Understanding Female Pelvic Floor Disorders: A Closer Look at the Etiology of Pelvic Organ Prolapse and the Efficacy of Sacral Neuromodulation for the Treatment of Refractory Urinary Urgency and Frequency, and Urinary Urge Incontinence
MetadataShow full item record
The objectives of the research are to test the hypothesis that pelvic outlet diameter (POD) is associated with pelvic organ prolapse (POP) in squirrel monkeys, and to measure long-term satisfaction of women treated with sacral neuromodulation (InterStim®) for refractory urinary urge incontinence, urinary urgency, and frequency. Magnetic resonance images (MRI) were obtained from 55 females with and without POP. Associations of age, parity, and body weight to POD were evaluated with linear regression analysis, while relationships between age, parity, and POD with POP were examined with multiple regression analysis. Women who were at least 3.3 years remote from InterStim® implantation were contacted by telephone to assess treatment satisfaction (Likert-type scale), symptom severity (UDI-6), disease related quality of life (IIQ-7), and patient global impression of improvement (PGI). Pelvic outlet diameter was not related to parity (p = 0.10) or weight (p = 0.053), but was inversely related to age. (p = 0.011) Animals with POP did not differ from those without POP in age (p = 0.10), weight (p = 0.17), or POD (p = 0.99). The groups differed in parity (p = 0.007) and multiple regression methods demonstrated that only parity had a significant relationship with POP (p = 0.002). In measuring long-term satisfaction of those treated with sacral neuromodulation, 37.5% of respondents were “satisfied” with their InterStim® and 50% would have the procedure again. Satisfied subjects were found to be younger then dissatisfied subjects (p = 0.10), and reported a median improvement in their bladder symptoms of 50%. Objective incontinence parameters and survey scores performed preoperatively and improvement during test stimulation were not predictive of long-term patient satisfaction. In conclusion, POD size does not contribute to POP in squirrel monkeys. Of the 24 subjects who were available for follow-up after 51 months of treatment, 50% would have InterStim® again.
Joyce, John Sullivan (2015). Understanding Female Pelvic Floor Disorders: A Closer Look at the Etiology of Pelvic Organ Prolapse and the Efficacy of Sacral Neuromodulation for the Treatment of Refractory Urinary Urgency and Frequency, and Urinary Urge Incontinence. Master's thesis, Texas A & M University. Available electronically from