Functional Disorders of the Pelvic Floor : assessment of quality of life and management strategies

Symptoms related to the dysfunction of the pelvic floor can disrupt dramatically the lives of the men and women who are affected by it. Symptoms relating to dysfunction of the pelvic floor include involuntary loss of urine, pelvic organ prolapse, inability to control the passage of stool or flatus, and sexual dysfunction.
Outcomes are fundamental measures of success in health care to provide for adequate patient care. When evaluating the efficacy of patient care for those with pelvic floor dysfunction, studies focused on measurable (objective of semi-objective) symptoms are useful to estimate disease burden and the effect of medical interventions. Examples of such traditional outcome measures are parameters obtained from urodynamic studies, voiding diaries and ultrasound results. Patient reported outcome measures (PROMs) are often standardized, validated questionnaires which are completed by patients to measure their perception of their functional well-being and health status. In this thesis traditional and patient reported outcome measures aimed to evaluate functional disorders of the pelvic floor are presented. Linguistically adapted and psychometrically adequate PROMs for assessing symptom distress and health related quality of life of urogenital functional disorders in Dutch are presented: the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) short forms (Chapter 2) to assess urinary incontinence; the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) short form (Chapter 3) to assess pelvic floor dysfunction; the Fecal Incontinence Quality of Life Questionnaire (FIQL) and the Fecal Incontinence Severity Index (FISI) (Chapter 4) to assess fecal incontinence; the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12) (Chapter 5) to assess prolapse and sexuality; the 5-item International Index of Erectile Function (IIEF-5) (Chapter 6) to assess erectile dysfunction. Furthermore, the effectiveness of different surgical therapies for the treatment of functional bladder outlet obstruction in adults with neurogenic bladder dysfunction was assessed by conducting a Cochrane Review. Lastly, we composed Dutch multidisciplinary guidelines consisting of guiding decisions and criteria regarding diagnosis, management, and treatment in patients with neurogenic bladder.