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Prevalence of Pelvic Floor Disorders in Women with Gynecologic Malignancies
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S26
Figure 1. FI Episodes at baseline, 3, 6, and 12 months and Treatment Response.
0 (range = 0-14.5) (p \ 0.001). The mean CCIS decreased from 13.9 at baseline to 9.6 at 12 months (p \ 0.001). FIQOL scores for all four domains improved significantly from baseline to 12 months (p \ 0.001) (Table 1). A total of 66 subjects experienced 104 procedure and/or device-related adverse events. Most AEs were short in duration and 97% were managed without therapy or with non-surgical interventions (Table 2). No treatment-related deaths, erosions, extrusions, or device revisions were reported. The most common AE categories were pelvic pain (n = 47) and infection (n = 26). Those subjects experiencing pelvic pain had a mean pain score (0-10 scale, 0 = no pain) during the 12 month follow-up of 1.2 (SD 2.4). Conclusion: The TOPASÔ system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Dee Fenner: AMS, P.I., research support Vincent Lucente: AMS, consultant, researcher, consulting fee, research support; Bard, consultant, consulting fee; Coloplast, consultant, researcher, consulting fee, research Massarat Zutshi: AMS, Consultant and Research Support, Honorarium and Research Support Patrick Culligan: Intuitive Surgical, Research Grant and Consultant/Advisory Board, Honorarium; AMS, Researcher, Research grant; Boston Scientific, Researcher, Research grant; Origami Surgical, LLC, Founder and Stock Holder, Ownership interest Anders Mellgren: AMS, Consultant, Honorarium; Medtronic, Consultant, Honorarium; Salix, Consultant, Honorarium
Oral Presentation 6 Prevalence of Pelvic Floor Disorders in Women with Gynecologic Malignancies Bretschneider CE,1 Doll K,1,3 Bensen JT,3 Gehrig PA,1,3 Wu JM,1,2 Geller EJ.1 1Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; 2Center for Women’s Health Research, University of North Carolina, Chapel Hill, North Carolina; 3 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina Objectives: Our knowledge of pelvic floor disorders (PFD) among women with gynecologic cancer, both at baseline and after treatment, is limited. Our objective was to describe the prevalence of PFD in women with gynecologic malignancies prior to surgical management. Materials and Methods: Women age 18 and older with a gynecologic malignancy were prospectively enrolled in a university Health Registry/
Cancer Survivorship Cohort from August 2012 to June 2013. Data regarding demographics and past medical and surgical history were abstracted. Subjects completed validated questionnaires to assess bladder and bowel dysfunction. Bladder symptoms included stress urinary incontinence (SUI), urge urinary incontinence (UUI), urgency, frequency, nocturia and enuresis. Bowel symptoms included fecal incontinence (FI), abdominal pain, constipation and diarrhea. The effect of age was assessed by comparing women \ versus R 50 years. Results: Among 186 women diagnosed with gynecologic malignancy, 154 (82%) completed baseline assessments prior to surgery. Mean age was 58.1 13.3 years and mean BMI was 33.6 8.8 kg/m2. The majority of subjects had endometrial cancer (61.8%), followed by ovarian (17.1%) and cervical (11.1%). The overall rate of urinary incontinence was 46.1%. More than half reported SUI (59.5%), more than one third reported UUI (33.9%), and 40.8% reported urgency. The rate of nocturia was 82.3%, with 21.5% of women reporting nocturia ‘‘most of the time’’ or ‘‘all the time.’’ The rate of enuresis was 7.2%. Regarding bowel symptoms, the overall rate of FI was 3.9%, abdominal or stomach pain was 46.8%, constipation was 42.2%, and diarrhea was 20.1%. When comparing cancer types, there were no differences in pelvic floor symptoms. In order to assess the impact of age, we compared women age \ 50 versus R 50 years, and found that the older cohort had higher rates of bladder pain (p = 0.008), SUI (p = 0.005), UUI (p = 0.009), and enuresis (p = 0.001). The older cohort also had higher rates of abdominal or stomach pain (p = 0.002) and constipation (p = 0.006). SUI and UUI were not significantly associated with age when modeled as a continuous variable. Conclusion: Pelvic floor dysfunction is common in women with all gynecologic malignancies at baseline prior to surgical intervention, with a higher prevalence in older women. Recognizing pelvic floor dysfunction in the preoperative setting will allow for more individualized and comprehensive perioperative counseling and care for these women. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Carol E. Bretschneider: Nothing to disclose Kemi Doll: Nothing to disclose Jeannette T. Bensen: Nothing to disclose Paola A. Gehrig: Nothing to disclose Jennifer M. Wu: Nothing to disclose Elizabeth J. Geller: Nothing to disclose
