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The article focuses on a study which investigated demographic and clinical predictors of midurethral sling failure in women with stress urinary incontinence (SUI). The study found that overall odds of midurethral sling failure are more common with women with previous incontinence surgery, more severe urinary incontinence symptoms, and urethral hypomobility. Pad weight testing was also considered to be a powerful predictor of midurethal sling failure.

The article presents a study which investigated whether perioperative and postoperative outcomes after Burch colposuspension or pubovaginal sling for stress urinary incontinence (SUI) differed with age in the U.S. The study is a prospective secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial. It is indicated that older women undergoing surgery for stress incontinence can expect to do and younger women with respect to perioperative outcomes.

The article presents a research from the U.S. Centers for Disease Control and Prevention (CDCP) and the World Health Organization (WHO) that summarizes the effect of obesity and outcomes of surgical treatment of pelvic floor disorders. It states that surgery for urinary incontinence (UI) in obese women is safe, but needs more trials in evaluating its long-term effectiveness. It is stated that weight loss should be considered in the treatment of pelvic floor disorders in the obese woman.

Pelvic organ prolapse, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of American women. This article, designed for the practicing clinician, highlights the clinical importance of prolapse, its pathophysiology, and approaches to diagnosis and therapy. Prolapse encompasses a range of disorders, from asymptomatic altered vaginal anatomy to complete vaginal eversion associated with severe urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial and may operate under a "multiple-hit" process in which genetically susceptible women are exposed to life events that ultimately result in the development of clinically important prolapse. The evaluation of women with prolapse requires a comprehensive approach, with attention to function in all pelvic compartments based on a detailed patient history, physical examination, and limited testing. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often challenging for the clinician to determine which symptoms are attributable to the prolapse itself and will therefore improve or resolve once the prolapse is treated. When treatment is warranted based on specific symptoms, prolapse management choices fall into 2 broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive (eg, sacral colpopexy) or obliterative (eg, colpocleisis). Concomitant symptoms require additional management. Virtually all women with prolapse can be treated and their symptoms improved, even if not completely resolved. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the two-year anatomic and functional outcomes after sacrocolpopexy in stress-continent women in the U.S. with or without prophylactic Burch colposuspension. The study found that the early advantage of prophylactic Burch colposuspension for stress incontinence that was seen at three months remains at two years. Apical anatomic success rates are found to be high and not affected by concomitant Burch.

OBJECTIVE: To estimate the prevalence and trends of these pelvic floor disorders in U.S. women from 2005 to 2010. METHODS: We used the National Health and Nutritional Examination Survey from 2005-2006, 2007-2008, and 2009-2010. A total of 7,924 nonpregnant women (aged 20 years or older) were categorized as having: urinary incontinence (UI)--moderate to severe (3 or higher on a validated UI severity index, range 0-12); fecal incontinence--at least monthly (solid, liquid, or mucus stool); and pelvic organ prolapse--seeing or feeling a bulge. Potential risk factors included age, race and ethnicity, parity, education, poverty income ratio, body mass index ([BMI] less than 25, 25-29, 30 or greater), comorbidity count, and reproductive factors. Using appropriate sampling weights, weighted X analysis and multivariable logistic regression models with odds ratios and 95% confidence intervals (95% Cls) were reported. RESULTS: The weighted prevalence rate of one or more pelvic floor disorders was 25.0% (95% Cl 23.6-26.3), including 17.1% (95% Cl 15.8-18.4) of women with moderate-to-severe UI, 9.4% (95% Cl 8.6-10.2) with fecal incontinence, and 2.9% (95% Cl 2.5-3.4) with prolapse. From 2005 to 2010, no significant differences were found in the prevalence rates of any individual disorder or for all disorders combined (P>.05). After adjusting for potential confounders, higher BMI, greater parity, and hysterectomy were associated with higher odds of one or more pelvic floor disorders. CONCLUSION: Although rates of pelvic floor disorders did not change from 2005 to 2010, these conditions remain common, with one fourth of adult U.S. women reporting at least one disorder. [ABSTRACT FROM AUTHOR]

The article discusses a study on the link between the magnitude of weight loss and improvements in the frequency of urinary incontinence in overweight women in the U.S. The research revealed that the improvement in the frequency of urinary incontinence has been significant in women who had 5% to 10% weight losses. Other studies suggested that the decrease of about 5% to 10% of body weight are correlated to better health outcomes such as lessening the risk of noninsulin-dependent diabetes and avoiding hypertension.

Objectives: To use static and dynamic magnetic resonance imaging (MRI) to compare dimensions of the bony pelvis and soft tissue structures in a sample of African-American and white women.Methods: This study used data from 234 participants in the Childbirth and Pelvic Symptoms Imaging Study, a cohort study of 104 primiparous women with an obstetric anal sphincter tear, 94 who delivered vaginally without a recognized anal sphincter tear and 36 who underwent by cesarean delivery without labor. Race was self-reported. At 6-12 months postpartum, rapid acquisition T2-weighted pelvic MRIs were obtained. Bony and soft tissue dimensions were measured and compared between white and African-American participants using analysis of variance, while controlling for delivery type and age.Results: The pelvic inlet was wider among 178 white women than 56 African-American women (10.7+/-0.7 cm compared with 10.0.+0.7 cm, P<.001). The outlet was also wider (mean intertuberous diameter 12.3+/-1.0 cm compared with 11.8+/-0.9 cm, P<.001). There were no significant differences between racial groups in interspinous diameter, angle of the subpubic arch, anteroposterior conjugate, levator thickness, or levator hiatus. In addition, among women who delivered vaginally without a sphincter tear, African-American women had more pelvic floor mobility than white women. This difference was not observed among women who had sustained an obstetric sphincter tear.Conclusion: White women have a wider pelvic inlet, wider outlet, and shallower anteroposterior outlet than African-American women. In addition, after vaginal delivery, white women demonstrate less pelvic floor mobility. These differences may contribute to observed racial differences in obstetric outcomes and to the development of pelvic floor disorders. [ABSTRACT FROM AUTHOR]

The article examines the costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement in the United States. Results reveal that women with severe urinary incontinence pay $900 each year for incontinence routine care, and incontinence related to a significant decrement in health-related quality of life. Effective incontinence treatment may reduce costs and enhance quality of life.

OBJECTIVE: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the ‘TOSH’ trial). We report here an analysis of 24-month resource use by patients in this trial. METHODS: A randomized controlled trial was performed at 3 clinical centers to compare resources used by 120 patients who received a total or supracervical abdominal hysterectomy. Service use during a 24-month follow-up period was identified from medical and billing records and patient reports. Each service used was assigned a relative value, which was then converted into 2002 U.S. dollars. RESULTS: Overall resource use was similar in the 2 study groups in the first 12 months after randomization (TAH $5,870; SCH $6,018; 95% confidence interval for difference -$960, $1,255; P < .79) and for the full 24 months (TAH $6,448; SCH $7,479; 95% confidence interval for difference -$533, $2,616; P < .20). In exploratory multivariable analyses, resource use was significantly associated with baseline body mass index greater than or equal to 35 kg/m² ($8,440 versus $6,398, P = .02) and heavy bleeding ($7,550 versus $5,368, P = .02). CONCLUSION: We conclude that the use of medical care resources over a 24-month period is comparable for total and supracervical hysterectomy. The association of a woman's weight and bleeding pattern with subsequent resource use requires further investigation. [ABSTRACT FROM AUTHOR]