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Pelvic floor disorders in women with gynecologic malignancies: a systematic review

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Abstract

Introduction and hypothesis

Pelvic floor disorders (PFDs) negatively affect quality of life in the general population, and their prevalence in gynecologic cancer survivors has not been systematically described. This study aimed to determine the prevalence of PFDs in cancer survivors. We hypothesized that the prevalence of PFDs in the gynecologic cancer population would be higher than in the general female population.

Methods

We searched PubMed (1809 to present), EMBASE (1974 to present), and the Cochrane Central Register of Controlled Trials (CENTRAL) through May 2017. The search combined subject headings, title, and abstract words for gynecologic cancer, PFDs, and prevalence. Any studies evaluating the prevalence of PFDs in gynecologic malignancies were included.

Results

A total of 550 articles met the designated search criteria and 31 articles were included in this review. In cervical cancer survivors, before treatment the prevalences of stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and fecal incontinence (FI) were 24–29%, 8–18% and 6%, respectively, and after treatment the prevalences of SUI, UUI, urinary retention, FI, fecal urge, dyspareunia and vaginal dryness were 4–76%, 4–59%, 0.4–39%, 2–34%, 3–49%, 12–58% and 15–47%, respectively. In uterine cancer survivors, before treatment the prevalences of SUI, UUI and FI were 29–36%, 15–25% and 3%, respectively, and after treatment the prevalences of urinary incontinence (UI) and dyspareunia were 2–44% and 7–39%, respectively. In vulvar cancer survivors, after treatment the prevalences of UI, SUI and FI were 4–32%, 6–20% and 1–20%, respectively. In ovarian cancer survivors, the prevalences of SUI, UUI, prolapse and sexual dysfunction were 32–42%, 15–39%, 17% and 62–75%, respectively.

Conclusions

PFDs are prevalent in gynecologic cancer survivors and this is an important area of clinical concern and future research.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, USA

    Aparna S. Ramaseshan, Dana Roque, Gautam Rao & Tatiana V. D. Sanses

  2. Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Jessica Felton

  3. Health Sciences & Human Services Library, University of Maryland School of Medicine, Baltimore, MD, USA

    Andrea G. Shipper

Authors
  1. Aparna S. Ramaseshan
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  2. Jessica Felton
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  3. Dana Roque
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  4. Gautam Rao
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  6. Tatiana V. D. Sanses
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Corresponding author

Correspondence to Aparna S. Ramaseshan.

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Conflicts of interest

Dr. Sanses was supported by Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 HD43489 from the National Institute of Child Health and Human Development at the time of the study, and by the National Institute on Aging (1R03AG053281–01).

The other authors have no conflicts of interest to disclose.

Appendix A: PFD search terms

Appendix A: PFD search terms

bladder outflow obstruction, acontractile detrusor, detrusor underactivity, non-functioning pelvic floor muscles, underactive pelvic floor muscles, overactive pelvic floor muscles, urinary tract infections, vulvar pain, absent bladder sensation, reduced bladder sensation, bladder oversensitivity, increased bladder sensation, lower urinary tract symptoms, lower urinary tract dysfunction, nocturnal polyuria, nocturnal enuresis, nocturia, irritative voiding symptoms, voiding dysfunction, retention of urine, urinary retention, pudendal neuralgia, cyclical pelvic pain, dysmenorrhea, perineal pain, vaginal pain, urethral pain, bladder pain, pelvic pain, vaginal dryness, vaginal atrophy, vaginal laxity, obstructed intercourse, dyspareunia, sexual dysfunction, autonomic dysreflexia, hematuria, detrusor sphincter dyssynergia, dysfunctional voiding, urethral sphincter obstruction, bladder neck obstruction, rectal bleeding, rectal prolapse, constipation, diminished rectal sensation, straining to defecate, fecal flatal urgency, fecal rectal urgency, fecal incontinence, bladder spasms, painful bladder, cystitis, interstitial cystitis, urethral diverticulum, urethral caruncle, urethral prolapse, vaginal wall prolapse, vaginal vault prolapse, vaginal apex prolapse, enterocele, uterovaginal prolapse, cervical prolapse, uterine prolapse, perineocele, rectocele, cystocele, pelvic pressure, vaginal bulge, pelvic organ prolapse, dysuria, post micturition dribble, post micturition leakage, need to immediately re-void, splitting of urinary stream, spraying of urinary stream, terminal dribble, straining to void, slow stream, daytime urinary frequency, involuntary detrusor contraction, detrusor incontinence, detrusor overactivity, detrusor instability, urethral hypermobility, incomplete bladder emptying, urinary bladder neurogenic, urinary bladder overactive, neurogenic bladder, overactive bladder, urinary incontinence, incontinence, pelvic floor disorders.

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Ramaseshan, A.S., Felton, J., Roque, D. et al. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecol J 29, 459–476 (2018). https://doi.org/10.1007/s00192-017-3467-4

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  • DOI: https://doi.org/10.1007/s00192-017-3467-4

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