Appendix 1. Activity Assessment Scale With Description of ScoringActivity Assessment Scale (AAS) consists of 13 questions that will be summarized.The overall AAS score will be calculated as follows:1) Answers of 1=No difficulty, through 5=Not able to do it, will be summed across questions 1-13. Answers of 6=Did not do it for other reasons, will not be included in the sum.2) The mean will be calculated by dividing the sum from step 1 by the number of answers contributing to the sum.3) The mean from step 2 will be multiplied by 13. The result will be the raw score. 4) The raw score will be scaled from 0 to 100 using the following formula: 5) (65 -raw score)/52 x 100. Note: 65 is the maximum raw score, and 52 is the range of possible scores (65-13=52).Boyd SS, O'Sullivan DM, Tunitsky-Bitton E. Two methods of catheter management after pelvic reconstructive surgery: a randomized controlled trial. Obstet Gynecol 2019;134. The authors provided this information as a supplement to their article.
Practice variability in catheterization after pelvic reconstructive and incontinence surgery is high. Distribution of catheterization type by specialty varies significantly, with clean-intermittent straight catheterization most prevalent. Future studies are necessary to establish a consensus on optimal catheterization management technique for patients with acute postoperative voiding dysfunction.
Purpose The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30 months postpartum, and to identify risk factors for UI during and after pregnancy. Methods Nulliparous women aged 18 to 35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30 months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identi ed risk factors for UI during pregnancy and during the follow-up period.Results Overall, 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy.The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11,). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6 months postpartum to 27.4% at 30 months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87). ConclusionOur ndings suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the rst 2-3 years postpartum, and treatment options discussed.
OBJECTIVES: To evaluate if long-term pessary use is associated with a change in pelvic organ prolapse (POP) severity and genital hiatus (GH) size. MATERIALS AND METHODS: This is a retrospective study of women using pessaries for treatment of symptomatic POP and/or incontinence from January 2014 to April 2017 at a single urogynecology practice. Baseline and most recent pelvic organ prolapse quantification (POPQ) measurements and stages were recorded. The primary outcome was change in POPQ point GH. Secondary outcomes included change in POPQ stage, type of pessary (e.g., space-filling or support), size of pessary, number of pessary changes over time (e.g., size and/or type of pessary), and duration of use. Demographic characteristics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used to compare categorical data as appropriate. Pearson's and Spearman's correlation coefficients were used where appropriate for evaluation of change over time. RESULTS: A total of 132 patients were included in the analysis. The cohort was predominantly non-Hispanic white (75%) women using pessaries for symptomatic POP greater than stage 2 (70.5%). All patients were post-menopausal. Median duration of pessary use was 39.5 months (IQR 17-64.5 months). POPQ point GH (r ¼ -0.215, p ¼ 0.014) and POPQ stage (r ¼ -0.276, p ¼ 0.001) decreased significantly as duration of pessary use increased. Compared to patients with baseline POPQ stage <3, those with baseline POPQ stages 3 had a significant decrease in GH as duration of pessary use increased (-0.5 cm vs. 0 cm, p <0.001). This relationship was not seen when comparing baseline GH <3 cm to those with baseline GH 3 cm. Patients underwent a significant number of changes in pessary type over time (p < 0.001); however, there was no significant change in the size of pessary over time (p ¼ 0.191). CONCLUSION: Pessary use by women with pelvic organ prolapse causes a change in vaginal anatomy over time as seen by decreasing POPQ stage and point GH. Prospective studies are needed to further characterize and confirm these findings.
POP-Q is the most common staging system used in published articles across studied subgroups. When used as an outcome measure, a greater number of authors use the recommended staging system rather than specific points.
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