Obesity prevalence is increasing worldwide, with significant healthcare implications. We searched PubMed/MEDLINE, Embase and the Cochrane Library for articles registered until June 2020 to explore the relationship between obesity and urinary (UI) and anal incontinence (AI). Obesity is associated with low‐grade, systemic inflammation and proinflammatory cytokine release, producing reactive oxygen species and oxidative stress. This alters collagen metabolism and, in combination with increased intra‐abdominal pressure, contributes to the development of UI. Whereas in AI, stool consistency may be a factor. Weight loss can reduce UI and should be a management focus; however, the effect of weight loss on AI is less clear.
Introduction and hypothesis The coronavirus (COVID-19) pandemic has impacted health systems worldwide. There is a continuing need for clinicians to adapt practice to facilitate timely provision of medical care, whilst minimising horizontal transmission. Guidance and recommendations are increasingly available, and this rapid review aimed to provide a timely evidence synthesis on the current recommendations surrounding urogynaecological care. Methods We performed a literature review using PubMed/Medline, Embase and Cochrane and a manual search of national and international societies for management recommendations for urogynaecological patients during the COVID-19 pandemic. Results Nine guidance documents and 17 articles, including 10 reviews, were included. Virtual clinics are recommended for new and follow-up patients, to assess and initiate treatment, as well as triage patients who require face-to-face appointments. Outpatient investigations such as urodynamics and cystoscopy for benign indications can be deferred. Prolapse and continence surgery should be suspended, except in specific circumstances such as procidentia with upper tract complications and failed pessaries. There is no evidence to support a particular route of surgery, but recommendations are made to minimise COVID-19 transmission. Conclusions Urogynaecological patients face particular challenges owing to inherent vulnerabilities of these populations. Behavioural and medical therapies should be recommended as first line options and initiated via virtual or remote clinics, which are integral to management during the COVID-19 pandemic. Expanding the availability and accessibility of technology will be increasingly required. The majority of outpatient and inpatient procedures can be deferred, but the longer-term effects of such practices are unclear.
Introduction and hypothesis Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP. Methods We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations. Results Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the “Applicability”, “Editorial Independence” and “Stakeholder Involvement” domains. Conclusion Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development.
Key content Pelvic organ prolapse and incontinence are significant health problems; one in nine women are affected by prolapse and one in three by stress urinary incontinence. Pelvic floor muscle training remains the first‐line treatment for stress urinary incontinence. Concomitant surgical correction for coexisting symptomatic prolapse and incontinence is an option for treatment, but persistent postoperative incontinence can be challenging to manage. Delayed or interval continence procedures may be beneficial and should be discussed with women preoperatively. Learning objectives To understand the health burden and prevalence of pelvic organ prolapse and incontinence in the population. To understand the surgical treatment options available. To learn about the advantages and disadvantages of concomitant surgery in patients with symptomatic or occult stress incontinence and in those who are continent. Ethical issues Should transvaginal prolapse repair and concomitant synthetic miduretheral sling be offered to women without stress urinary incontinence? Should all women be preoperatively screened for occult stress urinary incontinence, given its prevalence and implications for postoperative outcomes?
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