BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that ...BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral. AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns. METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics. RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51%(n = 26) of the PCP compared to 48%(n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals)(P = 0.02). CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.展开更多
目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其...目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其分成对照组和试验组,各41例。对照组给予改良Le Fort阴道封闭术,试验组给予改良全盆底重建术。比较两组围手术期指标,相关指标,术前、术后半年临床症状及生活质量,术前、术后1周排尿、排便情况。结果:两组手术时间、住院时间、留置尿管时间、术中出血量比较,差异无统计学意义(P>0.05)。试验组治愈率高于对照组,复发率、新发压力性尿失禁发生率、再次手术发生率均低于对照组,差异有统计学意义(P<0.05)。术后半年,两组盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评分、盆底功能影响问卷简表(pelvic floor impact questionnaire--short form 7,PFIQ-7)评分降低,试验组PFDI-20评分、PFIQ-7评分均低于对照组,差异有统计学意义(P<0.05)。术后1周,试验组尿急、尿频、排尿困难、排便困难发生率均低于对照组,差异有统计学意义(P<0.05)。结论:改良全盆底重建术更有助于改善患者脱垂复发率,改善患者排尿、排便情况,手术十分安全有效。展开更多
文摘BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral. AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns. METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics. RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51%(n = 26) of the PCP compared to 48%(n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals)(P = 0.02). CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.
文摘目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其分成对照组和试验组,各41例。对照组给予改良Le Fort阴道封闭术,试验组给予改良全盆底重建术。比较两组围手术期指标,相关指标,术前、术后半年临床症状及生活质量,术前、术后1周排尿、排便情况。结果:两组手术时间、住院时间、留置尿管时间、术中出血量比较,差异无统计学意义(P>0.05)。试验组治愈率高于对照组,复发率、新发压力性尿失禁发生率、再次手术发生率均低于对照组,差异有统计学意义(P<0.05)。术后半年,两组盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评分、盆底功能影响问卷简表(pelvic floor impact questionnaire--short form 7,PFIQ-7)评分降低,试验组PFDI-20评分、PFIQ-7评分均低于对照组,差异有统计学意义(P<0.05)。术后1周,试验组尿急、尿频、排尿困难、排便困难发生率均低于对照组,差异有统计学意义(P<0.05)。结论:改良全盆底重建术更有助于改善患者脱垂复发率,改善患者排尿、排便情况,手术十分安全有效。
