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Urinary incontinence in gynecology patients
Osteoporosis in Treated Gynecologic Oncology Patients Giuseppe Del Priore, MD, MPH NYU Medical School, New York, NY
Mehrangiz Hatami, MD, Holly Loudon, MD, and Paul C. Liu, MD OBJECTIVE: Osteoporosis kills more women each year than all gynecologic cancers combined. We sought to determine the prevalence, severity, and treatment of osteoporosis in women with gynecologic malignancies. METHODS: A cross-sectional analysis was performed on patients between November 2001and May 2002. Dual energy x-ray absorptiometry scan (DEXA) was offered to all patients attending clinics over 16 days. Eighty-four patients were seen and all offered screening, with 33 (39%) agreeing to testing. Charts were reviewed for osteoporosis risk factors, treatment, and cancer characteristics. RESULTS: The mean age of the patients was 51.25 years. 6 patients were excluded. 66% of screened patients had osteoporosis or osteopenia (OP), and 16% had had fractures. None took selective estrogen receptor modulators (SERMs), one was taking a bisphosphonate, and 44.7% of menopausal patients were receiving HRT. Patients with endometrial or cervical cancer (35.3%) were less likely to receive HRT than patients with other cancers (60%) (P ⬍ 0.05), and those with late stage/advanced disease (52.3%) were also less likely to receive HRT than early stage patients (38.5%) (P ⬍ 0.05). Patients with early stage disease (41.7%) were less likely to have OP than patients with late stage/advanced disease (69.2%) (P ⬍ 0.05); those treated with surgery alone had less risk of OP, with 68.4% receiving HRT. Seventy percent of the patients had no evidence of cancer. CONCLUSION: In this study ,we found a high rate of disease but no screening and very little treatment. OP screening and treatment should become a part of the routine care of these patients.
Supracervical Hysterectomy: A Survey of the Society of Gynecologic Oncologists Giuseppe Del Priore, MD, MPH NYU Medical School, New York, NY
Raffi A. Ghalian, MBBS, Debrah J. Goldfrank, MD, Ben A. Esdaile, Michael L. Silverstein, MD, and J. Richard Smith, MD OBJECTIVE: The aim of our study was to investigate the trends and opinions of the Society of Gynecologic Oncologists
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
(SGO) and compare them with UK gynecologic oncologists regarding the use of supracervical hysterectomies (SCH). METHODS: We designed a questionnaire to assess influences on a clinician’s decision to perform a supracervical hysterectomy, including practice setting, gender, and age of the clinician. RESULTS: The survey found that 88% of UK gynecologists and 50% of the SGO would perform a supracervical hysterectomy for benign disease. Younger practitioners (graduated for less than 15 years) were more likely to perform an SCH to reduce operative morbidity, to preserve sexual function, and for benign disease when compared with the more experienced practitioners (P ⬍ .05). The gender of the practitioner had no influence on the rates and indications for SCH. Female practitioners saw the same number of patients, worked the same number of hours, and performed the same number of hysterectomies per week as male practitioners. Twenty-one percent of the US practitioners identified the future potential development of cervical carcinoma as a contraindication to perform an SCH, compared with 6.3% of the UK practitioners. Seventyfive percent of teaching hospital practitioners considered decreased operative morbidity as an indication for SCH, versus 67.7% of non–teaching hospital practitioners (P ⬍ .05). CONCLUSIONS: Most gynecologic oncologists now accept SCH to be a treatment option for benign disease of the uterus. The decision on whether to perform a hysterectomy is not influenced by gender, but is influenced by the age and practice setting of the practitioner.
Urinary Incontinence in Gynecology Patients Giuseppe Del Priore, MD, MPH NYU School of Medicine, New York, NY
Sherri Y. Taylor, MD, Ben A. Esdaile, Rachel Masch, MD, Yvette Martaz, MD, and John Wirth, MD OBJECTIVE: To investigate the prevalence and significance of urinary incontinence (UI) symptoms in gynecologic oncology (GO) patients, and to test the physicians’ proficiency in eliciting these symptoms. METHODS: We used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ) to elicit urinary incontinence symptoms in gynecologic oncology patients, and compared them with their office charts. A control group from a primary care obstetrics-gynecology practice was included for comparison. RESULTS: GO patients were significantly more likely to report urinary incontinence symptoms on the questionnaire than to report them to their provider during an office visit (P ⬍ .001). The survey found that 60% of the GO patients reported
TUESDAY POSTERS
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at least one symptom of urinary incontinence, with 23% complaining of “severe” symptoms. Of those patients who reported the symptoms on a questionnaire, only 8% were detected at the initial physician assessment. Eighteen percent of the GO patients reported that the UI symptoms adversely affected their quality of life. The prevalence of symptoms was not associated with the primary cancer site. There was no difference in detection rates between the two practice settings. In a multivariate analysis, there was no factor that emerged as the best discriminator for a positive response to the questionnaire. CONCLUSIONS: A significant proportion of gynecologic oncology patients report severe urinary incontinence symptoms that are not detected by practitioners during routine office visits.
patient whose stripe exceeds 25 mm could be safely managed medically for a miscarriage.
Viagra (Sildenafil Citrate) in Serotonergic Reuptake Inhibitor-Associated Female Sexual Dysfunction* H. George Nurnberg, MD University of New Mexico, Albuquerque, NM
Paula L. Hensley, MD, and Maxine Dorin, MD
Utility of Endometrial Stripe Thickness in the Diagnosis of Symptomatic Early Pregnancy Beata Napiorkowski, MD Hospital of the University of Pennsylvania, Philadelphia, PA
Kurt Barnhart, MD, MSCE, Jesse Chittams, MS, and Mary Sammel, ScD OBJECTIVE: To determine the utility of endometrial stripe thickness in the diagnosis of women with a symptomatic first trimester pregnancy whose initial clinical evaluation is otherwise nondiagnostic. METHODS: Endometrial stripe (ES) thickness, serum -hCG, characterization of vaginal bleeding, and ultimate definitive clinical outcome were collected for 576 patients with a symptomatic early pregnancy. Correlations between ES, -hCG, bleeding, and subsequent outcome were evaluated using chisquare, t tests, and logistic regression. RESULTS: Overall the ES was thinner with increased vaginal bleeding (P ⫽ 0.015), but bleeding alone was not associated with thickness after adjusting for clinical outcome and -hCG. The ES for those ultimately diagnosed with ectopic pregnancies (EP), spontaneous abortion (SAB), and intrauterine pregnancy (IUP) were 9.56 ⫾ 4.87 (range 1–25), 10.19 ⫾ 6.10 (range 1–37), and 12.12 ⫾ 6.0 (range 1– 40), respectively. After further adjusting for both clinical outcome and bleeding, the ES in the EP group was significantly thinner than that in the IUP group (P ⫽ 0.0078). 99% of patients with EP had an ES less than 21 mm, and 100% had 25 mm or less. CONCLUSIONS: Of patients with symptomatic early pregnancies, those with an ectopic pregnancy have a thinner ES on ultrasound than patients with IUP or SAB. However, given the considerable overlap in thickness between groups, ES has poor sensitivity in the diagnosis of EP. Nevertheless, an ES greater than 21 mm in a woman with no evidence of a gestational sac on ultrasound can exclude an EP with 95% specificity. A
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TUESDAY POSTERS
OBJECTIVE: To present preliminary results of Viagra (sildenafil citrate) treatment for serotonergic reuptake inhibitor (SRI)–associated female sexual dysfunction (SRI-FSD) in women enrolled in the single-blind, open-label (OL) extension of a double-blind (DB), placebo-controlled trial. METHODS: An 8-week, DB, placebo-controlled trial evaluating Viagra (50 –100 mg; flexible) in 150 women with clinically recovered major depressive disorder (MDD) and SRI-FSD is ongoing. We report results for an initial group of DB completers at the 8-week end point of the single-blind, OL extension phase of this trial. DB study entry criteria included MDD in remission (Hamilton Rating Scale for Depression [HAM-D] scores less than 10), no preexisting SD, stable SRI dose for at least 8 weeks, and significant FSD (Clinical Global Impression Scale for Sexual Function [CGI-SF] and other instruments). After a minimum of 24 weeks of SRI treatment and up to 16 weeks of Viagra, patients were evaluated for FSD, MDD in remission, and SRI dose continuation. RESULTS: Female SRI-FSD was characterized by disturbed libido (95%), decreased lubrication (55%), orgasm delay (86%), dissatisfaction with overall sexual function (68%), and pain (86%); 95% had multiple sexual problems. All DB completers received OL Viagra (N ⫽ 38) in single-blind fashion; 84% reported improvement in SD (CGI-SF mean score less than or equal to 2 [“much/very much improved”]) at OL end point. HAM-D scores remained less than 10 among all patients (n ⫽ 42). Antidepressant dose remained stable. CONCLUSIONS: In agreement with findings from earlier studies, Viagra appears to effectively treat SRI-FSD, allowing women to continue effective SRI treatment for MDD.
*This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
OBSTETRICS & GYNECOLOGY
Mehrangiz Hatami, MD, Holly Loudon, MD, and Paul C. Liu, MD OBJECTIVE: Osteoporosis kills more women each year than all gynecologic cancers combined. We sought to determine the prevalence, severity, and treatment of osteoporosis in women with gynecologic malignancies. METHODS: A cross-sectional analysis was performed on patients between November 2001and May 2002. Dual energy x-ray absorptiometry scan (DEXA) was offered to all patients attending clinics over 16 days. Eighty-four patients were seen and all offered screening, with 33 (39%) agreeing to testing. Charts were reviewed for osteoporosis risk factors, treatment, and cancer characteristics. RESULTS: The mean age of the patients was 51.25 years. 6 patients were excluded. 66% of screened patients had osteoporosis or osteopenia (OP), and 16% had had fractures. None took selective estrogen receptor modulators (SERMs), one was taking a bisphosphonate, and 44.7% of menopausal patients were receiving HRT. Patients with endometrial or cervical cancer (35.3%) were less likely to receive HRT than patients with other cancers (60%) (P ⬍ 0.05), and those with late stage/advanced disease (52.3%) were also less likely to receive HRT than early stage patients (38.5%) (P ⬍ 0.05). Patients with early stage disease (41.7%) were less likely to have OP than patients with late stage/advanced disease (69.2%) (P ⬍ 0.05); those treated with surgery alone had less risk of OP, with 68.4% receiving HRT. Seventy percent of the patients had no evidence of cancer. CONCLUSION: In this study ,we found a high rate of disease but no screening and very little treatment. OP screening and treatment should become a part of the routine care of these patients.
Supracervical Hysterectomy: A Survey of the Society of Gynecologic Oncologists Giuseppe Del Priore, MD, MPH NYU Medical School, New York, NY
Raffi A. Ghalian, MBBS, Debrah J. Goldfrank, MD, Ben A. Esdaile, Michael L. Silverstein, MD, and J. Richard Smith, MD OBJECTIVE: The aim of our study was to investigate the trends and opinions of the Society of Gynecologic Oncologists
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
(SGO) and compare them with UK gynecologic oncologists regarding the use of supracervical hysterectomies (SCH). METHODS: We designed a questionnaire to assess influences on a clinician’s decision to perform a supracervical hysterectomy, including practice setting, gender, and age of the clinician. RESULTS: The survey found that 88% of UK gynecologists and 50% of the SGO would perform a supracervical hysterectomy for benign disease. Younger practitioners (graduated for less than 15 years) were more likely to perform an SCH to reduce operative morbidity, to preserve sexual function, and for benign disease when compared with the more experienced practitioners (P ⬍ .05). The gender of the practitioner had no influence on the rates and indications for SCH. Female practitioners saw the same number of patients, worked the same number of hours, and performed the same number of hysterectomies per week as male practitioners. Twenty-one percent of the US practitioners identified the future potential development of cervical carcinoma as a contraindication to perform an SCH, compared with 6.3% of the UK practitioners. Seventyfive percent of teaching hospital practitioners considered decreased operative morbidity as an indication for SCH, versus 67.7% of non–teaching hospital practitioners (P ⬍ .05). CONCLUSIONS: Most gynecologic oncologists now accept SCH to be a treatment option for benign disease of the uterus. The decision on whether to perform a hysterectomy is not influenced by gender, but is influenced by the age and practice setting of the practitioner.
Urinary Incontinence in Gynecology Patients Giuseppe Del Priore, MD, MPH NYU School of Medicine, New York, NY
Sherri Y. Taylor, MD, Ben A. Esdaile, Rachel Masch, MD, Yvette Martaz, MD, and John Wirth, MD OBJECTIVE: To investigate the prevalence and significance of urinary incontinence (UI) symptoms in gynecologic oncology (GO) patients, and to test the physicians’ proficiency in eliciting these symptoms. METHODS: We used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ) to elicit urinary incontinence symptoms in gynecologic oncology patients, and compared them with their office charts. A control group from a primary care obstetrics-gynecology practice was included for comparison. RESULTS: GO patients were significantly more likely to report urinary incontinence symptoms on the questionnaire than to report them to their provider during an office visit (P ⬍ .001). The survey found that 60% of the GO patients reported
TUESDAY POSTERS
59S
at least one symptom of urinary incontinence, with 23% complaining of “severe” symptoms. Of those patients who reported the symptoms on a questionnaire, only 8% were detected at the initial physician assessment. Eighteen percent of the GO patients reported that the UI symptoms adversely affected their quality of life. The prevalence of symptoms was not associated with the primary cancer site. There was no difference in detection rates between the two practice settings. In a multivariate analysis, there was no factor that emerged as the best discriminator for a positive response to the questionnaire. CONCLUSIONS: A significant proportion of gynecologic oncology patients report severe urinary incontinence symptoms that are not detected by practitioners during routine office visits.
patient whose stripe exceeds 25 mm could be safely managed medically for a miscarriage.
