Deborah L Myers

Publications (43)108.45 Total impact

• Article: Changes in bowel symptoms 1 year after rectocele repair.

  Vivian W Sung, Charles R Rardin, Christina A Raker, Christine A Lasala, Deborah L Myers
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  ABSTRACT: OBJECTIVE: We sought to evaluate changes in bowel symptoms after rectocele repair and identify risk factors for persistent symptoms. STUDY DESIGN: We conducted ancillary analysis of a randomized surgical trial for rectocele repair. Subjects underwent examinations and completed questionnaires for bowel symptoms at baseline and 12 months postoperatively. Outcomes included resolution, persistence, or de novo bowel symptoms. We used multiple logistic regression to identify risk factors for bowel symptom persistence. RESULTS: A total of 160 women enrolled: 139 had baseline bowel symptoms and 85% had 12-month data. The prevalence of bowel symptoms decreased after rectocele repair (56% vs 23% splinting, 74% vs 37% straining, 85% vs 19% incomplete evacuation, 66% vs 14% obstructive defecation; P < .001 for all). On multiple logistic regression, a longer history of splinting was a risk factor for persistent postoperative splinting (adjusted odds ratio, 2.25; 95% confidence interval, 1.02-4.93). CONCLUSION: Bowel symptoms may improve after rectocele repair but almost half of women will have persistent symptoms.
  American journal of obstetrics and gynecology 06/2012; · 3.28 Impact Factor
• Article: Pharmacologic treatment for urgency-predominant urinary incontinence in women diagnosed using a simplified algorithm: a randomized trial.

  Alison J Huang, Rachel Hess, Lily A Arya, Holly E Richter, Leslee L Subak, Catherine S Bradley, Rebecca G Rogers, Deborah L Myers, Karen C Johnson, W Thomas Gregory, Stephen R Kraus, Michael Schembri, Jeanette S Brown
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  ABSTRACT: 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. 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. After 12 weeks, women who had been assigned randomly to fesoterodine therapy reported 0.9 fewer urgency and 1.0 fewer total incontinence episodes/day, compared with placebo (P ≤ .001). Four serious adverse events occurred in each group, none of which was related to treatment. No participant had postvoid residual volume of ≥ 250 mL after treatment. Among ambulatory women with urgency-predominant incontinence diagnosed with a simple 3-item questionnaire, pharmacologic therapy resulted in a moderate decrease in incontinence frequency without increasing significant urinary retention or serious adverse events, which provides support for a streamlined algorithm for diagnosis and treatment of female urgency-predominant incontinence.
  American journal of obstetrics and gynecology 05/2012; 206(5):444.e1-11. · 3.28 Impact Factor
• Article: Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial.

  Vivian W Sung, Charles R Rardin, Christina A Raker, Christine A Lasala, Deborah L Myers
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  ABSTRACT: To estimate the effect of porcine subintestinal submucosal graft augmentation on improving anatomic and subjective rectocele repair outcomes compared with native tissue repair. We conducted a randomized controlled trial at two sites, including women with at least stage 2 symptomatic rectocele. Anatomic and subjective outcomes (vaginal bulge and defecatory) were collected 12 months postoperatively, including blinded Pelvic Organ Prolapse Quantification (POP-Q) examinations. Anatomic failure was defined as points Ap or Bp -1 or greater on POP-Q. Subjective failure was defined as no improvement or worsening of symptoms. We estimated number needed to treat and adjusted odds ratios (ORs). Assuming graft use is associated with 93% anatomic success, 63 women per group would be needed to detect a 20% difference at α=.05 and β=.20. One hundred sixty women were randomized; 137 had 12-month anatomic data (67 graft; 70 control). There was no difference in anatomic failure (12% compared with 9%, P=.5), vaginal bulge symptom failure (3% compared with 7%, P=.4, number needed to treat=26) or defecatory symptom failure (44% compared with 45%, P=.9, number needed to treat=91) for graft compared with control, respectively. Both groups reported improvement in vaginal bulge and defecatory symptoms (P<.05 for all). On multiple logistic regression, graft use was not associated with a decreased odds of anatomic failure (adjusted OR 1.36, 95% confidence interval [CI] 0.44-4.25), vaginal bulge symptoms (adjusted OR 0.46, 95% CI 0.08-2.68), or defecatory symptoms (adjusted OR 0.98, 95% CI 0.48-2.03). Although rectocele repair by either approach is associated with improved symptoms, subintestinal submucosal graft augmentation was not superior to native tissue for anatomic or subjective outcomes at 12 months. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00321867.
  Obstetrics and Gynecology 01/2012; 119(1):125-33. · 4.73 Impact Factor
• Article: Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence.

