Towards evidence based practice in pelvic floor physiotherapy

The PelFIs is new practical and conceptually clear questionnaire that focus on micturition, defecation and/or sexual dysfunction, related to pelvic floor dysfunction. The use of PelFIs may provide a better and reliable insight in the patients__ experience of specific complaints of pelvic floor dysfunction. o In our opinion the interaction of a patient and clinician during the administration of a questionnaire is essential in order to gain the patients__ trust and thus acquire a true perspective of FSDs and past or prevalent sexual abuse. We believe that a questionnaire administered by a clinician should be preferred to a self-administered questionnaire. o Pelvic floor dysfunction is correlated with urinary, sexual or gastroenterological complaints. In our retrospective study we found that 77, 2 % of patients who presented to the clinic with urinary, gastro or sexual complaints had measurable pelvic floor dysfunction (69, 3 % overactive rest tone and 7, 9 % under active rest tone). In relation to the ICS terminology there is a need for a well defined normal versus elevated rest tone of the pelvic floor. o The electrodes of the probes, as we use them now during electrostimulation and biofeedback training in the treatment of pelvic floor dysfunction, are not optimal for the structures we want to stimulate or to register. o Extracorporeal Magnetic Innervation (ExMI) appeared to have no beneficial effect on pelvic floor function. o We were able to demonstrate an acute effect of one application of TENS in the combined setting on bladder function using urodynamic parameters in patients with the overactive bladder syndrome o We were able to demonstrate an acute effect of one application of intravaginal ES (8 Hz, pulse duration 1000 _seconds and no pulse to rest) on bladder function using urodynamic parameters in patients with symptoms of the OAB. 137 131 It has been established and it is my personal believe that pelvic floor physiotherapy has an important place in the treatment of micturition-, defecation problems and sexual dysfunction. Pelvic Floor Physiotherapy should be at least considered before irreversible surgery is advocated. The treatment is safe, minimal invasive and not costly. A consensus should be reached on treatment indications, patient selection and treatment protocol. Further research is necessary to determine the mechanisms of action, the efficacy and the proper placement of probes in the treatment of pelvic floor dysfunction. This thesis is an effort towards evidenced based pelvic floor physiotherapy, but more fundamental research in pelvic floor science is necessary.Pelvic Floor & Sexuality Research Group Leiden, an unrestricted grant of Pfizer, Stichting Amsterdam 98, Astellas Pharma BV, Astra Zeneca, B-K Medical, Novartis Pharma BV, Koninklijk Nederlands Genootschap voor Fysiotherapie.UBL - phd migration 201

Pelvic floor dysfunction is not a risk factor for febrile urinary tract infection in adults

OBJECTIVE To determine whether pelvic floor dysfunction (PFD) might be a risk factor for or consequence of febrile urinary tract infection (UTI), as UTI in adults is a common infection in which an underlying urological abnormality is often considered, and as in children, PFD is also thought to have a pathophysiological role in adults with UTI. PATIENTS AND METHODS A multicentre case-control study was conducted at 26 primary-care centres and at six Emergency Departments of regional hospitals. Cases were consecutive patients aged >= 18 years, who presented with febrile UTI. Controls were randomly selected subjects who visited their general practitioner for reasons other than UTI or fever. A validated pelvic floor questionnaire (the Pelvic Floor Inventories Leiden, PelFIs) was used to assess pelvic floor function. RESULTS Between October 2006 and December 2007, 153 cases were included; of these, the completed questionnaires of 102 (response rate 67%) were compared to those of 100 of 110 (response rate 91%) controls. The median age of cases and controls was 65 and 58 years, respectively; 40% of cases and controls were men. The percentage of PelFIs outcomes consistent with PFD were comparable between cases and controls, at 21% vs 23%, respectively (odds ratio 0.9, 95% confidence interval, CI, 0.4-1.78). In the multivariate analysis, comorbidity (odds ratio 4.9, 95% CI 2.2-11.1) and a history of UTI (odds ratio 2.5, 95% CI 1.0-6.1) were independent significant risk factors for febrile UTI, whereas PFD was not (odds ratio 1.0, 0.5-2.2). Within the group of cases, PFD was not associated with bacteriuria during assessment of PelFIs (odds ratio 1.1, 95% CI 0.4-3.5) and inversely related to a history of UTI within the previous year (odds ratio 0.2, 0.1-0.9). CONCLUSIONS PFD is common among adults but it does not seem to be a risk factor for febrile UTI.Immunogenetics and cellular immunology of bacterial infectious disease

