Published online Jun 28, 2019. doi: 10.5662/wjm.v9.i2.26
Peer-review started: January 29, 2019
First decision: March 15, 2019
Revised: March 29, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: June 28, 2019
Processing time: 150 Days and 14.8 Hours
There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral.
To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns.
This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics.
There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51% (n = 26) of the PCP compared to 48% (n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals) (P = 0.02).
One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.
Core tip: The true value of this study highlights the finding that half of the patients sent for subspecialist (urogynecologic) evaluation did not receive any treatment from primary care physicians and specialists (obstetricians and gynecologists) prior to the referral. This suggests that there is a potential paucity of knowledge about non-invasive therapy options available for pelvic floor disorders. This leaves room for education about these disorders, whether during residency training or through certification examinations. This could result in decreased healthcare costs and morbidities associated with surgical procedures.