Medicine and Health Sciences Commons^™

Preservation Of Immune Function In Cervical Cancer Patients During Chemoradiation Using A Novel Integrative Approach., Susan Lutgendorf, Elizabeth Mullen-Houser, Daniel Russell, Koen De Geest, Geraldine Jacobson, Laura Hart, David Bender, Barrie Anderson, Thomas Buekers, Michael Goodheart, Michael Antoni, Anil Sood, David Lubaroff

Koen De Geest

Patients receiving chemoradiation for cervical cancer are at risk for distress, chemoradiation-related side-effects, and immunosuppression. This prospective randomized clinical trial examined effects of a complementary therapy, Healing Touch (HT), versus relaxation training (RT) and usual care (UC) for (1) supporting cellular immunity, (2) improving mood and quality of life (QOL), and (3) reducing treatment-associated toxicities and treatment delay in cervical cancer patients receiving chemoradiation. Sixty women with stages IB1 to IVA cervical cancer were randomly assigned to receive UC or 4 ×/weekly individual sessions of either HT or RT immediately following radiation during their 6-week chemoradiation treatment. Patients completed psychosocial …

Diurnal Cortisol Dysregulation, Functional Disability, And Depression In Women With Ovarian Cancer., Aliza Weinrib, Sandra Sephton, Koen De Geest, Frank Penedo, David Bender, Bridget Zimmerman, Clemens Kirschbaum, Anil Sood, David Lubaroff, Susan Lutgendorf

Koen De Geest

BACKGROUND: Multiple alterations in circadian rhythms have been observed in cancer patients, including the diurnal rhythm of the adrenal hormone cortisol. Diurnal cortisol alterations have been associated with cancer-related physiological processes as well as psychological stress. Here we investigate alterations in diurnal cortisol rhythm in ovarian cancer patients, and potential links with depression, life stress, and functional disability.

METHODS: Women (n = 177) with suspected ovarian cancer completed questionnaires and collected salivary cortisol 3× daily for 3 consecutive days before surgery. One hundred women were subsequently diagnosed with ovarian cancer and 77 with benign disease. In addition, healthy women (n …

A Single-Institution Evaluation Of Factors Important In Fallopian Tube Carcinoma Recurrence And Survival., Alireza Shamshirsaz, Thomas Buekers, Koen De Geest, David Bender, Gideon Zamba, Michael Goodheart

Koen De Geest

OBJECTIVE: The aim of this study was to identify prognostic factors and markers that influence clinical outcomes in patients with primary fallopian tube carcinoma at a single tertiary health care center. These prognostic factors may be of clinical importance and can subsequently be included in future clinical trials. MATERIALS AND METHODS: A retrospective review of our Tumor Registry and Gynecologic Oncology database was conducted to include any patients with a diagnosis of fallopian tube carcinoma between the years 1994 and 2005. We identified clinicopathological data to evaluate factors important in recurrence, disease-specific and overall survival. Kaplan-Meier curves were generated, and …

Sleep Disturbance, Cytokines, And Fatigue In Women With Ovarian Cancer., Lauren Clevenger, Andrew Schrepf, Desire Christensen, Koen De Geest, David Bender, Amina Ahmed, Michael Goodheart, Frank Penedo, David Lubaroff, Anil Sood, Susan Lutgendorf

Koen De Geest

Pro-inflammatory cytokines, such as interleukin-6 (IL-6), have been implicated in the underlying processes contributing to sleep regulation and fatigue. Despite evidence for sleep difficulties, fatigue, and elevations in IL-6 among women with ovarian cancer, the association between these symptoms and IL-6 has not been investigated. To address this knowledge gap, we examined relationships between sleep disturbance, fatigue, and plasma IL-6 in 136 women with ovarian cancer prior to surgery. These relationships were also examined in 63 of these women who were disease-free and not receiving chemotherapy one year post-diagnosis. At both time-points, higher levels of IL-6 were significantly associated with …

Social Isolation Is Associated With Elevated Tumor Norepinephrine In Ovarian Carcinoma Patients., Susan Lutgendorf, Koen De Geest, Laila Dahmoush, Donna Farley, Frank Penedo, David Bender, Michael Goodheart, Thomas Buekers, Luis Mendez, Gina Krueger, Lauren Clevenger, David Lubaroff, Anil Sood, Steve Cole