Oral Presentation 7 The Use of Mechanical Bowel Preparation in Laparoscopic Gynecologic Surgery: A Decision Analysis Kantartzis KL,1 Shepherd JP.2 1University of Arizona, Tempe, Arizona; 2 University of Pittsburgh, Pittsburgh, Pennsylvania Objectives: The use of mechanical bowel preparation (MBP) prior to laparoscopy is common in gynecology, but the use of MBP may affect the rates of perioperative events and complications. Recent randomized trials have shown that for both vaginal prolapse surgery and laparoscopic hysterectomy MBP conferred no benefit for surgeon visualization and decreased patient satisfaction. However, these studies used various MBP and routes of surgery thus making comparison difficult. Our objective was to compare different MBPs, including no MBP, to determine the optimal bowel preparation prior to laparoscopic gynecologic surgery. Materials and Methods: A decision analysis was constructed modelling perioperative outcomes with the following MBP: magnesium citrate (MgCit), sodium phosphate (NaPhos), polyethylene glycol (PEG), Fleets enema, and No MBP. Data from 28 studies was used to analyze 5 preoperative events and complications. We also modelled 4 intra- or postoperative complications. Comparisons were made using published utility values. The utility and probability values are listed in Table 1. Secondary analyses included the percentage that have R1 preoperative event or complication and the percentage with R1 intra- or postoperative complication. Results: Overall, the highest utility values were for No MBP (0.98) and MgCit (0.97), while the other values were: Fleets (0.95), NaPhos (0.93), PEG (0.90). The difference between No MBP and MgCit was less than
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S26
Figure 1. FI Episodes at baseline, 3, 6, and 12 months and Treatment Response.
0 (range = 0-14.5) (p \ 0.001). The mean CCIS decreased from 13.9 at baseline to 9.6 at 12 months (p \ 0.001). FIQOL scores for all four domains improved significantly from baseline to 12 months (p \ 0.001) (Table 1). A total of 66 subjects experienced 104 procedure and/or device-related adverse events. Most AEs were short in duration and 97% were managed without therapy or with non-surgical interventions (Table 2). No treatment-related deaths, erosions, extrusions, or device revisions were reported. The most common AE categories were pelvic pain (n = 47) and infection (n = 26). Those subjects experiencing pelvic pain had a mean pain score (0-10 scale, 0 = no pain) during the 12 month follow-up of 1.2 (SD 2.4). Conclusion: The TOPASÔ system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Dee Fenner: AMS, P.I., research support Vincent Lucente: AMS, consultant, researcher, consulting fee, research support; Bard, consultant, consulting fee; Coloplast, consultant, researcher, consulting fee, research Massarat Zutshi: AMS, Consultant and Research Support, Honorarium and Research Support Patrick Culligan: Intuitive Surgical, Research Grant and Consultant/Advisory Board, Honorarium; AMS, Researcher, Research grant; Boston Scientific, Researcher, Research grant; Origami Surgical, LLC, Founder and Stock Holder, Ownership interest Anders Mellgren: AMS, Consultant, Honorarium; Medtronic, Consultant, Honorarium; Salix, Consultant, Honorarium
Oral Presentation 6 Prevalence of Pelvic Floor Disorders in Women with Gynecologic Malignancies Bretschneider CE,1 Doll K,1,3 Bensen JT,3 Gehrig PA,1,3 Wu JM,1,2 Geller EJ.1 1Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; 2Center for Women’s Health Research, University of North Carolina, Chapel Hill, North Carolina; 3 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina Objectives: Our knowledge of pelvic floor disorders (PFD) among women with gynecologic cancer, both at baseline and after treatment, is limited. Our objective was to describe the prevalence of PFD in women with gynecologic malignancies prior to surgical management. Materials and Methods: Women age 18 and older with a gynecologic malignancy were prospectively enrolled in a university Health Registry/
