Results The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%-26.2%), with 15.7% of women (95% CI, 13.2%18.2%) experiencing urinary incontinence, 9.0% of women (95% CI, 7.3%-10.7%) experiencing fecal incontinence, and 2.9% of women (95% CI, 2.1%-3.7%) experiencing pelvic organ prolapse. The proportion of women reporting at least 1 disorder increased incrementally with age, ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older (P.001), and parity (12.8% [95% CI, 9.0%-16.6%], 18.4% [95% CI, 12.9%-23.9%], 24.6% [95% CI, 19.5%-29.8%], and 32.4% [95% CI, 27.8%37.1%] for 0, 1, 2, and 3 or more deliveries, respectively; P.001). Overweight and obese women were more likely to report at least 1 pelvic floor disorder than normal weight women (26.3% [95% CI, 21.7%-30.9%], 30.4% [95% CI, 25.8%-35.0%], and 15.1% [95% CI, 11.6%-18.7%], respectively; P.001). We detected no differences in prevalence by racial/ethnic group.

https://jamanetwork.com/journals/jama/articlepdf/182572/joc80087_1311_1316.pdf

Prevalence of symptomatic pelvic floor disorders in US women

Background
Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse.

Objectives
To determine the effects of the many different surgeries used in the management of pelvic organ prolapse.

Search methods
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In Process and handsearching of journals and conference proceedings, healthcare-related bibliographic databases, handsearched conference proceedings (searched 20 August 2012), and reference lists of relevant articles. We also contacted researchers in the field.

Selection criteria
Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse.

Data collection and analysis
Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding.

Main results
Fifty-six randomised controlled trials were identified evaluating 5954 women. For upper vaginal prolapse (uterine or vault) abdominal sacral colpopexy was associated with a lower rate of recurrent vault prolapse on examination and painful intercourse than with vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. In single studies the sacral colpopexy had a higher success rate on examination and lower reoperation rate than high vaginal uterosacral suspension and transvaginal polypropylene mesh.

Twenty-one trials compared a variety of surgical procedures for anterior compartment prolapse (cystocele). Ten compared native tissue repair with graft (absorbable and permanent mesh, biological grafts) repair for anterior compartment prolapse. Native tissue anterior repair was associated with more recurrent anterior compartment prolapse than when supplemented with a polyglactin (absorbable) mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.08, 95% CI 1.08 to 4.01), however there was no difference in post-operative awareness of prolapse after absorbable mesh (RR 0.96, 95% CI 0.33 to 2.81) or a biological graft (RR 1.21, 95% CI 0.64 to 2.30). Data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment prolapse on examination than for any polypropylene (permanent) mesh repair (RR 3.15, 95% CI 2.50 to 3.96). Awareness of prolapse was also higher after the anterior repair as compared to polypropylene mesh repair (28% versus 18%, RR 1.57, 95% CI 1.18 to 2.07). However, the reoperation rate for prolapse was similar at 14/459 (3%) after the native tissue repair compared to 6/470 (1.3%) (RR 2.18, 95% CI 0.93 to 5.10) after the anterior polypropylene mesh repair and no differences in quality of life data or de novo dyspareunia were identified. Blood loss (MD 64 ml, 95% CI 48 to 81), operating time (MD 19 min, 95% CI 16 to 21), recurrences in apical or posterior compartment (RR 1.9, 95% CI 1.0 to 3.4) and de novo stress urinary incontinence (RR 1.8, 95% CI 1.0 to 3.1) were significantly higher with transobturator meshes than for native tissue anterior repair. Mesh erosions were reported in 11.4% (64/563), with surgical interventions being performed in 6.8% (32/470).

Data from three trials compared native tissue repairs with a variety of total, anterior, or posterior polypropylene kit meshes for vaginal prolapse in multiple compartments. While no difference in awareness of prolapse was able to be identified between the groups (RR 1.3, 95% CI 0.6 to 1.7) the recurrence rate on examination was higher in the native tissue repair group compared to the transvaginal polypropylene mesh group (RR 2.0, 95% CI 1.3 to 3.1). The mesh erosion rate was 35/194 (18%), and 18/194 (9%) underwent surgical correction for mesh erosion. The reoperation rate after transvaginal polypropylene mesh repair of 22/194 (11%) was higher than after the native tissue repair (7/189, 3.7%) (RR 3.1, 95% CI 1.3 to 7.3).

Data from three trials compared posterior vaginal repair and transanal repair for the treatment of posterior compartment prolapse (rectocele). The posterior vaginal repair had fewer recurrent prolapse symptoms (RR 0.4, 95% CI 0.2 to 1.0) and lower recurrence on examination (RR 0.2, 95% CI 0.1 to 0.6) and on defecography (MD -1.2 cm, 95% CI -2.0 to -0.3).