  Alayne D Markland, Holly E Richter, Kathryn L Burgio, Deborah L Myers, Alexandra L Hernandez, Leslee L Subak
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  ABSTRACT: INTRODUCTION/HYPOTHESIS: To estimate the effect of weight loss on fecal incontinence (FI) severity among overweight and obese women with urinary incontinence, we analyzed data from women randomized to a weight loss intervention or control condition. The modified Fecal Incontinence Severity Index (FISI) was administered at 6, 12, and 18 months in 338 women. Repeated measures analyses identified factors associated with improved FISI scores among women with baseline scores >0. FISI scores improved in 45 (13%) across all time points among the 291 women (87%) completing the trial. Improved scores were associated with a one-point lower urinary tract symptoms (LUTS) score, p < 0.01. Improved liquid stool FI frequency was associated with ≥ 5 kg weight loss (p = 0.001), 10-g increase in fiber intake (p = 0.05), and decreased LUTS (p = 0.003). FI severity improved with weight loss. Women with liquid stool FI losing at least 5 kg and/or increased dietary fiber intake had improved FI frequency.
  International Urogynecology Journal 05/2011; 22(9):1151-7. · 1.83 Impact Factor
• Article: Content validation of the patient-reported outcomes measurement information system (PROMIS) framework in women with urinary incontinence.

  Vivian W Sung, Felisha Marques, Rebecca R Rogers, David A Williams, Deborah L Myers, Melissa A Clark
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  ABSTRACT: To assess whether the existing National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) conceptual framework and item banks sufficiently capture the concerns of women with urinary incontinence (UI). Thirty-five women with UI were recruited between February-April 2009 for 4 structured focus groups to develop and assess the content validity of a conceptual framework for the impact of UI. This framework included domains from the NIH PROMIS framework and item banks including broad domains of physical and social function and mental health. All sessions were transcribed, coded, and qualitatively and quantitatively analyzed using analytic induction and deductive analysis to identify new themes and domains relevant to women with UI. The focus groups provided information that confirmed the relevance of existing PROMIS domains and identified new outcome domains that are important to this patient population. The groups confirmed the relevance of the physical and social functioning, and mental health domains. Additional themes that emerged included the distinction between ability versus participation and satisfaction, role functioning, external mediators, re-calibration/coping, cognitive function and new possibilities. Participants also felt strongly that not all domains and items apply to all women with UI and an option to tailor questionnaires and skip non-relevant items was important. The PROMIS framework domains are relevant to women with UI, but additional patient-important themes are identified that may improve the comprehensiveness of this assessment framework for measuring outcomes important to women with UI. These results will inform future item content development for UI.
  Neurourology and Urodynamics 03/2011; 30(4):503-9. · 2.96 Impact Factor
• Article: Association between obesity, sexual activity and sexual function in women with pelvic floor disorders.

  Katy K Tsai, Felisha Marques, Deborah L Myers, Vivian W Sung
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  ABSTRACT: : The objective of this study was to determine the association between obesity, sexual activity and sexual function in women with pelvic floor disorders (PFDs). : A retrospective study of women seeking care for PFDs was conducted between May 2008 and May 2009. Obesity was defined as body mass index ≥ 30 kg/m. Outcomes included sexual activity and sexual function measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Multivariable regression was used to estimate the association between obesity and sexual inactivity and function. : There were 161 (45.5%) non-obese and 193 (54.5%) obese women, with a subset of 214 sexually active women. Obesity was not associated with sexual inactivity, but was associated with worse PISQ-12 scores compared with non-obese women (mean score 36.9 ± 38 versus 74.8 ± 34, P < 0.001). On multivariable linear regression, obese women had a mean score of 30 points lower (95% confidence interval -40.6 to -20.2, P < 0.001) on the PISQ-12 compared with non-obese women. : Obesity is associated with worse sexual function in women with PFDs.
  Journal of Pelvic Medicine and Surgery 11/2010; 16(6):331-5.
• Article: Treatment decision-making and information-seeking preferences in women with pelvic floor disorders.

  Vivian W Sung, Christina A Raker, Deborah L Myers, Melissa A Clark
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  ABSTRACT: The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences. Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences. One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient = 0.5 to 0.7; Cronbach's alpha = 0.8 for the API, and r = -0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information. Women seeking care for PFDs vary in their preferences for participating in treatment decisions.
  International Urogynecology Journal 09/2010; 21(9):1071-8. · 1.83 Impact Factor
• Article: The association between obesity and stage II or greater prolapse.

  Blair B Washington, Elisabeth A Erekson, Nadine C Kassis, Deborah L Myers
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  ABSTRACT: We sought to evaluate the association between obesity and vaginal prolapse as well as pelvic organ prolapse symptoms. This was a cross-sectional study of women referred for urogynecologic care. The exposure was obesity and outcome, stage>or=II prolapse. Secondary outcomes were symptom bother and disease-specific quality of life. Our study included 721 women. No difference in stage>or=II prolapse was observed between obese (n/N 58/721 [35.8%]) and nonobese (n/N=463/721 [64.2%]) women (50.8% vs 52.7%; P=.62). Obesity was associated with increased distress on the Pelvic Floor Distress Inventory-20 (100 [+/-57.3] vs 87.4 [+/-53.1]; P=.003) due to higher scores on the Colorectal-Anal Distress Inventory-8 (22.9 [+/-21.5] vs 18.3 [+/-19.7]; P=.003) and the Urinary Distress Inventory-6 (48.8 [+/-27] vs 42.4 [+/-26.1]; P=.002). Obesity was not associated with stage>or=II prolapse but was associated with increased pelvic floor symptoms secondary to urinary and anal incontinence subscales.
  American journal of obstetrics and gynecology 02/2010; 202(5):503.e1-4. · 3.28 Impact Factor
• Article: The Association Between Stage II or Greater Posterior Prolapse and Bothersome Obstructive Bowel Symptoms.

  Elisabeth A Erekson, Nadine C Kassis, Blair B Washington, Deborah L Myers
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  ABSTRACT: : The primary objective of this study was to estimate the association between stage II or greater posterior prolapse and individual obstructive bowel symptoms. : We conducted a cross-sectional study of all women presenting for initial visit at a tertiary center for pelvic floor disorders. Exposure was defined as stage II or greater posterior vaginal prolapse as measured by pelvic organ prolapse quantification measurements. Outcomes included the separate bothersome obstructive bowel symptoms of splinting, straining, or incomplete bowel emptying. : Our study included 721 women. Univariate analysis did not show an association between stage II or greater posterior prolapse and the bothersome symptoms of straining or incomplete emptying. Stage II or greater posterior prolapse was associated with bothersome splinting (adjusted OR, 1.63; 95% CI, 1.06-2.53). : Stage II or greater posterior prolapse was associated with the bothersome symptom of splinting, but not bothersome straining or the sensation of incomplete evacuation.
  Journal of Pelvic Medicine and Surgery 01/2010; 16(1):59-64.
• Article: Ambulatory care related to female pelvic floor disorders in the United States, 1995-2006.

  Vivian W Sung, Christina A Raker, Deborah L Myers, Melissa A Clark
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  ABSTRACT: The purpose of this study was to describe trends for pelvic floor disorder (PFD)-related ambulatory visits. Data were derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. PFD-related visits were based on ICD-9 codes. We collapsed 12 survey years into 3 study periods (1995-1998, 1999-2002, 2003-2006) to evaluate numbers, rates, and trends for PFD-related visits. The average annual number of PFD-related visits was 3.9 million (95% confidence interval, 3.1-4.7). The annual rate of PFD-related visits per 1000 women was 35.2% in 1995-1998, 40.6% in 1999-2002, and 36.3% in 2003-2006. PFD visits represent 0.9% of all ambulatory visits for adult women in the United States. Women > or =60 years old had higher rates of PFD-related visits compared with women <60 years old. The annual number of PFD-related visits is significant and represents 0.9% of all ambulatory visits made by adult women in the United States.
  American journal of obstetrics and gynecology 09/2009; 201(5):508.e1-6. · 3.28 Impact Factor
• Article: Patient-reported outcomes after combined surgery for pelvic floor disorders in older compared to younger women.

  Vivian W Sung, Katharine Joo, Felisha Marques, Deborah L Myers
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  ABSTRACT: The purpose of this study was to compare patient-reported outcomes after combined surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) between older and younger women. This was a retrospective cohort study including 122 younger (<65 years) and 70 older women (>/=65 years old) who underwent combined POP and SUI surgery. SUI and POP treatment failure were based on validated measures. Logistic regression was used to calculate adjusted odds ratios and 95% confidence interval [CI]. Mean follow-up was 10 +/- 1.2 months. Women in both age groups reported significant improvement in symptoms and life impact postoperatively. In multivariable analyses, older women had an increased odds of SUI treatment failure (adjusted odds ratio [AOR], 1.10; 95% CI, 1.05-2.5), but not POP treatment failure (AOR, 0.90; 95% CI, 0.29-2.8). Women 65 years and older undergoing combined surgery for POP and SUI are at risk for recurrent SUI, but still experience significant improvements in symptoms and life impact.
  American journal of obstetrics and gynecology 09/2009; 201(5):534.e1-5. · 3.28 Impact Factor
• Article: Socioeconomic indicators and hysterectomy status in the United States, 2004.

