Publications (69) View all
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Article: Racial differences in self-reported healthcare seeking and treatment for urinary incontinence in community-dwelling women from the EPI Study.
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ABSTRACT: Objectives of this study are: (1) to examine the prevalence of healthcare seeking among black and white women with self-reported urinary incontinence (UI), (2) to investigate barriers to treatment for incontinence, and (3) To investigate commonly used therapeutic modalities for UI. This is a planned secondary analysis of responses from 2,812 black and white community-dwelling women living in southeastern Michigan, aged 35-64 years, who completed a telephone interview concerning UI, healthcare-seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self-identified as having urinary incontinence. Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, P = 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m(2) , prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self-care strategies, for example, pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels. Black and white women seek healthcare for UI at similar, low rates. Improved patient-doctor relationships and public education may foster healthcare seeking behavior.Neurourology and Urodynamics 06/2011; 30(8):1442-7. · 2.96 Impact Factor -
Article: Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center.
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ABSTRACT: OBJECTIVE: To describe the characteristics of recurrent pelvic organ prolapse (POP). METHODS: A convenience sample of patients presenting with recurrent POP symptoms between October 2007 and February 2010 completed questionnaires. The survey focused on timing of recurrence(s), symptoms, and demographics. RESULTS: Ninety-seven women completed questionnaires. Thirty-four (35.1%) had undergone multiple prior treatments. Overall, 23 of 76 (30.3%) women had not informed their surgeon of the recurrence. Twenty-seven of 59 (45.8%) women reported that their symptoms were the same as before treatment, whereas 23 of 59 (39.0%) reported more severe symptoms. POP was considered to be persistent if symptoms returned within 3months, and recurrent if symptom relief exceeded 3months. After primary surgery, 28 of 79 (35.4%) cases were considered to be persistent, whereas 51 (64.6%) cases were recurrent. Similar percentages were seen after second and third treatments. CONCLUSION: Overall, 35% of participants experienced early return of symptoms. Almost one-third of participants had not informed their surgeon of the recurrence, indicating that there may not be an accurate self-assessment of outcome in the absence of careful follow-up.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 10/2012; · 1.41 Impact Factor -
Article: Not all that bulges is vaginal prolapse.
Obstetrics and Gynecology 08/2011; 118(2 Pt 2):411-2. · 4.73 Impact Factor -
Article: Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse.
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ABSTRACT: To evaluate whether major levator ani muscle defects were associated with differences in postoperative vaginal support after primary surgery for pelvic organ prolapse (POP). A retrospective chart review of a subgroup of patients in the Organ Prolapse and Levator (OPAL) study. Of the 247 women recruited into OPAL, 107 underwent surgery for prolapse and were the cohort for the present analysis. Major levator ani defects were diagnosed when more than 50% of the pubovisceral muscle was missing on MRI. Postoperative vaginal support was assessed via POP-quantification system. Postoperative anatomic outcome was analyzed according to levator ani defect status, as determined by MRI. Support of the anterior vaginal wall 2 cm above the hymen occurred among 62% of women with normal levator ani muscles/minor defects and 35% of those with major defects. Support of the anterior wall 1cm above the hymen occurred among 32% women with normal muscles /minor defects and 59% of those with major defects. Levator ani defects were not associated with differences in postoperative apical/posterior vaginal support. Six weeks after primary surgery for prolapse, women with normal levator ani muscles/minor defects had better anterior vaginal support than those with major levator defects.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2011; 114(2):141-4. · 1.41 Impact Factor -
Article: Perineal body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging.
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ABSTRACT: The objective of the study was to describe a framework for visualizing the perineal body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Three distinct perineal body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Advances in MR technology allow visualization of perineal body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep.American journal of obstetrics and gynecology 11/2010; 203(5):494.e15-21. · 3.28 Impact Factor