Sixteen trials included significant data on bladder outcomes following a variety of prolapse surgeries. Women undergoing prolapse surgery may have benefited from having continence surgery performed concomitantly, especially if they had stress urinary incontinence (RR 7.4, 95% CI 4.0 to 14) or if they were continent and had occult stress urinary incontinence demonstrated pre-operatively (RR 3.5, 95% CI 1.9 to 6.6). Following prolapse surgery, 12% of women developed de novo symptoms of bladder overactivity and 9% de novo voiding dysfunction.

Authors' conclusions
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinous colpopexy, uterosacral colpopexy and transvaginal mesh. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living, and increased cost of the abdominal approach.

The use of mesh or graft inlays at the time of anterior vaginal wall repair reduces the risk of recurrent anterior wall prolapse on examination. Anterior vaginal polypropylene mesh also reduces awareness of prolapse, however these benefits must be weighted against increased operating time, blood loss, rate of apical or posterior compartment prolapse, de novo stress urinary incontinence, and reoperation rate for mesh exposures associated with the use of polypropylene mesh.

Posterior vaginal wall repair may be better than transanal repair in the management of rectocele in terms of recurrence of prolapse. The evidence is not supportive of any grafts at the time of posterior vaginal repair. Adequately powered randomised, controlled clinical trials with blinding of assessors are urgently needed on a wide variety of issues, and they particularly need to include women's perceptions of prolapse symptoms. Following the withdrawal of some commercial transvaginal mesh kits from the market, the generalisability of the findings, especially relating to anterior compartment transvaginal mesh, should be interpreted with caution.

/pdf/surgical-management-of-pelvic-organ-prolapse-in-women-4v2ip7dbgk.pdf

Surgical management of pelvic organ prolapse in women

AND FULL-TEXT SCREENING To identify studies which were a) relevant to one or more key questions b) primary analytic research, systematic review or meta-analysis and c) written in English DATA EXTRACTION AND SYNTHESIS Data abstracted into evidence tables; study quality assessed DRAFT RECOMMENDATIONS Strength of evidence graded; summaries and recommendations drafted FINALIZE RECOMMENDATIONS Recommendations finalized; guideline published

/pdf/guideline-for-prevention-of-catheter-associated-urinary-3p259w8m65.pdf

Guideline for prevention of catheter-associated urinary tract infections 2009.

Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity.

Nowadays, most nurses, pre- and post-qualification, will be required to undertake a literature review at some point, either as part of a course of study, as a key step in the research process, or as part of clinical practice development or policy. For student nurses and novice researchers it is often seen as a difficult undertaking. It demands a complex range of skills, such as learning how to define topics for exploration, acquiring skills of literature searching and retrieval, developing the ability to analyse and synthesize data as well as becoming adept at writing and reporting, often within a limited time scale. The purpose of this article is to present a step-by-step guide to facilitate understanding by presenting the critical elements of the literature review process. While reference is made to different types of literature reviews, the focus is on the traditional or narrative review that is undertaken, usually either as an academic assignment or part of the research process.

/pdf/undertaking-a-literature-review-a-step-by-step-approach-glcq6s3886.pdf

Undertaking a literature review: a step-by-step approach

Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

Objective

To test an individualized form of habit training for urinary incontinence (UI) among long-stay cognitively and/or physically impaired elderly nursing home residents over time.



Design

Randomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24-hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12-week intervention period was administered by indigenous staff after they attended a 4-hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects.



Setting

Four non-profit nursing homes; west, mid-west, east coast.



Patients

Consent was obtained from 154 (71%) who met primary inclusion criteria. Forty-one failed the secondary inclusion criteria leaving 113 who entered the 37-week study. Eighty-eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI.



Results

UI was significantly decreased during the 3-month period (P < 0.001). Eighty-six per cent showed improvement over baseline while one-third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P < 0.005) while the control group's UI volume increased.



Conclusions

The training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.

The Effects of Patterned Urge‐Response Toileting (PURT) on Urinary Incontinence among Nursing Home Residents

To test a behavioral approach for urinary incontinence (UI), 166 staff in four nursing homes participated in a quasi-experimental study that measured knowledge and attitudes about UI and compliance with toileting protocols. The intervention group (N = 96) showed a slight increase in knowledge; their attitudes remained positive over the four testing times. Compliance with the more critical component of the toileting protocol was only 72%, although evidence existed that the protocol reduced UI. Results are discussed in terms of the sociocultural environment of nursing homes.

Effect of an Incontinence Training Program on Nursing Home Staff's Knowledge, Attitudes, and Behavior

Urinary incontinence among community-dwelling frail elderly is estimated to affect 6.23 million people at an annual cost of over $7 billion. Overwhelmed caregivers may seek institutional placement of their incontinent family member. Results from this study of 78 subjects demonstrate that even in physically and cognitively impaired persons a behavioral treatment program can reduce incontinence, lower costs, and relieve caregiver burden.

Joyce Colling

Papers

Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

The Effects of Patterned Urge‐Response Toileting (PURT) on Urinary Incontinence among Nursing Home Residents

Effect of an Incontinence Training Program on Nursing Home Staff's Knowledge, Attitudes, and Behavior

The effects of a continence program on frail community-dwelling elderly persons.

Short-term reciprocal international academic exchange program.