Authors' Response Re: Panwar P, Bora GS, Mayuduru RS. Letter to the Editor. Re: Dijkstra-Eshuis J, van den Bos TW, Splinter R, Bevers RF, Zonneveld WC, Putter H, et al. Effect of Preoperative Pelvic Floor Muscle Therapy With Biofeedback Versus Standard Care on Stress Urinary Incontinence and Quality of Life in Men Undergoing Laparoscopic Radical Prostatectomy: A Randomised Control Trial. Neurourol Urodyn. 2015 Feb; 34(2): 144-50

Neuro-urology: functional disorders in male and female urogenital trac

Chronic Testicular Pain as a Symptom of Pelvic Floor Dysfunction

Purpose: We determined whether chronic testicular pain is related to pelvic floor overactivity after ruling out other disease pathology. Materials and Methods: A total of 41 patients with chronic testicular pain evaluated at our Pelvic Floor Department at a tertiary academic center were included in this retrospective study. All patients underwent standard pelvic floor investigation, including history using a standardized questionnaire and electromyography registration of the pelvic floor. In the questionnaire patients were asked about complaints in 3 domains (micturition, defecation and sexual function) suggestive of pelvic floor dysfunction. Electromyography registration of the pelvic floor was performed. The resting tone of the pelvic floor was considered increased at 3 mu V or greater. Results: Mean patient age was 48 years. Of the patients 93% had at least 1 symptom suspicious of pelvic floor dysfunction. A total of 22% had complaints in 1 of the domains of micturition, defecation or sexual function, 24% had complaints in 2 domains and 49% had complaints in all 3 domains. On electromyography registration of the pelvic floor 88% of patients appeared to have an increased resting tone of the pelvic floor muscles at a mean of 6.7 AV (normal less than 3). The patients with a normal pelvic floor resting tone were significantly older than those with an increased resting tone (65.6 vs 45.6, p = 0.0001). Conclusions: Chronic testicular pain can be a symptom of pelvic floor overactivity, especially in younger patients. A diagnostic evaluation should be performed when no pathophysiology can be found.Neuro-urology: functional disorders in male and female urogenital trac

Chronic Testicular Pain as a Symptom of Pelvic Floor Dysfunction

Purpose: We determined whether chronic testicular pain is related to pelvic floor overactivity after ruling out other disease pathology. Materials and Methods: A total of 41 patients with chronic testicular pain evaluated at our Pelvic Floor Department at a tertiary academic center were included in this retrospective study. All patients underwent standard pelvic floor investigation, including history using a standardized questionnaire and electromyography registration of the pelvic floor. In the questionnaire patients were asked about complaints in 3 domains (micturition, defecation and sexual function) suggestive of pelvic floor dysfunction. Electromyography registration of the pelvic floor was performed. The resting tone of the pelvic floor was considered increased at 3 mu V or greater. Results: Mean patient age was 48 years. Of the patients 93% had at least 1 symptom suspicious of pelvic floor dysfunction. A total of 22% had complaints in 1 of the domains of micturition, defecation or sexual function, 24% had complaints in 2 domains and 49% had complaints in all 3 domains. On electromyography registration of the pelvic floor 88% of patients appeared to have an increased resting tone of the pelvic floor muscles at a mean of 6.7 AV (normal less than 3). The patients with a normal pelvic floor resting tone were significantly older than those with an increased resting tone (65.6 vs 45.6, p = 0.0001). Conclusions: Chronic testicular pain can be a symptom of pelvic floor overactivity, especially in younger patients. A diagnostic evaluation should be performed when no pathophysiology can be found

THE EFFECT OF EMG BIOFEEDBACK ASSISTED PELVIC FLOOR MUSCLE THERAPY WITH THE MAPLE ON SYMPTOMS OF THE OVERACTIVE BLADDER SYNDROME IN WOMEN AFTER NINE WEEKS OF TREATMENT: A RANDOMISED TRIAL

Development and application of statistical models for medical scientific researc

THE EFFECT OF EMG BIOFEEDBACK ASSISTED PELVIC FLOOR MUSCLE THERAPY WITH THE MAPLE ON SYMPTOMS OF THE OVERACTIVE BLADDER SYNDROME IN WOMEN AFTER NINE WEEKS OF TREATMENT: A RANDOMISED TRIAL

Development and application of statistical models for medical scientific researc

The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial

Neuro-urology: functional disorders in male and female urogenital trac