References

1. Sun JH, Aguirre OA, Davila GW. Team approach to pelvic floor dysfunction [abstract]. Dis Colon Rectum 1999;42(4):A15.

2. Halverson AL, Hull TL, Paraiso MF, Floruta C. Outcome of sphincteroplasty combined with surgery for urinary incontinence and pelvic organ prolapse. Dis Colon Rectum 2001;44(10):1421-1426.

Section XIV

Severity Assessment

Severity Assessment

Steven D.Wexner

Before treating any pelvic floor problem, albeit one of inability to evacuate or one of inability to prevent evacuation, an assessment of the severity of illness is imperative. A physician or surgeon would certainly not embark upon a course of therapy for cancer without adequate knowledge of the stage, and functional pelvic floor disorders are certainly no different.The only problem lies in the fact that whereas cancer and other organic pathologies can be objectively staged by clinical and histopathologic criteria, the staging of functional pelvic floor disorders relies on the conversion of subjective to objective information. The three chapters within this section provide an excellent up-to-date review of the most widely used currently available severity assessment scoring systems for these functional disorders. Use of these systems is imperative not only to decide upon appropriate therapies for individual patients but in fact to decide upon whether or not to even embark upon potentially invasive and/or expensive testing. An example is that if a patient has a mild score with limited impact on quality of life, one might elect not to pursue investigation, knowing that extensive treatment would not be offered. Conversely, a patient with a high score or a severe compromise in quality of life, would by all means undergo extensive evaluation. Therefore, it is incumbent upon every patient to have a score obtained during initial evaluation so as to determine the necessity for any more extensive preliminary investigations. Such scores should again be obtained at every stage after conservative and more aggressive managements. Certainly, such scores are also useful in the longer term for data collection in terms of providing both prognostic information to future generations of patients, allowing comparison of results in individual patients to the preoperative baseline and allowing research-gathering for data assessment and scientific presentation and publication. The ability to share such data allows not only a comparison within and among patients in a given department but also among groups of patients throughout the world. Although no single severity assessment score is universally used for either bladder or bowel dysfunction, and no single quality-of-life instrument is always applicable, providers should endeavor to, at the very least, be internally consistent with use of the same scoring system(s) for all patients at all stages of treatment.

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