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Pelvic Floor Dysfunction Surgery Tops Other Treatments for Patients Reaching Personal Goals: Presented at AUGS

By Mike Fillon

ATLANTA, GA -- September 21, 2005 -- A new study shows that surgical treatments for pelvic floor dysfunction are more likely to help patients achieve their personal goals, and satisfaction with their quality-of-life than non-surgical treatments.

Lead researcher Kathie L. Hullfish, MD, Associate Professor of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Medicine, University of Virginia Health System presented the results here on September 17^th at the 26^th Annual Scientific Meeting of The American Urogynecologic Society (AUGS).

For the study, Dr. Hullfish and colleagues recruited 60 women between September 2003 and December 2004 during their initial referral visit for PFD treatment at their outpatient urogynecology clinic. Subjects were followed for 6 months.

The average age was 60.4 years. Ninety five percent of the subjects were White, 70% were married; 93.3% did not smoke; 91.5% had delivered at least one baby vaginally.

Diagnoses included prolapse (70.0%), urinary incontinence (58.3%), and fecal incontinence (31.7%), and more than half had multiple conditions (58%); 31.7% underwent surgical procedures, while the others were managed non-surgically.

During the first visit, patients were asked to list their top five treatment goals, and "anchored" each goal by anticipating best and worst possible outcomes. After 1.5 months, 3 months and 6 months, the women were asked to indicate their level of goal attainment (-2 was the worst outcome and +2 for best).

At baseline and at each follow-up visit, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) with a range of 0-100 and high scores indicating greater impact or distress. Patients indicated level of treatment satisfaction on a 4-level ordinal scale.

The women indicated an average of 2.7 treatment goals (SD=1.4) that focused primarily on symptom or pain relief, as well as improved activity or self-image. Goal achievement did not differ by condition or number of conditions. Also, goal achievement did not differ at 1.5 or 3 months by treatment.

At 6 months, mean goal achievement levels were higher for women who underwent surgery compared to medically-managed subjects (1.2 vs. 0.5; t= -2.6, P = .01.

Women who were treated surgically reported significantly lower impact scores on the IIQ compared to those treated medically at 3 months (4.4 vs. 15.2, t=2.8, P = .008), but not at 1.5 or 6 months.

Surgical treatment was associated with significantly lower distress scores on the UDI at 3 months (15.9 vs. 28.8, t=2.7, P = .001) and 6 months (11.5 vs. 27.4, t=3.4, P = .001), but not at 1.5 or 6 months. Surgery was also associated with significantly lower distress scores on the UDI at 3 months (15.9 vs. 28.8, t=2.7, P = .01) and 6 months (11.5 vs. 27.4, t=3.4, P = .001), but not at 1.5 months.

"Medically and surgically managed patients did not differ significantly in their satisfaction with care," Dr. Hullfish said.

She added that by 6 months, goals were more likely to be achieved and quality of life maintained in the surgically managed group. "Further follow-up will determine whether longer-term goal achievement differs by treatment," she said.


[Presentation title: Achieving Pelvic Floor Dysfunction (PFD) Treatment Goals in Medically and Surgically Managed Patients. Paper 49]

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