Viagra (Sildenafil Citrate) in Serotonergic Reuptake Inhibitor-Associated Female Sexual Dysfunction* H. George Nurnberg, MD University of New Mexico, Albuquerque, NM
Paula L. Hensley, MD, and Maxine Dorin, MD
Utility of Endometrial Stripe Thickness in the Diagnosis of Symptomatic Early Pregnancy Beata Napiorkowski, MD Hospital of the University of Pennsylvania, Philadelphia, PA
Kurt Barnhart, MD, MSCE, Jesse Chittams, MS, and Mary Sammel, ScD OBJECTIVE: To determine the utility of endometrial stripe thickness in the diagnosis of women with a symptomatic first trimester pregnancy whose initial clinical evaluation is otherwise nondiagnostic. METHODS: Endometrial stripe (ES) thickness, serum -hCG, characterization of vaginal bleeding, and ultimate definitive clinical outcome were collected for 576 patients with a symptomatic early pregnancy. Correlations between ES, -hCG, bleeding, and subsequent outcome were evaluated using chisquare, t tests, and logistic regression. RESULTS: Overall the ES was thinner with increased vaginal bleeding (P ⫽ 0.015), but bleeding alone was not associated with thickness after adjusting for clinical outcome and -hCG. The ES for those ultimately diagnosed with ectopic pregnancies (EP), spontaneous abortion (SAB), and intrauterine pregnancy (IUP) were 9.56 ⫾ 4.87 (range 1–25), 10.19 ⫾ 6.10 (range 1–37), and 12.12 ⫾ 6.0 (range 1– 40), respectively. After further adjusting for both clinical outcome and bleeding, the ES in the EP group was significantly thinner than that in the IUP group (P ⫽ 0.0078). 99% of patients with EP had an ES less than 21 mm, and 100% had 25 mm or less. CONCLUSIONS: Of patients with symptomatic early pregnancies, those with an ectopic pregnancy have a thinner ES on ultrasound than patients with IUP or SAB. However, given the considerable overlap in thickness between groups, ES has poor sensitivity in the diagnosis of EP. Nevertheless, an ES greater than 21 mm in a woman with no evidence of a gestational sac on ultrasound can exclude an EP with 95% specificity. A
60S
TUESDAY POSTERS
OBJECTIVE: To present preliminary results of Viagra (sildenafil citrate) treatment for serotonergic reuptake inhibitor (SRI)–associated female sexual dysfunction (SRI-FSD) in women enrolled in the single-blind, open-label (OL) extension of a double-blind (DB), placebo-controlled trial. METHODS: An 8-week, DB, placebo-controlled trial evaluating Viagra (50 –100 mg; flexible) in 150 women with clinically recovered major depressive disorder (MDD) and SRI-FSD is ongoing. We report results for an initial group of DB completers at the 8-week end point of the single-blind, OL extension phase of this trial. DB study entry criteria included MDD in remission (Hamilton Rating Scale for Depression [HAM-D] scores less than 10), no preexisting SD, stable SRI dose for at least 8 weeks, and significant FSD (Clinical Global Impression Scale for Sexual Function [CGI-SF] and other instruments). After a minimum of 24 weeks of SRI treatment and up to 16 weeks of Viagra, patients were evaluated for FSD, MDD in remission, and SRI dose continuation. RESULTS: Female SRI-FSD was characterized by disturbed libido (95%), decreased lubrication (55%), orgasm delay (86%), dissatisfaction with overall sexual function (68%), and pain (86%); 95% had multiple sexual problems. All DB completers received OL Viagra (N ⫽ 38) in single-blind fashion; 84% reported improvement in SD (CGI-SF mean score less than or equal to 2 [“much/very much improved”]) at OL end point. HAM-D scores remained less than 10 among all patients (n ⫽ 42). Antidepressant dose remained stable. CONCLUSIONS: In agreement with findings from earlier studies, Viagra appears to effectively treat SRI-FSD, allowing women to continue effective SRI treatment for MDD.
*This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
OBSTETRICS & GYNECOLOGY