DUBAI, UAE (UroToday.com) - Dr. Dirk DeRidder commenced his lecture by noting the increasing complexity of terminology for female pelvic floor dysfunction and the need for a female-specific approach. There has not been an update on any terminology since ICS 2002 so two professional organizations, IUGA and ICS, convened a panel and collaborated on the new report. It is interesting to note that all panel members were male. The terminology was organized into appropriate clinical categories that included symptoms, signs and investigations or testing. The diagnoses were sub-classified to give each definition an appropriate descriptor. Definitions were obtained form a wide range of sources (e.g. ICS, published reports). Before final approval, the report was posted and open for public comment. Dr. DeRidder went on to highlight parts of the report.
Symptoms were defined as any morbid phenomenon or departure from the normal in structure, function or sensation experienced by women, indicative of disease or health problem (e.g. urinary incontinence, bladder storage symptoms, sensory symptoms, voiding and postmicturition symptoms, pelvic organ prolapse, sexual dysfunction, anorectal dysfunction, lower urinary tract or pelvic pain, lower urinary tract infection. The new definitions for urinary incontinence included postural incontinence (replaces changing position), insensible incontinence (replaces unaware) and the addition of coital incontinence. Voiding symptoms changes include position dependent micturition and urinary retention. Sensory symptoms is a new addition to this report and is defined as a departure from normal sensation or function, experienced during bladder filling and is further categorized into:
- increased bladder sensation which is a desire to void occurs earlier or is more persistent, but can be postponed,
- reduced bladder sensation or a desire to void occurs later despite an awareness of bladder filling and absent bladder sensation.
Signs were defined as any abnormality indicative of disease or a health problem, discoverable on examination of the patient or an objective indication of disease or health problem (e.g. urinary incontinence signs, POPQ, other signs such as pelvic floor muscle strength or neurological signs, frequency/volume chart/ bladder diary, pad testing). Investigations included tests such as uroflowmetry, PVR, cystometry (filling, voiding), urethral function, ultrasound imaging, radiological investigation and MRI.
Dr. DeRidder presented the 3 new diagnoses in this report including:
- bladder oversensitivity which is the early first desire to void (which occurs at low bladder volume) , with a low maximum cystometric capacity, no abnormal increases in detrusor pressure and absent of an UTI,
- voiding dysfunction which is abnormally slow and / or incomplete micturition, and
- recurrent urinary tract infections (UTI) which is the determination of the occurrence of at least three symptomatic and medical diagnosed UTI in the previous twelve months.
The other major additions in this report include female-specific imaging (ultrasound, radiology, MRI), and appropriate figures to help supplement and clarify the text. Dr. DeRidder reported that the consensus process has proved successful in bringing to completion a complex (250 definitions) document. It has clarity and is user-friendly with its key aim that it be interpretable to practicing clinicians and students in all the different specialty groups. He noted that an ongoing review is a must to keep the document updated.
[ refs: Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A,. International Urogynecological Association; International Continence Society.An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20]
Presented by Dirk De Ridder, MD, PhD, FEBU at the 7th Pan Arab Continence Society (PACS) Annual Meeting - February 3 - 5, 2011 - Dubai, United Arab Emirates.
Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.
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