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Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (PD06): Podium 6: Friday, September 10, 2021

PD06-12 APPLICATION OF URODYNAMIC STUDIES AND ADVERSE CHILDHOOD EXPERIENCES MODULE AS TEACHING TOOLS IN THE EVALUATION AND MANAGEMENT OF SEXUAL ABUSE ASSOCIATED LOWER URINARY TRACT DYSFUNCTION

Stothers, Lynn; Macnab, Andrew

doi: 10.1097/JU.0000000000001974.12
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INTRODUCTION AND OBJECTIVE:

It is now well established that adverse childhood experiences (ACE’s) including abuse are associated with life-long negative adult health impacts. Only a small urologic literature discusses evaluation of LUTS following abuse, and clinical approaches in care are lacking. Objective: a) to evaluate uroflow with EMG coupled with educational models in the management of sexual abuse related LUTS & b) to report satisfaction and outcome of an educational clinical care protocol developed to reduce sexual abuse associated LUTS.

METHODS:

N=210 women (28-72 yrs. mean 48) with a history of sexual abuse and LUTS participated completing history, physical exam, urinalysis and clinical tools (perineometry, bladder diary, Center for Disease Control ACE Module, Behavioural Risk Factor Surveillance System (BRFSS), UDI-6, CRADI-8 and POPDI; uroflow with EMG). Personalized teaching of pelvic anatomy with models along with viewing of uroflow with EMG graphs before & after anatomy teaching was compared. Secondary education about bladder/pelvic floor function & the conduct and rationale for urodynamics preceded CMG, & pressure flow studies. A validated satisfaction assessment tool recorded satisfaction with the clinical protocol and willingness to recommend the approach to others.

RESULTS:

Of 210 women N=80 self-declared abuse of which 80% was physical sexual abuse and 20% mental; while N=130 reported abuse in response to intake history questioning 55% of which was physical abuse (forced perineal touching, vaginal/anal penetration accompanied in 35% by forced viewing of adult explicit pornographic images). 90% completed uroflow with EMG of which 87% had dysfunctional voiding correlating 92% with increased perineal tone on exam and perineometry. Physical abuse history was more likely associated with lower education (p<0.05), history of substance abuse (p<0.01) & minority ethnicity (p<0.05) compared to those with mental abuse. 92% of subjects were highly satisfied with the educational teaching modules & 90% would recommend the approach to others.

CONCLUSIONS:

Sexual abuse associated LUTS may only be reported in response to clinical questioning; the educational approach of non-invasive uroflow with EMG with teaching of bladder function & pelvic anatomy was found to be highly satisfactory and valued by those with a history of sexual abuse, dysfunctional voiding & LUTS. Important differences in social & educational backgrounds were found between physical and mental sexual abuse victims.

Source of Funding:

n/a

© 2021 by American Urological Association Education and Research, Inc.