The following is a summary of “Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms,” published in the December 2023 issue of Obstetrics and Gynecology by Ackerman, et al.

Myofascial pelvic floor dysfunction, known as myofascial urinary frequency syndrome, presents with lower urinary tract symptoms, causing confusion with other disorders and often leading to underdiagnosis. The absence of objective diagnostic methods contributes to this issue, emphasizing the need for an effective screening measure based on patient-reported symptoms. Current diagnostic procedures involve a skilled provider’s detailed pelvic floor myofascial examination. 

For a study, researchers sought to develop a screening tool, termed the Persistency Index, to identify myofascial urinary frequency syndrome through patient-reported symptoms.

Patients diagnosed with isolated myofascial urinary frequency syndrome were identified through provider diagnoses in a tertiary urology practice. The verification process involved standardized pelvic floor myofascial examination and perineal surface pelvic floor electromyography. Employing the Least Angle Shrinkage and Selection Operator, potential features were selected from the Overactive Bladder Questionnaire, Female Genitourinary Pain Index, and Pelvic Floor Distress Index. 

This analysis included a pooled population, including subjects with overactive bladder (n=42), interstitial cystitis/bladder pain syndrome (n=51), and asymptomatic controls (n=54), forming the derivation cohort. A straightforward summation of the most discriminatory questions was computed, utilizing the original scaling of the Pelvic Floor Distress Index 5 (0–4), Genitourinary Pain Index 5 (0–5), and modified scaling of Female Genitourinary Pain Index 2b (0–3). The resulting area under the curve was determined to be 0.75. Given the higher prevalence of myofascial urinary frequency syndrome in younger subjects, an age penalty (3 points added for those under 50 years) was introduced, enhancing the area under the curve to 0.8. The composite score, the Persistency Index, ranged from 0 to 15. The optimal cut point for maximizing sensitivity and specificity was identified using the Youden Index, providing a valuable screening tool for identifying myofascial urinary frequency syndrome based on reported symptoms, especially in a younger demographic.

The study proposed a novel screening method for individuals with lower urinary tract symptoms to identify myofascial urinary frequency syndrome. Particularly relevant in the era of increasing telemedicine, the Persistency Index offers a means of screening and initiating pelvic floor physical therapy before a confirmatory pelvic examination.

Source: ajog.org/article/S0002-9378(23)00587-2/fulltext