Cancer Survivorship Cohort from August 2012 to June 2013. Data regarding demographics and past medical and surgical history were abstracted. Subjects completed validated questionnaires to assess bladder and bowel dysfunction. Bladder symptoms included stress urinary incontinence (SUI), urge urinary incontinence (UUI), urgency, frequency, nocturia and enuresis. Bowel symptoms included fecal incontinence (FI), abdominal pain, constipation and diarrhea. The effect of age was assessed by comparing women \ versus R 50 years. Results: Among 186 women diagnosed with gynecologic malignancy, 154 (82%) completed baseline assessments prior to surgery. Mean age was 58.1 13.3 years and mean BMI was 33.6 8.8 kg/m2. The majority of subjects had endometrial cancer (61.8%), followed by ovarian (17.1%) and cervical (11.1%). The overall rate of urinary incontinence was 46.1%. More than half reported SUI (59.5%), more than one third reported UUI (33.9%), and 40.8% reported urgency. The rate of nocturia was 82.3%, with 21.5% of women reporting nocturia ‘‘most of the time’’ or ‘‘all the time.’’ The rate of enuresis was 7.2%. Regarding bowel symptoms, the overall rate of FI was 3.9%, abdominal or stomach pain was 46.8%, constipation was 42.2%, and diarrhea was 20.1%. When comparing cancer types, there were no differences in pelvic floor symptoms. In order to assess the impact of age, we compared women age \ 50 versus R 50 years, and found that the older cohort had higher rates of bladder pain (p = 0.008), SUI (p = 0.005), UUI (p = 0.009), and enuresis (p = 0.001). The older cohort also had higher rates of abdominal or stomach pain (p = 0.002) and constipation (p = 0.006). SUI and UUI were not significantly associated with age when modeled as a continuous variable. Conclusion: Pelvic floor dysfunction is common in women with all gynecologic malignancies at baseline prior to surgical intervention, with a higher prevalence in older women. Recognizing pelvic floor dysfunction in the preoperative setting will allow for more individualized and comprehensive perioperative counseling and care for these women. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Carol E. Bretschneider: Nothing to disclose Kemi Doll: Nothing to disclose Jeannette T. Bensen: Nothing to disclose Paola A. Gehrig: Nothing to disclose Jennifer M. Wu: Nothing to disclose Elizabeth J. Geller: Nothing to disclose
Oral Presentation 7 The Use of Mechanical Bowel Preparation in Laparoscopic Gynecologic Surgery: A Decision Analysis Kantartzis KL,1 Shepherd JP.2 1University of Arizona, Tempe, Arizona; 2 University of Pittsburgh, Pittsburgh, Pennsylvania Objectives: The use of mechanical bowel preparation (MBP) prior to laparoscopy is common in gynecology, but the use of MBP may affect the rates of perioperative events and complications. Recent randomized trials have shown that for both vaginal prolapse surgery and laparoscopic hysterectomy MBP conferred no benefit for surgeon visualization and decreased patient satisfaction. However, these studies used various MBP and routes of surgery thus making comparison difficult. Our objective was to compare different MBPs, including no MBP, to determine the optimal bowel preparation prior to laparoscopic gynecologic surgery. Materials and Methods: A decision analysis was constructed modelling perioperative outcomes with the following MBP: magnesium citrate (MgCit), sodium phosphate (NaPhos), polyethylene glycol (PEG), Fleets enema, and No MBP. Data from 28 studies was used to analyze 5 preoperative events and complications. We also modelled 4 intra- or postoperative complications. Comparisons were made using published utility values. The utility and probability values are listed in Table 1. Secondary analyses included the percentage that have R1 preoperative event or complication and the percentage with R1 intra- or postoperative complication. Results: Overall, the highest utility values were for No MBP (0.98) and MgCit (0.97), while the other values were: Fleets (0.95), NaPhos (0.93), PEG (0.90). The difference between No MBP and MgCit was less than