8% in 2007. "Other repair of SUI" (ICD-9 59.79) comprised 22.4% in 1998, increasing to 75.2% in 2007, likely representing midurethral slings. CONCLUSIONS: The total number and incidence rates of SUI surgeries have increased from 1998 to 2007. The type of SUI surgery performed has also changed significantly, likely secondary to adoption of midurethral slings.


Assuntos
Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estados Unidos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/tendências , Adulto Jovem
3.
Clin Obstet Gynecol ; 53(1): 26-39, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20142641

RESUMO

Although most gynecologists are comfortable performing vaginal hysterectomy in the patient without significant uterovaginal prolapse, vaginal hysterectomy for the prolapsed uterus poses unique challenges and requires an increased awareness of deviations in pelvic anatomy that may result. This review article discusses the background of vaginal hysterectomy performed for uterovaginal prolapse, the pathophysiology of uterovaginal prolapse, preoperative assessment of the patient with uterovaginal prolapse, surgical technique, ureteral anatomy, techniques to avoid injury to the ureter at the time of vaginal hysterectomy for uterovaginal prolapse, and other relevant considerations.


Assuntos
Histerectomia Vaginal/métodos , Prolapso Uterino/cirurgia , Cistoscopia , Feminino , Humanos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Ureter/anatomia & histologia , Ureter/lesões , Prolapso Uterino/diagnóstico , Prolapso Uterino/fisiopatologia
4.
Int Urogynecol J Pelvic Floor Dysfunct ; 19(9): 1283-9, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18480958

RESUMO

The objective of this study is to develop a reliable, validated questionnaire to assess patient knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). We designed a written questionnaire comprised of UI and POP scales and administered it to 133 gynecologic and 61 urogynecologic patients. We performed a principal components factor analysis for UI and POP items and assessed construct validity, internal consistency, and stability of each scale. For both scales, mean total urogynecologic group scores exceeded those for gynecologic patients (P values < 0.001), suggesting construct validity. Both scales had excellent internal consistency (Cronbach's alpha > 0.8). Mean test scores were slightly higher upon retest (UI, 0.46, P = 0.046; POP, 0.33, P = 0.126). Pearson's correlation between initial and repeat scores was high for UI (0.675) and POP scales (0.940), indicating questionnaire stability. We developed a reliable, valid instrument for assessing patient knowledge about UI and POP.


Assuntos
Inquéritos e Questionários , Incontinência Urinária/psicologia , Prolapso Uterino/psicologia , Adulto , Análise Fatorial , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
5.
Int Urogynecol J Pelvic Floor Dysfunct ; 19(10): 1371-8, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18465075

RESUMO

The objective of this study is to assess knowledge about urinary incontinence and pelvic organ prolapse in white versus nonwhite women. We hypothesize that there are racial differences in patient knowledge about these issues. One hundred twenty-six women presenting to our institution's gynecology clinic completed a two-scale, validated questionnaire assessing knowledge about incontinence and prolapse. Responses were compared for white versus nonwhite women using nonparametric statistical methods. Logistic regression was used to control for confounding variables. Mean score for white women exceeded that for nonwhite women for the incontinence (p = 0.019) but not the prolapse scale (p = 0.354). Of the white patients, 37.9% versus 19.1% of the nonwhite patients scored > or =80% on the incontinence scale (p = 0.019). This difference remained significant after controlling for potential confounders using logistic regression (p = 0.039). White women may have improved tested urinary incontinence knowledge as compared to nonwhite women.


