Surgical Repair of Pelvic-Floor Prolapse: Lessons Learned from Longitudinal Follow-Up of Quality-of-Life Survey

Abstract

Background: Scant evidence has been reported on the evaluation of quality-of-life (QOL) in patients who had undergone surgical treatment due to pelvic floor prolapse including cystocele. The aim of this study is to evaluate the impact of surgical intervention on patients’ QOL before and after surgery. Methods: Between 1997 and 2007, 135 patients (median age: 66.6 years) with pelvic floor prolapse including cystocele underwent bladder neck suspension with anterior / posterior colporrhaphy. The follow-up period was 39.6 months. Seventy-two patients (53 %) had urinary incontinence. The cystocele was graded as mild (grade 2), moderate (grade 3), and severe (grade 4) in 35, 60, and 40, respectively, according to the Baden-Walker classification. A urodynamic study was performed in 69 patients (51 %) who had obstructive symptoms with 100 ml or more of postvoid residual urine. Postoperative QOL was longitudinally assessed in 114 patients by scoring three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL), and compared with corresponding baseline scores. Results: A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow-up of 62.2 months. HR-QOL was significantly associated with vitality assessed by SF 36 (p = 0.036). Multivariate analysis revealed that update urinary incontinence, pre­operative HR-QOL was independent prognostic factors for predicting postoperative patient’s satisfaction. Conclusions: Although surgical repair of pelvic floor prolapse can achieve acceptable results with intermediate-term durability as well as improving the QOL, preoperative patients’ HR-QOL may be considered in the decision making process for treatment. 

Key words

pelvic prolapse - cystocele - bladder neck suspension - colporrhaphy - QOL - SF36

Appendix

Original questionnaires

Q1. Do you bother about vaginal bulging?
Q2. Do you feel difficulty to urinate?
Q3. Do you leak urine?
Never 0
Once a couple of weeks 1
Once every week 2
Once every 2–3 days 3
Once a day 4
All times 5

Q4. How much does you urinary interfere with your life?
Not at all 0
A little 1
Somewhat 2
Not a little 3
A lot 4
Very much 5

References

• 1 Latini J M, Brown J A, Kreder K J. Abdominal sacral colpopexy using autologous fascia lata.  J Urol. 2004;  171 1176-1179
• 2 Kobashi K C, Leach G E, Chon J et al. Continued multicenter follow-up of cadaveric prolapse repair with sling.  J Urol. 2002;  168 2063-2068
• 3 Dwyer P L, O’Reilly B A. Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh.  BJOG. 2004;  111 831-836
• 4 Baessler K, Maher C F. Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits.  Curr Opin Obstet Gynecol. 2006;  18 560-566
• 5 Hirata H, Matsuyama H, Yamakawa G et al. Does surgical repair of pelvic prolapse improve patients’ quality of life.  Eur Urol. 2004;  45 213-218
• 6 Matsuyama H, Hirata H, Tomimatsu T et al. Follow up of surgical repair of female pelvic floor disorders by a mailed questionnaire.  Int J Urol. 2006;  13 389-394
• 7 Ware Jr J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
• 8 Fukuhara S, Ware Jr J E, Kosinski M et al. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey.  J Clin Epidemiol. 1998;  51 1045-1053
• 9 Baden W F, Walker T A. Surgical Repair of Vaginal Defects. Philadelphia: J. B. Lippincott; 1992
• 10 Raz S, Klutke C, Golomb J. Four-corner bladder and urethral suspension for moderate cystocele.  J Urol. 1989;  142 712-715
• 11 Kohli N, Sze E, Roat T et al. Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension.  Am J Obstet Gynecol. 1996;  175 1476-1480