The assessment of the prevalence of urogynecological symptoms among the group of patients diagnosed with gynecological maligncies.ancies.

Zietek-Strobl A1, Futyma K1, Kuna_Broniowska I2, Rechberger T1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 753
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Incontinence Pelvic Organ Prolapse Quality of Life (QoL)
1.2nd Gynecology Department Medical University in Lublin, 2.The University of Life Sciences in Lublin
Links

Abstract

Hypothesis / aims of study
Pelvic floor disorders (PFDs) either anatomical (pelvic organs prolapse) or 
functional (urinary incontinence and stool incontinenc) negatively affect quality of life in the
general population. In fact every second female patient in postmenopausal age suffer 
from urinary incontinence or pelvic organ prolapse, whereas 6% to 19% of this population 
may demand surgery in the future. (1) The prevalence of PFD in various gynecologic 
cancer survivors has not been systematically studied. This study aimed to determine the 
prevalence of PFDs in women after various types of oncological therapy. We hypothesized
that the prevalence of PFDs in the gynecological cancer survivors would be higher than in 
the general female population. It is obvious that surgery itself, but also additional 
oncological treatment (radiation, radiochemotherapy) can negatively affect not only 
genitourinary system, but also quality of life. (2,3)
	Therefore the aim of this study was to determine the impact of treatment used
among female oncological patients before and 6 months after therapy due to various gynecological malignancies.
Study design, materials and methods
The study was conducted on the group of 160 patients age between 28 to 87 years. All the patients were diagnosed with gynecological malignancy and underwent surgery  in the years 2015-2016.
All the patients signed up the consent agreement form, filled up the questionnaires and self-assessed general wellbeing using the 7-points Likert's Scale.
A standarized and validated forms of: SF-36 v.2 Questionnaire (assessing general quality of life), King's Health Questionnaire (assessing general quality of life with concommitant LUTS) and short forms of UDI-6 (assessing prevalence of urinary incontinence) and II-Q7 (assessing the impact of urinary incontinenceon everyday functioning) were used in the study.
	Statistical analyses were performed with Statistica package version 12.0 (StatSoft Inc.,Tulsa, OK, USA). A p value <0.05 was considered statistically significant.
Results
Demographic data did not differ between study groups.
Almost 50% of female patients declare to suffer from the pelvic organe prolapse and more than 60% suffer from urinary incontinence by the moment of oncological disease diagnosis.
The global statistical analysis of UDI-6 and II-Q7 questionnaires revealed that oncological treatment incerases the frequency of urinary incontinence and its' impact on everyday functioning.
Analysing the KHQ domains revealed statistically significants differences in the study group before the surgery and 6 months after oncological therapy. There were also statistically significant differences found between the operative groups and combined therapy (surgery plus additional therapy) groups.
The use of non-parametric statistical tests revealed that values of MCS and PCS domains of SF-36 v.2 Questionnaire are significantly lower among oncological patients than in the general population.
The patients diagnosed with uterine malignancies (endometrial cancer and cervical cancer) were assessed with additional statistical analysis. There were statistically significant differences between the operative groups revealed, considering the total abdominal hysterectomy and bilateral salpingo-oophorectomy and total abdominal hysterectomy and bilateral salpingo-oophorectomy supported by pelvic lymphadenectomy. Surprisngly there were no statistically significant differences found in the radical hysterectomy group of patients, which can be the result of too small group count.
Interpretation of results
The study resulted in certain conclusions considering: more than 50% of female oncological patients suffer from pelvic floor disorders at the moment of oncological disease diagnosis. Oncological treatment results in the deterioration in pelvic floor disorders. Type of surgery results in deterioration of the urogynecological symptoms and quality of life in oncological patients group. Combination of surgical and additional oncological therapy results in the higher prevalence of urogynecological symptoms. Among oncological therapies: pelvic radiation and radiochemotherapy seem to mostly negatively affect female pelvic floor.
Concluding message
Urogenital symptoms are exagerrated in oncological patients treated due to gynecological malignancies. This exagerration is more pronounced in patients who required combined therapy.
The general quality of life among oncological survivors is lower than in general population.
References
  1. Barber MD, Brubaker L, Nygaard I et al. Defining success after surgery for pelvic organ prolapse. Pelvic Floor Disorders Network.Obstet Gynecol. 2009 Sep; 114 (3): 600-9
  2. Ellerkman RM, Dunn JS Jr, Bent AE et al. Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J Pelvic Floor Dysfunct. 2004 Jan-Feb; 15 (1): 25-31
  3. Erekson EA, Sung VW, DiSilvestro PA et al. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Feb; 20 (2): 159-63
Disclosures
<span class="text-strong">Funding</span> none <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Bioethical Commission by medical University in Lublin <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes