May 2003 · Vol. 15, No. 5Simple yet thorough office evaluation of pelvic floor disorders
This practical, step-by-step article—complete with detailed diagrams to guide you through evaluation—describes a focused examination that often yields a diagnosis in just 1 office visit.
NOELANI
M.
PRIETTO,
MD;
KARL
LUBER,
MD;
CHARLES
W.
NAGER,
MDDr. Prietto is a fellow, division of female pelvic medicine and reconstructive surgery, University of California, San Diego, School of Medicine. Dr. Luber is assistant clinical professor, division of female pelvic medicine and reconstructive surgery, University of California, San Diego, School of Medicine, and director of the female continence program at Kaiser Permanente in San Diego. Dr. Nager is professor, division of female pelvic medicine and reconstructive surgery, University of California, San Diego, School of Medicine.
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KEY POINTS
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A voiding diary, stress test, and postvoid residual volume measurement often can provide as much useful information as complex urodynamic investigations.
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In addition to performing the standard gynecologic exam, clinicians should assess patients for evidence of pelvic organ prolapse.
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A lower urinary tract infection can cause urgency, frequency, and nocturia, which can mimic urge incontinence or interstitial cystitis.
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Documentation of the postvoid residual volume is a prerequisite for any incontinence or anterior/apical prolapse procedure, because the clinician will need the information to interpret any postoperative voiding difficulty.
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The meticulous evaluation and diagnosis of pelvic floor disorders, critical precursors of treatment, are feasible for any gynecologist—without specialized equipment. A specific history, voiding diary, focused physical exam, and simple office tests provide sufficient data to diagnose most complaints in a single office visit, allowing clinicians to initiate a management plan immediately.
This approach frequently can be carried out without additional studies. In other cases, the evaluation steers the practitioner to the appropriate investigations.
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