Koen De Geest

Noradrenergic pathways have been implicated in growth and progression of ovarian cancer. Intratumoral norepinephrine (NE) has been shown to increase with stress in an animal cancer model, but little is known regarding how tumor NE varies with disease stage and with biobehavioral factors in ovarian cancer patients. This study examined relationships between pre-surgical measures of social support, depressed mood, perceived stress, anxiety, tumor histology and tumor catecholamine (NE and epinephrine [E]) levels among 68 ovarian cancer patients. We also examined whether associations observed between biobehavioral measures and tumor catecholamines extended to other compartments. Higher NE levels were found in advanced …

A Phase Ii Study Of Docetaxel In Paclitaxel-Resistant Ovarian And Peritoneal Carcinoma: A Gynecologic Oncology Group Study, Peter Rose, John Blessing, Harrison Ball, James Hoffman, David Warshal, Koen Degeest, David Moore

Koen De Geest

OBJECTIVES: Docetaxel is an inhibitor of microtubule depolymerization and has demonstrated activity in paclitaxel-resistant breast cancer and gynecologic cancer. The Gynecologic Oncology Group (GOG) conducted a study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma to determine its activity, and nature and degree of toxicity, in this cohort of patients.

METHODS: Patients with platinum- and paclitaxel-resistant ovarian or peritoneal carcinoma, defined as progression while on or within 6 months of therapy, were eligible if they had measurable disease and had not received more than one chemotherapy regimen. Docetaxel at a dose of 100 mg/m(2) was administered iv over 1 h …

Postoperative Irradiation In Malignant Tumors Of Submandibular Gland, Donghai Dai

Donghai Dai

A retrospective review of 18 patients with treated primary malignant tumors of submandibular gland is presented. The data revealed that initial control of malignancies was inversely related to the presence of disease and surgical margins. Postoperative radiation therapy was used in cases with positive surgical margins. Of the patients with inadequate surgical margins, 71% achieved local relapse when they had surgery alone, compared with 27% of the group that received postoperative irradiation. This study suggests that adjuvant radiation therapy may improve the local control and survival. Such therapy can serve as the salvage method for those who have inadequate surgical …

The Sensitivity And Specificity Of A Simple Test To Distinguish Between Urge And Stress Urinary Incontinence., Jeanette Brown, Catherine Bradley, Leslee Subak, Holly Richter, Stephen Kraus, Linda Brubaker, Feng Lin, Eric Vittinghoff, Deborah Grady

Catherine S. Bradley

BACKGROUND: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. OBJECTIVE: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. DESIGN: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. SETTING: 5 academic medical centers in the United States. PARTICIPANTS: 301 women enrolled from April to December 2004 who were older …

Pelvic Organ Prolapse In Older Women: Prevalence And Risk Factors., Ingrid Nygaard, Catherine Bradley, Debra Brandt

Catherine S. Bradley

OBJECTIVE: We sought to estimate the prevalence of pelvic organ prolapse in older women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse. METHODS: Women with a uterus enrolled at one site of the Women's Health Initiative Hormone Replacement Therapy randomized clinical trial were eligible for this ancillary cross-sectional study. Subjects underwent a Pelvic Organ Prolapse Quantification examination during a maximal Valsalva maneuver and in addition completed a questionnaire. Logistic regression was used to identify independent risk factors for each of 2 definitions of prolapse: 1) Pelvic Organ Prolapse Quantification stage II or greater and …

A New Questionnaire For Urinary Incontinence Diagnosis In Women: Development And Testing, Catherine Bradley, E. Rovner, M. Morgan, M. Berlin, J. Novi, J. Shea, L. Arya

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. STUDY DESIGN: One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). RESULTS: Clinical diagnoses included stress (n = 15), urge (n = 26), …

Vaginal Wall Descensus And Pelvic Floor Symptoms In Older Women, Catherine Bradley, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms. METHODS: In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus. RESULTS: Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and …

The Questionnaire For Urinary Incontinence Diagnosis (Quid): Validity And Responsiveness To Change In Women Undergoing Non-Surgical Therapies For Treatment Of Stress Predominant Urinary Incontinence, Catherine Bradley, D. Rahn, I. Nygaard, M. Barber, C. Nager, K. Kenton, N. Siddiqui, R. Abel, C. Spino, H. Richter

Catherine S. Bradley

AIMS: The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure. METHODS: Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI and completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach's alpha) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was …

