Pelvic organ prolapse surgery and quality of life—a nationwide cohort study

Abstract

BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of Improvement-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58e2.70) and vaginal bulge (1.90, 1.30e2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02e2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.

Agreement between patient global impression scale of improvement, pelvic floor distress inventory and 15D in measuring the outcome of pelvic organ prolapse surgery

“…Pelvic organ prolapse surgery has been shown to improve in both generic and disease‐specific patient‐reported outcome measures, 2,8,9 but the findings of this study demonstrate that the quantified health gains are dependent on the chosen patient‐reported outcome measure. In our study, the three patient‐reported measures (PFDI‐20, 15D, and PGI‐I) were only weakly correlated, and the proportion of concordant ratings between instruments varied between 31.1% and 72.8%.…”

“…However, it is unknown how consistently different validated questionnaires evaluate the changes in HrQoL after POP surgery. We 8 and others 2,9 have previously shown that POP surgery leads to improvement in both generic and disease‐specific PROM measures, but it is unknown how strongly these measures are correlated, that is, whether those among whom improvement in generic HRQoL is detected are the same women who report symptom alleviation. Furthermore, as many generic instruments such as 15‐dimensional instrument (15D) measure also sexual function and excretion symptoms, it is important to assess whether they capture the symptom alleviation detected by symptom‐specific instruments such as Pelvic Floor Distress Inventory‐20 (PFDI‐20) and its subscales.…”

Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study

“…However, access to POP surgery in low income countries is very limited because it is expensive and the skilled personnel to perform the surgery are few [ 25 ]. Surgery for symptomatic POP has been shown to improve the QOL in high income countries [ 5 , 13 , 26 – 28 ]. However, in low income countries including Uganda, the impact of surgery on QOL is rarely reported yet this evidence is important for advocacy in scaling up treatment for POP in these resource limited settings where women with POP face various challenges in accessing care [ 12 ].…”

Proteins in plasma as a potential biomarkers diagnostic for pelvic organ prolapse

“…POP can have significant effects on a woman's quality of life, along with their physical and mental health (1). The global incidence of POP is approximately 20% and is increasing on an annual Original Article basis (2,3). Multiple factors including age, menopause, parity, obesity (4), hysterectomy, and connective tissue disorders have been reported to be in association with POP development (5,6).…”