Assuntos
Educação de Pacientes como Assunto , Grupos Raciais , Incontinência Urinária/etnologia , Prolapso Uterino/etnologia , Adulto , Feminino , Humanos , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
6.
Int Urogynecol J Pelvic Floor Dysfunct ; 19(8): 1085-92, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18373047

RESUMO

The objective of this study was to evaluate the prevalence, demographics and complications of stress urinary incontinence (SUI) surgery across races in the United States (US) in 2003. We hypothesized that there would be racial differences in surgical rates. Data from the 2003 National Census and National Hospital Discharge Survey were used. Continuous variables were tested for statistical significance by one-way analysis of variance and categorical variables by chi2 analysis. 129,778 women underwent SUI surgery in the US in 2003, a rate of 12 surgical procedures per 10,000 women (95% CI 10-14). By race, rates (per 10,000 women, 95% CI) of SUI surgery were: ten (7-12) in white women, three (0-9) in black women, and six (0-13) in women of other races. Racial disparities in the receipt of SUI surgery may exist.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Incontinência Urinária por Estresse/etnologia , Incontinência Urinária por Estresse/cirurgia , Negro ou Afro-Americano/estatística & dados numéricos , Comorbidade , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Prevalência , Estados Unidos/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Prolapso Uterino/etnologia , Prolapso Uterino/cirurgia , População Branca/estatística & dados numéricos
7.
Artigo em Inglês | MEDLINE | ID: mdl-18043958

RESUMO

The objective of this study was to describe the distribution of stress urinary incontinence (SUI) surgery across age groups in the USA in 2003. Patients were grouped into four age categories: reproductive, perimenopausal, postmenopausal, and elderly. Data from the 2003 National Hospital Discharge Survey and National Census were used to estimate surgical rates by age group. In 2003, 129,778 women underwent 165,776 surgical procedures for SUI. Of these women, 12.2, 53.0, 30.4, and 4.5% belonged to reproductive, perimenopausal, postmenopausal, and elderly age groups, respectively. Surgical rates (per 10,000 women) were 4, 17, 19, and 9 in these age groups, respectively. Complications occurred most frequently in reproductive age women. Overall, SUI surgical rates were similar for perimenopausal and postmenopausal women and exceeded that in the elderly population. The greatest percentage of surgical procedures occurred in perimenopausal women. Women at all stages of reproductive life may seek surgical treatment for SUI.


Assuntos
Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estados Unidos , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/métodos
8.
Artigo em Inglês | MEDLINE | ID: mdl-17882343

RESUMO

The objective of this study was to describe the distribution of pelvic organ prolapse (POP) surgery across age groups in the USA in 2003. Patients were grouped into four age categories: Reproductive age, perimenopausal, postmenopausal, and elderly. Data from the 2003 National Hospital Discharge Survey and National Census were used to estimate surgical rates by age group. In 2003, 199,698 women underwent a total of 311,587 surgical procedures for POP. Prolapse surgical rates (per 10,000 women) were 7, 24, 31, and 17 in reproductive age, perimenopausal, postmenopausal, and elderly age groups, respectively. Surgical complications occurred in 28.8, 19.6, 18.6, and 22.1% of women in these age groups, respectively. Mortality was uncommon. Although often considered a condition of the elderly, this study suggests that pelvic organ prolapse is a condition affecting women across the reproductive life cycle and for which women of all ages seek surgical treatment.


Assuntos
Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos , Prolapso Uterino/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Prolapso Uterino/cirurgia
9.
Am J Obstet Gynecol ; 197(1): 70.e1-8, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17618763

RESUMO

OBJECTIVE: This study was undertaken to compare the prevalence, demographics, and complications of pelvic organ prolapse surgery across races in the United States. STUDY DESIGN: Data from the 2003 National Census and the 2003 National Hospital Discharge Survey were used to determine rates of prolapse surgery, demographic characteristics, morbidity, and mortality across races. RESULTS: In 2003, 199,698 women underwent prolapse surgery. Rates of prolapse surgery per 10,000 women were 14.8, 5.6, and 8.7 in women of white, black, and other races. By geographic region, surgical rates per 10,000 white vs black women differed most in the West (16.0 vs 0.8). Of black women, 27% were on public assistance, compared with 5.9% and 9.6% women of white and other races. Complications occurred in 19.4%, 34.1%, and 27.4% of women of white, black, other races. Mortality was uncommon for all races. CONCLUSION: Racial disparities between white and black women undergoing prolapse surgery appear to exist.


Assuntos
População Negra/estatística & dados numéricos , Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos , Prolapso Uterino/etnologia , Prolapso Uterino/epidemiologia , População Branca/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Prolapso Uterino/cirurgia
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