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Am J Obstet Gynecol. 2019 Dec 10. pii: S0002-9378(19)32723-1. doi: 10.1016/j.ajog.2019.11.1285. [Epub ahead of print]

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

Author information

1
Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland; Institute of Clinical Medicine, University of Eastern Finland, Finland. Electronic address: nina.mattsson@fimnet.fi.
2
Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland; Institute of Clinical Medicine, University of Eastern Finland, Finland.
3
School of Pharmacy, University of Eastern Finland, Finland.
4
Terveystalo, Finland; Institute of Clinical Medicine, University of Eastern Finland, Finland.
5
Department of Public Health, University of Helsinki, Finland.
6
Helsinki University Hospital and University of Helsinki, Finland.
7
Department of Obstetrics and Gynecology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland.
8
Faculty of Medicine and Health Technology, Tampere University, Finland; Central Finland Hospital District, Finland.

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 (PFDI)-20, and Patient Global Index of Improvement (PGI)-I) 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 PFDI-20 at the 6-month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison to the preoperative state with PGI-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio: 2.06, 95% CI: 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by PGI-I (1.69, 1.02-2.81).

CONCLUSION:

Pelvic organ prolapse surgery improved health-related quality of life in 7 out 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.

KEYWORDS:

15D; HRQoL; PFDI-20; PGI-I; POP; Patient Global Index of Improvement; Pelvic Floor Distress Inventory; patient reported outcome measure; patient satisfaction; pelvic organ prolapse; pelvic reconstructive surgery; quality of life; surgery; urogynecology

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