Urinary Incontinence Self-Report Questions: Reproducibility And Agreement With Bladder Diary, Catherine Bradley, J. Brown, S. Van Den Eeden, M. Schembri, A. Ragins, D. Thom

Catherine S. Bradley

INTRODUCTION AND HYPOTHESIS: This study aims to measure self-report urinary incontinence questions' reproducibility and agreement with bladder diary. METHODS: Data were analyzed from the Reproductive Risk of Incontinence Study at Kaiser. Participating women reporting at least weekly incontinence completed self-report incontinence questions and a 7-day bladder diary. Self-report question reproducibility was assessed and agreement between self-reported and diary-recorded voiding and incontinence frequency was measured. Test characteristics and area under the curve were calculated for self-reported incontinence types using diary as the gold standard. RESULTS: Five hundred ninety-one women were included and 425 completed a diary. The self-report questions had moderate …

Vaginal Erosion After Pubovaginal Sling Procedures Using Dermal Allografts, Catherine Bradley, M. Morgan, L. Arya, E. Rovner

Catherine S. Bradley

No abstract provided.

Urodynamically Defined Stress Urinary Incontinence And Bladder Outlet Obstruction Coexist In Women, Catherine Bradley, E. Rovner

Catherine S. Bradley

PURPOSE: The definition and significance of female bladder outlet obstruction (BOO) are poorly understood. We identified patients with urodynamic evidence of BOO in a cohort of women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI were identified from a videourodynamic data base and pressure flow studies were reexamined. Subjects were excluded if detrusor pressures could not be measured. BOO was diagnosed if the maximum flow rate was less than 12 ml per second and detrusor pressure at maximum flow was greater than 20 cm water or maximum detrusor pressure was greater than 20 cm water in those …

Pharmacologic Treatment For Urgency-Predominant Urinary Incontinence In Women Diagnosed Using A Simplified Algorithm: A Randomized Trial, A. Huang, R. Hess, L. Arya, H. Richter, L. Subak, Catherine Bradley, R. Rogers, D. Myers, K. Johnson, W. Gregory, S. Kraus, M. Schembri, J. Brown

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to evaluate clinical outcomes associated with the initiation of treatment for urgency-predominant incontinence in women diagnosed by a simple 3-item questionnaire. STUDY DESIGN: We conducted a multicenter, double-blinded, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence in ambulatory women diagnosed by the simple 3-item questionnaire. Participants (N = 645) were assigned randomly to fesoterodine therapy (4-8 mg daily) or placebo. Urinary incontinence was assessed with the use of voiding diaries; postvoid residual volume was measured after treatment. RESULTS: After 12 weeks, women who had been assigned randomly to fesoterodine therapy reported 0.9 …

Sexual Function In Women After Rectocele Repair With Acellular Porcine Dermis Graft Vs Site-Specific Rectovaginal Fascia Repair, J. Novi, Catherine Bradley, N. Mahmoud, M. Morgan, L. Arya

Catherine S. Bradley

The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage 2 or greater. Fifty women underwent rectocele repair utilizing porcine dermis graft (group 1) and 50 women underwent a site-specific repair of the rectovaginal fascia (group 2). The same questionnaire was administered to all subjects 6 months after surgery. The …

Bowel Symptoms In Women Planning Surgery For Pelvic Organ Prolapse, Catherine Bradley, M. Brown, G. Cundiff, P. Goode, K. Kenton, I. Nygaard, W. Whitehead, P. Wren, A. Weber

Catherine S. Bradley

OBJECTIVE: The objective of the study was to measure associations between bowel symptoms and prolapse. STUDY DESIGN: Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed. RESULTS: Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. …

Gastrointestinal Complications Following Abdominal Sacrocolpopexy For Advanced Pelvic Organ Prolapse, W. Whitehead, Catherine Bradley, M. Brown, L. Brubaker, R. Gutman, R. Varner, A. Visco, A. Weber, H. Zyczynski

Catherine S. Bradley

OBJECTIVE: The aims of this secondary analysis of the "Colpopexy And Urinary Reduction Efforts" (CARE) study were to estimate the incidence of postoperative gastrointestinal complications and identify risk factors. STUDY DESIGN: We prospectively identified gastrointestinal complications and serious adverse events (SAE) for 12 months after sacrocolpopexy. Two surgeons independently reviewed reports of ileus or small bowel obstruction (SBO). RESULTS: Eighteen percent of 322 women (average age 61.3 years) reported "nausea, emesis, bloating, or ileus" during hospitalization and 9.8% at 6 weeks. Nineteen women (5.9%; CI 3.8%, 9.1%) had a possible ileus or SBO that generated SAE reports: 4 (1.2%, CI …