  Elisabeth A Erekson, Sherry Weitzen, Vivian W Sung, Christina A Raker, Deborah L Myers
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  ABSTRACT: To examine the association between socioeconomic indicators and hysterectomy. We performed a cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance Survey database. The effect of multiple socioeconomic exposures (education level, annual income and employment status) on hysterectomy status was evaluated. Logistic regression was used to estimate ORs between the multiple exposures and the outcome of hysterectomy status. Our analytic sample included 180,982 women. Prior hysterectomy was reported by 26.4%. After adjusting for confounders, women who had not graduated from high school had 1.75 times higher odds (95% CI 1.68-1.83) of having a hysterectomy as compared to women who were college graduates, and women with an annual household income of < $15,000 had 1.06 times higher odds (95% CI 1.02 to 1.10) of having a hysterectomy as compared to women who reported an income of > $50,000/year. Women who were unemployed did not have higher odds of having a hysterectomy than women who were employed. Socioeconomic indicators of education level and income are associated with hysterectomy status; however, employment status is not.
  The Journal of reproductive medicine 09/2009; 54(9):553-8. · 0.87 Impact Factor
• Article: Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches.

  Charles R Rardin, Elisabeth A Erekson, Vivian W Sung, Renee M Ward, Deborah L Myers
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  ABSTRACT: To compare the risk of ureteral compromise and of recurrent vault prolapse following vaginal vs. laparoscopic uterosacral vault suspension at the time of vaginal hysterectomy. In this retrospective, cohort study, uterosacral ligament suspension was performed using either a vaginal or laparoscopic approach. The primary outcome was intraoperative ureteral compromise; secondary outcomes were postoperative anatomic result and recurrent prolapse. The Canadian Task Force Classification was II-2. One hundred eighteen patients were included: 96 patients in the vaginal group and 22 patients in the laparoscopic group. Ureteral compromise was identified intraoperatively in 4 (4.2%) cases in the vaginal group; no ureteral compromise was observed in the laparoscopic group (p = 0.33). Failure at the apex, defined as stage > or = II for point C, was seen in 6.3% of patients in the vaginal group as compared with 0% in the laparoscopic group; this difference did not achieve statistical significance. Similarly, trends toward lower recurrent symptomatic vault prolapse (10% vs. 0%), any symptomatic prolapse recurrence (12.5% vs. 4.6%), and higher postoperative Pelvic Organ Prolapse Quantification point C were observed in the laparoscopic group (p > 0.05 for all). Laparoscopic uterosacral vault suspension following vaginal hysterectomy is a safe alternative to the vaginal approach.
  The Journal of reproductive medicine 05/2009; 54(5):273-80. · 0.87 Impact Factor
• Source

  Available from: rimed.org

  Article: The role of urogynecology in women's pelvic floor disorders.

  Deborah L Myers
  Medicine and health, Rhode Island 02/2009; 92(1):4.
• Source

  Available from: rimed.org

  Article: Interstitial cystitis.

  Deborah L Myers
  Medicine and health, Rhode Island 02/2009; 92(1):22-6.
• Article: Association between urinary incontinence and depressive symptoms in overweight and obese women.

  Vivian W Sung, Delia S West, Alexandra L Hernandez, Thomas L Wheeler, Deborah L Myers, Leslee L Subak
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  ABSTRACT: The objective of the study was to determine the association between urinary incontinence (UI) and depressive symptoms. The study was a cross-sectional study of 338 incontinent and overweight women at baseline in the Program to Reduce Incontinence by Diet and Exercise trial. Depressive symptoms were defined as a Beck Depression Inventory score of 10 or greater. UI frequency was determined by a 7-day voiding diary. Symptom bother and quality of life were determined using the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Multivariable regression was used to estimate the association between UI and depressive symptoms. Women with depressive symptoms (n = 101) reported a higher mean number of UI episodes per week (28 vs 23; P = .005) and higher (worse) mean scores on the UDI (176 vs 162; P = .02) and IIQ (136 vs 97; P < .001) compared with women without depressive symptoms. The risk of having depressive symptoms increased with each 7-episode increase in UI per week (adjusted odds ratio [AOR], 1.10; 95% confidence interval [CI], 1.01-1.21), each 50-point increase in UDI (AOR, 1.27; 95% CI, 1.01-1.60), and each 50-point increase in IIQ (AOR, 1.44; 95% CI, 1.22-1.71). Urinary incontinence frequency, symptom bother, and quality of life are independently associated with depressive symptoms in overweight and obese women.
  American journal of obstetrics and gynecology 02/2009; 200(5):557.e1-5. · 3.28 Impact Factor
• Article: Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial

  Holly E. Richter, Jennifer M. Creasman, Deborah L. Myers, Thomas L. Wheeler, Kathryn L. Burgio, Leslee L. Subak, for the Program to Reduce Incontinence by Diet and Exercise (PRIDE) Research Group
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  ABSTRACT: The purpose of this study was to describe urodynamic characteristics of overweight or obese women with urinary incontinence and explore the relationship between urodynamic parameters, body mass index (BMI), and abdominal circumference (AC). One hundred ten women underwent a standardized cough stress test and urodynamic study. Eighty-six percent of women had urodynamic stress incontinence and 15% detrusor overactivity. Intra-abdominal pressure (Pabd) at maximum cystometric capacity (MCC) increased 0.4cm H2O per kg/m2 unit of BMI (95% confidence interval [CI] = 0.0,0.7, p = 0.04) and 0.4cm H2O per 2cm increase in AC (CI = 0.2, 0.7, p < 0.01). Intravesical pressure (Pves) at MCC increased 0.4cm H2O per 2cm increase in AC (CI = 0.0, 0.8, p = 0.05) but was not associated with BMI (p = 0.18). BMI and AC had a stronger association with Pabd than with Pves, suggesting a possible mechanism for the association between obesity and urinary incontinence.
  International Urogynecology Journal 11/2008; 19(12):1653-1658. · 1.83 Impact Factor
• Article: Pay for performance: what the urogynecologist should know.

  Elisabeth A Erekson, Vivian W Sung, Deborah L Myers
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  ABSTRACT: As urogynecologists, we should educate ourselves about pay for performance and be proactive in the development of outcome measures.
  International Urogynecology Journal 08/2008; 19(8):1039-41. · 1.83 Impact Factor
• Article: Combined trans- and periurethral injections of bulking agents for the treatment of intrinsic sphincter deficiency.

  Eric R Sokol, Vivian C Aguilar, Vivian W Sung, Deborah L Myers
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  ABSTRACT: The purpose of this study was to compare Contigen combined with Durasphere to Contigen injections alone for the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Subjective and objective incontinence outcomes were compared at 2 weeks and 6 months. We compared rates of urinary retention and future incontinence surgery between groups. Thirty-three women underwent combined injections, and 51 underwent Contigen injections. Two weeks postoperatively, more women in the combined group were cured (72.7 vs. 39.2%, P = 0.003), but this difference diminished at 6 months (33.3 vs. 29.4%, P = 0.70). Retention was more common in the combined group (P = 0.002, odds ratio [OR] = 0.062 [95% confidence interval (CI) = 0.007, 0.52]). Twenty-three women in the Contigen and ten in the combined group underwent subsequent incontinence surgery (P = 0.17, OR = 2.03 [95% CI = 0.80, 5.1]). Combining Contigen and Durasphere injections to treat SUI with ISD does not improve outcomes compared to Contigen injections alone.
  International Urogynecology Journal 06/2008; 19(5):643-7. · 1.83 Impact Factor
• Article: Effect of body mass index on the risk of anal incontinence and defecatory dysfunction in women.

  Elisabeth A Erekson, Vivian W Sung, Deborah L Myers
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  ABSTRACT: The primary objective was to estimate the effect of body mass index on the risk of anal incontinence and defecatory dysfunction in a tertiary referral urogynecologic population. This was a cross-sectional study, including 519 new patients. Exposure was defined as body mass index. The primary outcome was any reported anal incontinence. The secondary outcome was any defecatory dysfunction. We used multiple logistic regression to estimate odds ratios and 95% confidence intervals for the effect of body mass index on anal incontinence and defecatory dysfunction. After adjusting for confounders, every 5 unit increase in body mass index was associated with a significantly increased odds of anal incontinence (odds ratio 1.25; 95% confidence interval, 1.09 to 1.44) and a trend toward an increased odds of defecatory dysfunction (odds ratio 1.13; 95% confidence interval, 0.98 to 1.31), although this was not statistically significant. Increasing body mass index is significantly associated with anal incontinence, but not defecatory dysfunction in women.
  American journal of obstetrics and gynecology 06/2008; 198(5):596.e1-4. · 3.28 Impact Factor