Biomedical subjects

Emily S Lukacz

Publications and source records attributed to Emily S Lukacz.

11 recordsLinked to original sources

PubMed2006

Determinants of vaginal length.

OBJECTIVE: The purpose of this study was to describe quantitatively the associations between total vaginal length and demographic, historic, and physical characteristics. STUDY DESIGN: At 2 clinical sites, patients completed a standardized questionnaire and physical examination. Bivariate correlations explored relationships between total vaginal length and demographic, historic, and examination variables. Significant variables were evaluated with a multivariate linear regression model. RESULTS: The study included 3247 women. Hysterectomy and pelvic reconstructive surgery contribute 0.63 cm and 0.22 cm, respectively, to total vaginal length shortening; 10 years of age decreases total vaginal length by 0.08 cm. One meter of height and 10 kg of weight increases total vaginal length by 0.09 cm and 0.02 cm, respectively. Menopause is associated with a shortening of total vaginal length by 0.17 cm. CONCLUSION: Although there appears to be statistically significant associations between total vaginal length and the aforementioned factors, the impact is unlikely to be clinically significant.

Aged↗

PubMed2006

The correlation of urethral mobility and point Aa of the pelvic organ prolapse quantification system before and after surgery.

OBJECTIVE: The purpose of the study was to determine the effects of pelvic floor surgery on Q-tip angle and point Aa of the pelvic organ prolapse quantification system. STUDY DESIGN: A clinical database was used for this retrospective review of Q-tip and prolapse measurements before and after pelvic floor surgery. Subanalyses of isolated bladder neck and prolapse surgeries were also performed. Correlations between Q-tip and point Aa were assessed with Pearson and Spearman coefficients and the Z statistic. RESULTS: Correlations between Q-tip and point Aa for all 350 women were not significantly different before and after the operation (r = 0.45 vs 0.49; P = .50). Subanalysis of the bladder neck-only group demonstrated similarly fair correlations (r = 0.26 vs 0.31; P = .71; n = 94). The prolapse-only group demonstrated better overall correlation without significant differences before and after the operation (r = 0.78 vs 0.51; P = .10; n = 26). CONCLUSION: Point Aa does not reflect bladder neck mobility accurately as measured by the Q-tip angle after surgical restoration of the pelvic anatomy.

Aged↗

PubMed2006

Elevated postvoid residual in women with pelvic floor disorders: prevalence and associated risk factors.

A retrospective case-control study was designed to assess risks for elevated post void residual (PVR) in women with pelvic floor disorders. The 1,399 women underwent evaluation including standardized questionnaire, examination, and catheterized PVR. Elevated PVR was defined as > or =100 ml and anterior and apical prolapse was defined as at or beyond the hymen. Overall, the prevalence of elevated PVR was 11%. After matching, the absence of stress incontinence symptoms (OR 0.55, CI 0.33-0.92), the symptoms of vaginal bulge (OR 2.19, CI 1.38-3.48), pelvic pressure (OR 1.79, CI 1.14-2.86), urinary splinting (OR 2.89, CI 1.24-6.74), and presence of prolapse (OR 2.60 CI 1.62-4.18) were significantly associated with an elevated PVR. Only prolapse (OR 1.96 CI 1.37-2.79) maintained a significant association after multivariate analysis. Symptoms alone do not predict which women may have an elevated PVR, but the finding of prolapse at or beyond the hymen is associated with incomplete emptying. Elevated post void residuals cannot be predicted based on symptoms alone; however, prolapse beyond the hymen may help identify women with incomplete bladder emptying.

Adult↗

PubMed2006

Parity, mode of delivery, and pelvic floor disorders.

OBJECTIVE: This study aimed to assess the associations between parity, mode of delivery, and pelvic floor disorders. METHODS: The prevalence of pelvic organ prolapse, stress urinary incontinence, overactive bladder, and anal incontinence was assessed in a random sample of women aged 25-84 years by using the validated Epidemiology of Prolapse and Incontinence Questionnaire. Women were categorized as nulliparous, vaginally parous, or only delivered by cesarean. Adjusted odds ratios and 95% confidence intervals (CIs) for each disorder were calculated with logistic regression, controlling for age, body mass index, and parity. RESULTS: In the 4,458 respondents the prevalence of each disorder was as follows: 7% prolapse, 15% stress urinary incontinence, 13% overactive bladder, 25% anal incontinence, and 37% for any one or more pelvic floor disorders. There were no significant differences in the prevalence of disorders between the cesarean delivery and nulliparous groups. The adjusted odds of each disorder increased with vaginal parity compared with cesarean delivery: prolapse = 1.82 (95% CI 1.04-3.19), stress urinary incontinence = 1.81 (95% CI 1.25-2.61), overactive bladder = 1.53 (95% CI 1.02-2.29), anal incontinence = 1.72 (95% CI 1.27-2.35), and any one or more pelvic floor disorders = 1.85 (95% CI 1.42-2.41). Number-needed-to-treat analysis revealed that 7 women would have to deliver only by cesarean delivery to prevent one woman from having a pelvic floor disorder. CONCLUSION: The risk of pelvic floor disorders is independently associated with vaginal delivery but not with parity alone. Cesarean delivery has a protective effect, similar to nulliparity, on the development of pelvic floor disorders when compared with vaginal delivery. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2005

Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey.

The epidemiology of prolapse and incontinence questionnaire (EPIQ) was developed to screen for female pelvic floor disorders (PFD). Content and face validity, reliability, internal consistency and criterion validity of the EPIQ to detect the presence of pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) is presented. Cronbach's alpha; Spearman's, kappa, intraclass correlations, factor analysis and Chi-Squared tests were used for analysis. Questions related to PFD proved internally consistent (alpha = 0.91) and reproducible (correlations >0.70) for all but three items on the EPIQ. Positive and negative predictive values of the EPIQ to detect PFD were: POP = 76% and 97%, SUI = 88% and 87%, OAB = 77% and 90% and AI = 61% and 91% respectively. EPIQ is a psychometrically validated screening instrument that may identify women at high risk of having pelvic floor disorders in large undiagnosed populations.

Adult↗

PubMed2004

Predictive value of prolapse symptoms: a large database study.

We sought to describe the relationship between patient symptoms and pelvic organ prolapse (POP) and report the sensitivity, specificity, and positive and negative predictive value of these POP symptoms. Two urologists and four urogynecologists developed a standardized pelvic floor questionnaire based on face validation for use at three female pelvic floor disorder clinics. Specific questions related to prolapse included questions on urinary splinting, digital assistance for defecation, and a bulge per vagina. Prolapse was assessed with the standardized Pelvic Organ Prolapse Quantitative (POP-Q) terminology. The analysis included 1912 women. Urinary splinting was uncommon (< 10%) when Ba < 0, but ranged between 23 and 36% for stage III and IV Ba prolapse. Digital assistance was equally common in stage II Bp prolapse (21-38%) and stage III-IV Bp prolapse (26-29%). Only 6-11% of women with stage 0 or I POP reported symptoms of bulge, but with stage II it increased to 77%. Urinary splinting is 97% specific for anterior prolapse. The report of a bulge has an 81% positive predictive value and a 76% negative predictive value. Very few patients without anterior prolapse will report urinary splinting. Digital assistance for fecal evacuation is no more common with massive posterior prolapse than with moderate posterior prolapse. Patient report of a bulge is a valuable screening tool for POP and should prompt a careful exam.

Adolescent↗

PubMed2004

Determinants of patient satisfaction after the tension-free vaginal tape procedure.

OBJECTIVE: This study was undertaken to compare patient satisfaction with subjective and objective measures of success. STUDY DESIGN: Satisfaction at 1-year was measured by using a self-administered written questionnaire. Success was assessed both subjectively and objectively by using the short form Urogenital Distress Inventory, stress testing, and multichannel urodynamics. Outcomes were compared to determine the relationship between satisfaction and success. Satisfied and dissatisfied patients were compared with respect to pre-, intra-, peri-, and postoperative characteristics. Student t and chi(2) tests were used for continuous and ordinal data, respectively. RESULTS: Of 66 (80%) patients, 53 were satisfied. These patients were more likely to achieve subjective cure (91% vs 62%, P=.009) but not statistically more likely to be objectively cured (92% vs 75%, P=.08). Dissatisfied patients tended to have overactive bladder symptoms, voiding difficulty, and required sling release. Other patient characteristics did not influence satisfaction rates. CONCLUSION: Satisfaction after tension-free vaginal tape procedure is highly dependent on normal bladder function. Dissatisfied patients deserve comprehensive evaluation, although objective measures may not reflect patient satisfaction.

Adult↗

PubMed2004

The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation.

OBJECTIVE: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. STUDY DESIGN: In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert-type scale and Visual Analog Scale formats. Reliability was estimated with Spearman's correlations and Cronbach's alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations. RESULTS: In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P <.05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively ( P <.001). CONCLUSION: The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research.

Factor Analysis, Statistical↗

PubMed2003

The effects of the tension-free vaginal tape on voiding function: a prospective evaluation.

The impact of tension-free vaginal tape (TVT) on voiding function was studied in a cohort of 103 patients. Voiding was assessed with quality of life questionnaires, non-invasive urine flow and voiding pressure-flow studies both preoperatively and 1 year postoperatively. Paired t-tests and Wilcoxon's signed ranks tests were used for analysis. Data from 65 patients were analyzed. Subjective voiding function did not change; however, maximum flow rates decreased by up to 43%: from 29 ml/s to 16 ml/s on free flow studies. This was associated with a 27% increase in detrusor pressure at maximum flow: from 15 to 19 cmH(2)O. Postvoid residuals were not clinically different, changing from a median of 15 ml to 30 ml postoperatively. Thirty-eight patients (37%) required postoperative catheterization for urinary retention (median duration 4 days). We concluded that the TVT sling reduces maximum flow rates without clinically significant effects on detrusor pressure, residual urine or subjective voiding.

Adult↗

PubMed2003

The effects of the tension-free vaginal tape on proximal urethral position: a prospective, longitudinal evaluation.

This study was designed to determine the anatomic effects of the tension-free vaginal tape (TVT). A cohort of 94 patients was followed for 1 year. Urethral position was quantified using the Q-tip angle. Statistical analysis employed the ANOVA and paired t tests. A total of 54 (57%) patients met the criteria for analysis. In these 54 patients the success rate was 81%. Straining Q-tip angles decreased from a mean preoperative value of 52 degrees to 28 degrees before 1 month, 34 degrees at 1-6 months, 41 degrees at 6-12 months, and 45 degrees at 1 year ( P <0.05). The postoperative resting angles remained essentially unchanged. The sling initially provides support to the proximal urethra which diminishes over time. Unchanged resting Q-tip angles confirm the tension-free concept and there appears to be no shrinkage or tightening of the sling. We concluded that the success of the TVT is not due to proximal urethral support.

Female↗

PubMed2002

Rectocele repair: when and how?

Pelvic organ prolapse repair poses a unique challenge to the reconstructive pelvic surgeon. Traditional levator plication has been promoted for the past century and has recently been shown to create unsatisfactory functional results, among them dyspareunia. In an attempt to improve both functional and quality-of-life outcomes, new methods for posterior vaginal wall defect repair have been developed and are now undergoing critical evaluation. We present a review of posterior vaginal wall repair with a focus on new anatomic concepts and site-specific rectocele repair.

Digestive System Surgical Procedures↗