Obesity And Outcomes After Sacrocolpopexy, Catherine Bradley, K. Kenton, H. Richter, X. Gao, H. Zyczynski, A. Weber, I. Nygaard

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to compare outcomes after sacrocolpopexy (SC) between obese and healthy-weight women. STUDY DESIGN: Baseline and postoperative data were analyzed from the Colpopexy And Urinary Reduction Efforts (CARE) randomized trial of SC with or without Burch colposuspension in stress continent women with stages II-IV prolapse. Outcomes and complications were compared between obese and healthy-weight women. RESULTS: CARE participants included 74 obese (body mass index >/=30 kg/m(2)), 122 overweight (25-29.9 kg/m(2)), and 125 healthy-weight (18.5-24.9 kg/m(2)) women, and 1 underweight (< 18.5 kg/m(2)) woman. Compared to healthy-weight women, obese women were younger (59.0 +/- 9.9 vs 62.1 +/- 10.3 yrs; P = .04), more likely to have stage II prolapse (25.7% vs 11.2%; P = .01), and had longer operative times (189 +/- 52 vs 169 +/- 58 min; P = .02). Two years after surgery, stress incontinence, prolapse, symptom resolution, and satisfaction did not differ between the obese and healthy-weight groups. CONCLUSION: Most outcomes and complication rates after SC are similar in obese and healthy-weight women.

Urinary Incontinence, Depression And Posttraumatic Stress Disorder In Women Veterans, Catherine Bradley, I. Nygaard, M. Mengeling, J. Torner, Colleen Stockdale, B. Booth, A. Sadler

Catherine S. Bradley

OBJECTIVE: To study associations between urinary incontinence (UI) symptoms, depression, and posttraumatic stress disorder in women veterans. STUDY DESIGN: This cross-sectional study enrolled women 20 to 52 years of age registered at 2 midwestern US Veterans Affairs Medical Centers or outlying clinics within 5 years preceding study interview. Participants completed a computer-assisted telephone interview assessing urogynecologic, medical, and mental health. Multivariable analyses studied independent associations between stress and urgency UI and depression and posttraumatic stress disorder. RESULTS: Nine hundred sixty-eight women mean aged 38.7 +/- 8.7 years were included. Of these, 191 (19.7%) reported urgency/mixed UI and 183 (18.9%) stress …

Bowel Symptoms In Women 1 Year After Sacrocolpopexy, Catherine Bradley, I. Nygaard, M. Brown, R. Gutman, K. Kenton, W. Whitehead, P. Goode, P. Wren, C. Ghetti, A. Weber

Catherine S. Bradley

OBJECTIVE: The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy. STUDY DESIGN: This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II-IV prolapse. In addition to sacrocolpopexy (+/- Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon's discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively. RESULTS: The sacrocolpopexy + PR group (n = …

Bladder And Bowel Symptoms Among Women With Vulvar Disease: Are They Universal?, Colleen Kennedy, I. Nygaard, Catherine Bradley, R. Galask

Catherine S. Bradley

OBJECTIVE: To compare the prevalence of painful bladder syndrome, recurrent urinary tract infections, urinary leakage and irritable bowel syndrome between women with specific vulvar disorders and controls. STUDY DESIGN: Women with a primary diagnosis of vulvar intraepithelial neoplasia (dysplasia), vulvar vestibulitis (vestibulitis), contact vulvitis, atrophic vulvovaginitis, lichen simplex, lichen sclerosus and lichen planus, were compared to women presenting for annual examinations. RESULTS: As compared to controls, painful bladder syndrome was more prevalent among subjects with dysplasia, vestibulitis and contact vulvitis; a history of recurrent urinary tract infection was more prevalent among subjects with contact vulvitis; and urinary incontinence was less …

Pelvic Organ Prolapse, Constipation, And Dietary Fiber Intake In Women: A Case-Control Study, L. Arya, J. Novi, A. Shaunik, M. Morgan, Catherine Bradley

