Development/pilot evaluation of a compact symptom-based diagnostic model/database for female pelvic floor dysfunction

Background There is a pressing need among individual surgeons and busy clinics for a time-efficient method to record, assess, and monitor cases going to surgery. Purpose To develop a compact, symptom-based, simplified diagnostic model and database, designed to be sufficiently comprehensive, accurate and predictive of causation to guide pelvic floor surgeries and monitor their results postoperatively. Methods We condensed the four parts of the validated comprehensive Integral Theory Diagnostic System into a 10-minute assessment, including QOL and "simulated operations" to test the possibility of ligamentous origins of SUI, OAB and chronic pelvic pain. Results The pilot model was tested in 109 women, 82 with pelvic organ prolapse and 27 with stress urinary incontinence (SUI) from a busy urogynecology clinic. The model succeeded in what it was planned to do: record symptoms in a database, deduce possible ligament causation of symptoms and observed prolapses graded simply I-IV, all within 10 minutes. Initial testing for monitoring post-operative anatomical and symptom results is promising. Conclusions The model has been found to be helpful as a clinical guide. It is now in general use for all planned incontinence and prolapse surgeries. It records symptoms, prolapses and diagnoses, and potential connective tissue causation for SUI, urge and pain, which is then tested. The simplified database is a low-cost monitoring system for incontinence and prolapse surgery, especially useful for an individual surgical practice and low-resource clinics. Being symptom-based, the model is amenable to tailoring for individual practices and institutions.