Prevalence of Multidisciplinary Symptomatology in Patients with Pelvic Floor Disorders

Gaba F1, Denis T1, Walia J2, Patel S2, Feustel P3, De E4

Research Type

Clinical

Abstract Category

Pregnancy and Pelvic Floor Disorders

Abstract 757
Open Discussion ePosters
Scientific Open Discussion Session 108
Friday 25th October 2024
13:10 - 13:15 (ePoster Station 3)
Exhibit Hall
Pelvic Floor Sexual Dysfunction Voiding Dysfunction Questionnaire
1. Department of Urology, Albany Medical Center, 23 Hackett Blvd, Albany, NY, 2. Albany Medical College, 43 New Scotland Avenue, Albany, NY, 3. Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY, 4. Professor of Urology, Obstetrics and Gynecology, Neurology Director, Multidisciplinary Pelvic Health, Albany Medical Center Albany Medical College, Albany New York Department of Urology, Albany Medical Center, 23 Hackett Blvd, Albany, NY
Presenter
S

Shreya Patel
Links

Abstract

Hypothesis / aims of study 
People presenting with pelvic floor disorders have been reported to have a high prevalence of overlapping pelvic conditions. This association has not been fully characterized.  We hypothesize that those presenting with chronic pelvic pain have co-existing bowel, urinary, sexual, and neuro-urological symptomatology necessitating a multidisciplinary approach.
Study design, materials and methods 
259 patients completed the electronic intake for our subspecialized adult Urogynecology and Reconstructive Pelvic Surgery (URPS) clinic. 38 (14.7%) were male, 215 (83%) female, and 6 (2.3%) identified as transgender.  Of the 259 patients, 114 reported “yes” to pelvic pain, and 138 reported “no”, the remaining 7 patients did not answer the survey. Validated scoring systems: PHQ4 (anxiety and depression), AUASS (urinary symptoms), CRAD-8 (lower urinary tract symptoms, POPDI-6 (pelvic organ distress inventory), GUPI (genitourinary pain), PISQIR (sexual health and function), UDI-6 (urinary symptoms), and SHIM (sexual health inventory) were used. Binary data using cut-off values for presence of dysfunction was defined as UDI-6 score greater or equal to 25 (1) or AUA symptoms score greater than 8 (2), bowel dysfunction as CRAD-8 greater than 25 (3), PISQR score of less than 2.68 for sexual dysfunction (4), IIEF sexual function score of less than 5 (5), POPD-6 score greater than or equal to 25 (6), and autonomic symptom tally score of greater than 5.  Statistical analysis utilized Pearson correlation or Chi-square.
Results 
Results are attached below as Table 1, Figure 1 and Figure 2.
Interpretation of results 
56 (51%) of patients with pelvic pain reported bowel symptoms (Chi-square = 19.5 p value = <0.001), 84 (82%) reported urinary symptoms (Chi-square = 33.1 p value = <0.001). 69 (73%)  reported prolapse symptoms (Chi-square = 41.3, p value = <0.001), 40 (54%)  reported autonomic symptoms (Chi-square = 8.0, p value = 0.005). 73 (50%) of patients with urinary symptoms reported bowel symptoms (Chi-square = 27.9, p value = <0.001), 52 (48%) reported autonomic symptoms (Chi-square = 7.8, p value = 0.005). 88 (67%) reported prolapse symptoms (Chi-square = 55.2, p value = <0.001). 52 (48%) reported autonomic symptoms (Chi-square = 27.9, p value = <0.001). 67 (84%) of patients with bowel symptoms reported prolapse symptoms (Chi-square = 67.7, p value = <0.001). 40 (62.5%) reported autonomic symptoms (Chi-square = 16.6, p value = <0.001), 44 (57%) reported prolapse symptoms (Chi-square =14.3, p value = <0.001) (Table 1).  

Using a histogram the mean number of symptoms per patient was 2.55 +- 1.55, n=150) (Figure 1). 

 Using binary logistic regression, the odds of pelvic pain significantly increased with urinary symptoms [odds 5.6 (CI 3.0 -10.3)], bowel symptoms [odds 3.3 (CI 1.9-5.7)], prolapse symptoms [odds 6.7 (CI 3.6-12.2)], and autonomic symptoms [odds 2.42 (CI 1.3 to 4.4) present relative to when they were absent]. The odds of urinary symptoms significantly in the setting of bowel symptoms [odds 5.3 (CI 2.7-10.3)], prolapse symptoms [odds 12.4 (CI 5.9-25.9)], and autonomic symptoms [odds 2.6 (CI 1.3-5.0) if present, relative to when they were absent]. The odds of bowel symptoms significantly increased when autonomic symptoms [odds 3.7 (CI 1.9-7.1)], and prolapse symptoms were present [odds 15.2 (CI 7.4-31.3), relative to when they were absent]. The odds of autonomic symptoms were significantly increased when prolapse symptoms were present [odds 3.44 (CI 1.7-6.6)]. (Table 2)
Concluding message 
Our findings demonstrate a significant overlap among pelvic pain, urinary, bowel, sexual, prolapse, autonomic, and autonomic symptoms. A comprehensive multidisciplinary intake is recommended to screen for comorbid pelvic symptomatology when treating patients with pelvic floor disorders.
Figure 1 Table 1: Tabulated statistics comparing associations between pelvic, urinary, bowel, sexual, autonomic and prolapse symptoms. Each cell represents the number of patients with both symptoms (% of patients). * denotes statistically significant result ** den
Figure 2 Figure 1: Histogram showing the distribution of patients with x number of symptoms on the x axis and number of patients with x symptoms on the y axis. The mean number of symptoms per patient was 2.55, n=150).
Figure 3 Table 2: Multidisciplinary symptom analysis with binary logistic regression showing a significant association between pelvic pain, urinary symptoms, bowel symptoms, prolapse symptoms, autonomic symptoms but not sexual symptoms.
References 
  1. afni-Kane A, Zhou Y, Botros SM. Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory. Neurourol Urodyn. 2016 Nov;35(8):949-954. doi: 10.1002/nau.22833. Epub 2015 Jul 24. PMID: 26207922.
  2. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992 Nov;148(5):1549-57; discussion 1564. doi: 10.1016/s0022-5347(17)36966-5. PMID: 1279218.
  3. Jelovsek JE, Chen Z, Markland AD, Brubaker L, Dyer KY, Meikle S, Rahn DD, Siddiqui NY, Tuteja A, Barber MD. Minimum important differences for scales assessing symptom severity and quality of life in patients with fecal incontinence. Female Pelvic Med Reconstr Surg. 2014 Nov-Dec;20(6):342-8. doi: 10.1097/SPV.0000000000000078. PMID: 25185630; PMCID: PMC4213305.
Disclosures
Funding Grants: Underactive Bladder (NIDDK) Clinical Research: PI, Ironwood Pharmaceuticals Consultant: Flume catheters, Luca Biologics. Infinite MD / Consumer Medical/ Alight Online 2nd Opinion Advisory Board: Ironwood Pharmaceuticals Glycologix Other: National Institute of Diabetes and Digestive and Kidney Diseases, PsyD ClinicalTrials.gov ID: NCT05127616 Protocol Number: EPPIC22001, version 1.0 Date of Charter: July 13, 2022 – Chair, DSMB* Clinical Trial No Subjects Human Ethics Committee Albany Medical College Institutional Review Board Helsinki Yes Informed Consent Yes
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