Urinary incontinence and prolapse are debilitating conditions significantly affecting quality of life. They are extremely prevalent, affecting a significant number of women attending gynaecology clinics with complex symptoms. ePAQ-PF offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation which is an advantage over history and may enhance the clinical episodes detection as well as the quality of care for women with pelvic floor disorders. The aim of the study is to compare effectiveness of ePAQ-PF against history for diagnosis in complex urogynaecology patients.
Data was collected retrospectively from ePAQ-PF and history in a tertiary level urogynaecology unit and collated onto microsoft excel. 40 patients were selected randomly from 56 eligible (administered and succeessfully completed ePAQ-PF) patients attending Urogynaecology and PEARL (combined urogynaecology and colorectal) clinics between July 2018 and July 2021. Fisher's exact test was used for inferring on statistical significance in the comparative analysis. The software used for this analysis was SAS version 9.4.
Thirty-four out of the forty patients were eligible for analysis for overactive bladder and stress urinary incontinence; twenty-four for prolapse and twenty-six patients for voiding difficulty. Patients were between 18 and 80 years of age with highest participants between 40 and 69 years. Four scored symptom domain was chosen for statistical analysis due to adequate power of comparative data in these domains. The additional diagnostic yield by ePAQ-PF for overactive bladder (OAB), stress urinary incontinence (SUI), voiding difficulty (VD) and prolapse was 26.47%, 0%, 67% and 16.67% respectively. P value for OAB, VD and prolapse was 0.0294, 0.0031 and 0.01 respectively. Apart from these four symptoms ePAQ-PF contributed additional symptoms over and above history in all 40 patients due to its wide range of symptom domains. History provided additional symptoms in 3 women with recurrent urinary tract infection which was not identified on ePAQ-PF.
ePAQ-PF has shown significant additional diagnostic yield for overactive bladder, voiding difficulty and prolapse. P value for each has supported this statement. Although there was no additional diagnostic yield for stress urinary incontinence by ePAQ-PF, it has shown an accuracy of 96.97% (n = 33) for diagnosing the cases like history taking for SUI. ePAQ-PF enabled us to identify more symptoms in 100% cases (n = 40) which includes body image, general sex life, pain and altered sensation of vagina, reduced capacity of vagina etc, in comparison to history, for complex urogynaecology patients. History contributed to additional symptom diagnosis such as recurrent urinary tract infection in 7.5% (n = 40) of cases.
ePAQ-PF is a useful diagnostic tool providing additional benefit for the diagnosis of the complex urogynaecology patient. Overall recommendation is to implement a policy of using ePAQ-PF evaluation in all complex urogynaecology patients in addition to history. Further studies are needed to assess the pattern of the yield across age, parity, disease severity related to complex urogynaecology symptoms.
European journal of obstetrics, gynecology, and reproductive biology. 2022 Jul 05 [Epub ahead of print]
Suvalagna Chatterjee, Supriya Bulchandani
Clinical Research Fellow, Urogynaecology, University Hospitals Coventry and Warwickshire, UK. Electronic address: ., Consultant Gynaecologist and Subspecialist Urogynaecology, University Hospitals Coventry and Warwickshire, UK.