Catherine S. Bradley

OBJECTIVE: This study was undertaken to determine whether there is an association among pelvic organ prolapse, constipation, and dietary fiber intake. STUDY DESIGN: Sixty consecutive women with prolapse were compared with 30 control women without prolapse. All women completed 2 validated questionnaires to assess constipation and dietary fiber intake. Multivariate analysis was performed. RESULTS: The risk for constipation was greater in women with prolapse than controls (odds ratio 4.03, 95% CI 1.5-11.4). Median insoluble fiber intake was significantly lower in women with prolapse (2.4 g) than controls (5.8 g, P < .01). The increased risk for constipation was reduced but remained …

Predictors Of Success And Satisfaction Of Nonsurgical Therapy For Stress Urinary Incontinence, J. Schaffer, C. Nager, F. Xiang, D. Borello-France, Catherine Bradley, J. Wu, E. Mueller, P. Norton, M. Paraiso, H. Zyczynski, H. Richter

Catherine S. Bradley

OBJECTIVE: To identify factors that may predict success and satisfaction in women undergoing nonsurgical therapy for stress urinary incontinence. METHODS: Baseline demographic and clinical characteristics of women participating in a multicenter randomized trial of pessary, behavioral, or combined therapy for stress urinary incontinence were evaluated for potential predictors of success and satisfaction. Success and satisfaction outcomes were assessed at 3 months and included the Patient Global Impression of Improvement, stress incontinence subscale of the Pelvic Floor Distress Inventory, and Patient Satisfaction Questionnaire. Logistic regression was performed to identify predictors, adjusting for treatment and other important clinical covariates. Adjusted odds ratios …

Risk Factors For Painful Bladder Syndrome In Women Seeking Gynecologic Care, Colleen Kennedy, Catherine Bradley, R. Galask, I. Nygaard

Catherine S. Bradley

The aim of this cross-sectional study was to report risk factors for painful bladder syndrome in women. We surveyed 645 women presenting for care to general gynecology clinics and a vulvar specialty clinic using a standardized questionnaire and validated outcome measures. We used two definitions for painful bladder syndrome, based on the O'Leary-Sant interstitial cystitis symptom and problem indices. Of those women surveyed, 29.5% met broader criteria and 8.5% met more restrictive criteria for painful bladder syndrome. After adjusting for confounders, bladder pain was significantly associated with current smoking, irritable bowel syndrome, and a generalized pain disorder. Tobacco use, the …

Continence Pessary Compared With Behavioral Therapy Or Combined Therapy For Stress Incontinence: A Randomized Controlled Trial, H. Richter, K. Burgio, L. Brubaker, I. Nygaard, W. Ye, A. Weidner, Catherine Bradley, V. Handa, D. Borello-France, P. Goode, H. Zyczynski, E. Lukacz, J. Schaffer, M. Barber, S. Meikle, C. Spino

Catherine S. Bradley

OBJECTIVE: To compare the effectiveness of a continence pessary to evidence-based behavioral therapy for stress incontinence and to assess whether combined pessary and behavioral therapy is superior to single-modality therapy. METHODS: This was a multisite, randomized clinical trial (Ambulatory Treatments for Leakage Associated with Stress Incontinence [ATLAS]) that randomly assigned 446 women with stress incontinence to pessary, behavioral therapy, or combined treatment. Primary outcome measures, at 3 months, were Patient Global Impression of Improvement and the stress incontinence subscale of the Pelvic Floor Distress Inventory. A priori, to be considered clinically superior, combination therapy had to be better than both …

Natural History Of Pelvic Organ Prolapse In Postmenopausal Women, Catherine Bradley, M. Zimmerman, Y. Qi, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To describe the natural history of pelvic organ prolapse and risk factors for changes in vaginal descent in older women. METHODS: This 4-year prospective observational study included 259 postmenopausal women with a uterus enrolled at one Women's Health Initiative clinical site who completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations. We calculated 1-year and 3-year incidence and resolution risks for prolapse (defined as maximal vaginal descent to or beyond the hymen) and estimated progression and regression rates (1 cm or greater and 2 cm or greater changes in maximal vaginal descent) and risk factors. RESULTS: Mean …

The "Costs" Of Urinary Incontinence For Women, L. Subak, J. Brown, S. Kraus, L. Brubaker, F. Lin, H. Richter, Catherine Bradley, D. Grady

Catherine S. Bradley

OBJECTIVE: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. METHODS: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. RESULTS: Mean age was 56 +/- …

Vaginal Descent And Pelvic Floor Symptoms In Postmenopausal Women: A Longitudinal Study, Catherine Bradley, M. Zimmerman, Q. Wang, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women. METHODS: This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized …