Symptoms, quality of life, and factors affecting women's treatment decisions regarding pelvic organ prolapse

Determinants of women's preferences for surgical versus conservative management for pelvic organ prolapse: a survey-based study from Italy

BACKGROUND AND OBJECTIVE

Pelvic organ prolapse (POP) affects 40% of women, with a 12%-19% lifetime surgical risk. Italy showed high practice variation in POP surgery, possibly impacting equity of access to healthcare services, a central goal of Beveridge-like health systems. According to the literature, unwarranted variation, influenced by physician attitudes or resource allocation, must be reduced. We aimed to identify determinants influencing women's choice when asked whether they prefer surgical or conservative POP management.

DESIGN, SETTING AND POPULATION

In this nationwide prospective study, we distributed a Qualtrics questionnaire via social media to any Italian women over 18 years old who voluntarily decided to participate in the survey.

INTERVENTION

A grade 3 POP scenario was presented. Women were asked how likely they would have surgery. Each woman randomly received only 1 question out of 11: 1 question was the reference question ('How likely would you have surgery?') while 10 questions contained a potential determinant influencing woman's choice ('How likely would you have surgery if…?').

OUTCOME

The outcome was the chance of choosing surgery expressed as a percentage. We analysed the effect of each factor on the outcome by using adjusted beta regression models.

RESULTS

Respondents (n=222) opted for surgery with a median probability of 61.5%. Factors significantly increasing the chance of choosing surgery were advice from physicians, the presence of a trusted physician during hospitalisation, surgical approach with low complication rates, uterine-sparing surgery, the absence of postoperative abdominal scars and nearby hospital.

CONCLUSIONS

Our findings provide health managers and policy-makers with new evidence to better understand women's decision-making and partly capture the determinants of unwarranted variation. These inputs may also be used as attributes for a future discrete choice experiment.

Quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics Southern Ethiopia 2022

INTRODUCTION

Pelvic organ prolapse is the implosion of one or more pelvic floor structures which affect womens quality of life by compromising overall health, physical, social, structural, functional and emotional well-being.

OBJECTIVE

To assess the quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics at Gurage zone hospitals, Southern Ethiopia 2022.

METHODS

Facility-based cross-sectional study was applied in gurage zone hospital from April, 30 to Jun 30, 2022. Systematic random sampling was employed to select 416 women. Interview based structured questionnaires were applied to collect the data. The collected data were analyzed using Statistical Produte and Service Solution. Binary and multivariable logistic regressions were fitted to assess the association between dependent and independent variables. P-value < 0.05 was used to declare the final statistical significance.

RESULT

The mean (SD) score of quality of life in this study was 53.57 (21.59). The most affected domains were general health perception and physical limitation (mean (SD) score 67.45 29.24) and (64.26 32.36)) respectively. Had no formal education (AOR = 1.50, 95% CI: 1.02, 3.12), stage III/IV POP (AOR = 2.02, 95% CI: 1.19, 3.60), constipation (AOR = 3.51, 95% CI: 2.12, 7.21), urge urinary incontinence (AOR = 3.89, 95% CI: 2.32, 6.95), and not did regular physical exercise (AOR = 2.18, 95% CI: 1.41, 3.37) were significantly associated with poor quality of life.

CONCLUSION

More than half of the participants in this study had impaired quality of life. The factor associated with quality of life was had no formal education, stage III/IV, constipation, urge urinary incontinence, and regular physical activity. It is recommended to have access education, counseling regular physical activity, detection, and management of its comorbidity.

The effect of the COVID-19 lockdown on women presenting with pelvic organ prolapse

PURPOSE

To determine whether there is a difference in pelvic organ prolapse (POP) stage at time of presentation after lifting coronavirus disease (COVID-19) lockdown restrictions, as compared to before the lockdown. Enhancing our understanding of how healthcare utilization for pelvic floor disorders may be affected by limited accessibility, such as the COVID-19 pandemic, could prove invaluable for similar future circumstances.

METHODS

This is a retrospective study of women with POP at their initial visit. Patients were grouped into two cohorts based on their initial presentation time: pre-COVID-19 lockdown (before March 2020) and post-COVID-19 lockdown (after December 2020). The cohorts were compared using demographic, clinical, and surgical variables. A logistic regression controlling for confounders was used to evaluate the influence of the COVID-19 lockdown on prolapse stage.

RESULTS

There were 656 (50.3%) patients in the pre-COVID-19 lockdown cohort and 648 (49.7%) in the post-COVID-19 lockdown cohort. All baseline characteristics were similar between both cohorts except for race (p = 0.015). Treatment choices differed with the post-COVID-19 lockdown cohort having a lower proportion (26.5%) opting for surgery and a higher proportion (50.5%) of patients opting for nonsurgical interventions compared to the pre-COVID-19 lockdown cohort (p = 0.0005). A higher proportion of women presented with stages I and II prolapse in the post-COVID-19 lockdown (70.4%) cohort as compared to the pre-COVID-19 lockdown (62.5%) cohort (p = 0.002).

CONCLUSIONS

Women in the post-COVID-19 lockdown cohort presented with early stage prolapse with preference for more conservative treatment options.

Outcomes in Women With Pelvic Organ Prolapse Presenting With Pessary-Related Complications

IMPORTANCE

There is currently a paucity of data describing the outcomes of women with pelvic organ prolapse (POP) and/or urinary incontinence (UI) who present with pessary-related complications.

OBJECTIVE

This study aimed to describe outcomes in women with POP and UI managed with a pessary who present with pessary-related complications.

STUDY DESIGN

This was a retrospective cohort study of women with POP and/or UI who elected for management with a pessary from January 1, 2016, to December 31, 2020. Patients were included if they had used a pessary for at least 1 year and had a documented pessary-related complication. Complications were defined a priori, and patient charts were abstracted using International Classification of Diseases, Ninth and Tenth Revisions codes associated with pessary use.

RESULTS

Of 2,088 of women receiving pessary care, 444 (21%) experienced a complication. Of 154 of women, 34.6% experienced 2 pessary-related complications during the study period, whereas 12.6% (56) experienced 3, 4.5% (20) experienced 4, and 1.8% (8) experienced 5. One hundred fifty-two patients (34.2%) underwent surgery during the study period to manage their POP and/or UI. Patients who were older were less likely to have surgery (adjusted odds ratio, 0.70 [95% confidence interval, 0.20-0.90]; P = 0.002), and patients who had an indication of pessary use for both POP and UI were more likely to undergo surgery during the study period (adjusted odds ratio, 2.12 [95% confidence interval, 1.29-3.48]; P = 0.003).

CONCLUSIONS

Our results suggest that 1 in 5 patients has a documented complication associated with pessary use of greater than 1 year. Of these patients, one third will eventually undergo surgery for management of their POP and/or UI.

[Radiological imaging following pelvic prolapse surgery]

CLINICAL/METHODICAL ISSUE

Pelvic organ prolapse is a common condition in women, for which both conservative and surgical interventions are available. Knowledge of the different surgical procedures and the materials used is essential for adequate radiological diagnosis after prolapse surgery in order to differentiate potential complications from normal postoperative changes.

STANDARD RADIOLOGICAL METHODS

In the immediate postoperative period, computed tomography (CT) is often the modality of choice for evaluating acute complications such as bleeding or organ injuries. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and is therefore generally preferred for assessing subacute and chronic complications.

METHODICAL INNOVATIONS

Innovative techniques such as dynamic MRI protocols can improve the radiological assessment after prolapse surgery by enabling the evaluation of organ mobility.

PERFORMANCE

Radiological standard procedures such as computed tomography (CT) and MRI provide detailed and reliable information about the postoperative site and potential complications following prolapse surgery.

ACHIEVEMENTS

Radiological imaging plays an important role in the evaluation of patients after prolapse surgery, particularly when complications are suspected. Accurate radiological diagnosis can guide further appropriate therapeutic measures.

Quality of life among women with a diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: an institutional based cross-sectional study

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse is among the most common gynecologic problems worldwide. It greatly influences women's quality of life. However, research regarding the effect of pelvic organ prolapse on quality of life is limited in our study area.

METHODS

An institutional-based study design among women with the diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital was employed from May to July 2018. Interviewer-administered questionnaire and Prolapse Quality of Life assessment tool were used to collect data. Gynecologic speculum examination was done to collect objective data. Data were entered into Epi info version 7 and then exported in to SPSS, version 20.0, for analysis. Descriptive statistics and logistic regression were used. All the statistical tests were significant at P < 0.05.

RESULTS

The average prolapse quality of life score was 48.35 ± 22.75 SD. The physical limitation (score: 69.83 ± 28.77 SD) and general health perception (score: 67.39 ± 20.26 SD) domains were the most affected life domains. Younger age (AOR = 3.02 [95% CI: 1.22-7.45]), being illiterate (AOR = 3.52 [95% CI: 1.12-11.10]), and having stage IV POP (AOR = 2.84 [95% CI: 1.16-7.00]) were associated with lower quality of life.

CONCLUSIONS

The QOL score showed huge variability among the study participants. The physical limitation and general health perception domains were most affected. Being illiterate, being < 35 years old, and having stage IV pelvic organ prolapse were the factors associated with lower quality of life.

International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain

INTRODUCTION AND HYPOTHESIS

This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP.

METHODS

An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category.

RESULTS

The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies.

CONCLUSIONS

The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.

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

Background

Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life.

Methods

We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery.

Results

Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p < 0.001). The overall QOL improved by 38.9% after surgery (p < 0.001).

Conclusions

The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.

Pelvic organ prolapse and treatment decisions- developing an online preference-sensitive tool to support shared decisions

Background

Female patients with pelvic organ prolapse and clinicians need to take decisions regarding treatment that are often unpredictable in relation to how they impact the future everyday lives of the patients.

This study formed the developmental phase of a larger study to develop and test an online tool to support shared decision-making.

Methods

Patients, health care professionals and other stakeholders participated in the development and evaluation process of this tool. The collected data was generated from observational studies, exploratory interviews with prompt cards and workshops with end users from four Danish gynecology outpatient clinics.

Results

Content analysis led to important themes. For the patients three themes emerged: 1) how the impact of symptoms on everyday life affected the need for relief, 2) their bodily perception and sex life and 3) their worries about the future. For clinicians the different symptoms and their severity was a main theme.

Conclusions

This article provides an overall description and discussion of the development methodology. It demonstrates how user involvement informed the prototyping process and how patients’ preferences were included in the final prototype. Whether the tool actually increases SDM, remains to be tested in a pilot feasibility study.

Quality of Life in POP: Validity, Reliability and Responsiveness of the Prolapse Quality of Life Questionnaire (P-QoL) in Spanish Women

The Prolapse Quality of Life Questionnaire (P-QoL) is a specific questionnaire created to assess the impact of pelvic organ prolapse on women’s quality of life. The aim of the present study was to cross-culturally adapt and assess the psychometric properties of the P-QoL for Spanish women. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Psychometric analysis was performed by assessing the validity, reliability, responsiveness and feasibility. A total of 200 Spanish women were recruited and assigned to symptomatic and asymptomatic groups. The Spanish P-QoL version demonstrated good content validity. Convergent validity showed high intercorrelations with the Pelvic Floor Distress Inventory short form and the Pelvic Floor Impact Questionnaire short form. The discriminant validity showed statistically significant differences between the symptomatic and the asymptomatic groups. The internal consistency was high and of acceptable values. The test-retest reliability was shown to be high in all the cases. Regarding responsiveness, the effect size and standardized response mean demonstrated moderate values. The average time for administration was 10 (3) min. The Spanish P-QoL showed considerable support for the appropriate metric properties of validity, reliability, responsiveness and feasibility to evaluate the symptom severity and its impact on the quality of life in Spanish women with urogenital prolapse.

Development of a biotensegrity focused therapy for the treatment of pelvic organ prolapse: A retrospective case series

INTRODUCTION

Pelvic organ prolapse (POP), the bulging of pelvic organs into the vagina, is a common condition thought to be caused by weak pelvic tissue. There is a paucity of evidence supporting current treatment approaches. This case series proposes a new biotensegrity-focused hypothesis that POP is caused by taut pelvic tissue and that releasing pelvic tension will improve POP.

METHODS

Three retrospective patient cohorts are presented illustrating the development of the new biotensegrity-focused therapy (BFT) approach. All women received: postural assessment; pelvic tissue examination; and myofascial release of taut pelvic tissue, trigger points, and scar tissue. A standard assessment protocol (SOTAP) recorded patients' Subjective experience, the therapist's Objective assessment, the Treatment plan, Assessment of treatment outcomes, and subsequent treatment and self-care Plans. Cohort three additionally self-reported symptoms using the short-form PDFI-20 questionnaire at baseline and after final treatment.

RESULTS

Twenty-three women participated (Cohort 1 n = 7; Cohort 2 n = 7; Cohort 3 n = 9). Fourteen (61%) presented with cystocele, 10 (44%) urethracele, 7 (30%), cervical descent, and 17 (74%) rectocele. Seven (30%) presented with single prolapse, 8 (35%) double, 6 (26%) triple, and 2 (9%) quadruple. Median treatments received was 5 (range 3-8). All women reported improved prolapse symptoms. Cohort 3 (n = 9) reported clinically meaningful reductions (mean 56%) in PFDI-20 total after final treatment.

CONCLUSIONS

This case series offers preliminary evidence for the association between POP and pelvic tissue tension. Further research is needed to explore these findings and to determine the efficacy of BFT for treating POP in a wider sample.

Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse

OBJECTIVE

The aim of this study is to estimate the long-term survival and to identify adverse events associated with the use of Gellhorn pessaries over a 9-year period.

METHODS

This was a retrospective case series study at a tertiary urogynecology unit in Taiwan. Between January 2009 and June 2017, 93 patients who opted for self-management Gellhorn pessaries to treat symptomatic pelvic organ prolapse (POP) and who were continuously followed-up were enrolled. Long-term use was defined as use for longer than 1 year. Length of use, factors that predicted discontinuation, and adverse events were analyzed and reviewed by chart or telephone inquiry.

RESULTS

The cumulative probabilities of continued pessary use at 1 and 5 years were 62.4% and 47.2%, respectively. Of those who discontinued use, 34 (70.8%) participants discontinued use within 1 year, and the mean duration of use was 13.7 months (range, 0-75 months; median, 5 months). Most of the participants stopped using the pessary because of bothersome adverse events such as pessary expulsion, vaginal pain, de novo urinary incontinence, and erosion/infection.

CONCLUSIONS

Self-management Gellhorn pessary was safe and relatively effective and increased patients' autonomy and ability to manage their POP. One third of the patients discontinued use by 1 year, and half of the patients discontinued use at 5 years.

Longitudinal follow-up of levator ani muscle avulsion: does a second delivery affect it?

OBJECTIVES

To evaluate the morphological outcome of levator ani muscle (LAM) avulsion 3-5 years after a first delivery and to assess the effect of a second delivery on this condition. The impact of LAM avulsion on pelvic floor disorders was also studied.

METHODS

Six hundred and sixty-six women who had been assessed for LAM avulsion 8 weeks after their first delivery were invited for a follow-up examination 3-5 years later. Women completed the Pelvic Floor Distress Inventory including the Urinary Distress Inventory (UDI) and Pelvic Organ Prolapse Distress Inventory (POPDI) questionnaires to explore symptoms of pelvic floor disorders, and the pelvic floor was examined using three-dimensional translabial ultrasound and assessed using the pelvic organ prolapse quantification system.

RESULTS

Three hundred and ninety-nine women completed the study, of whom 151 were multiparous. Mean interval between first delivery and follow-up was 42.3 ± 7.6 months. Among 69 women who had LAM avulsion 8 weeks after their first delivery, nine (13.0%) had no LAM avulsion at follow-up. One (0.9%) woman had a new LAM avulsion after her second vaginal delivery. A greater proportion of women with LAM avulsion reported symptoms of stress urinary incontinence (SUI) (adjusted odds ratio, 2.09 (95% CI, 1.18-3.70); P = 0.01) and symptoms of prolapse than did women without avulsion; however, this difference did not reach statistical significance (P = 0.61). Women with LAM avulsion had higher UDI and POPDI scores than did women without avulsion (median UDI score, 17.7 (interquartile range (IQR), 5.0-32.4) vs 9.2 (IQR, 0.0-22.1); P = 0.045 and median POPDI score, 20.8 (IQR, 8.8-40.5) vs 10.7 (IQR, 0.0-32.8); P = 0.021).

CONCLUSIONS

The risk of developing new LAM avulsion after a second vaginal delivery is low (0.9%). Healing of LAM avulsion was observed in 13% of women who had at least one vaginal delivery. At 3-5 years after delivery, women with LAM avulsion reported symptoms of SUI more often than did those without, and had higher UDI and POPDI scores, implying more bothersome symptoms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Vaginal Pessary in Women With Symptomatic Pelvic Organ Prolapse: A Randomized Controlled Trial

OBJECTIVE

To compare pelvic floor symptoms, quality of life, and complications in women with symptomatic pelvic organ prolapse (POP) with or without vaginal pessaries in addition to those who do pelvic floor exercises for 12 months.

METHODS

This was a parallel-group, single-blind, randomized controlled trial with 12 months of follow-up. Women with symptomatic stage I to stage III POP were randomized to either pelvic floor exercises training (control group) or pelvic floor exercises training and insertion of a vaginal pessary (pessary group). The primary outcome was the change of prolapse symptoms and quality of life by using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaires. Secondary outcomes included bothersome of prolapse symptoms, desired treatment, and any complications.

RESULTS

From December 2011 through November 2014, 311 women were screened and 276 were randomized as follows: 137 to the control and 139 to the pessary group. One hundred thirty-two (95.0%) women in the pessary group and 128 (93.4%) in the control group completed the study. The Pelvic Organ Prolapse Distress Inventory of Pelvic Floor Distress Inventory and the Pelvic Organ Prolapse Impact Questionnaire of Pelvic Floor Impact Questionnaire scores decreased in both groups after 12 months, but the mean score differences were higher in the pessary group (Pelvic Organ Prolapse Distress Inventory: -29.7 compared with -4.7, P<.01; Pelvic Organ Prolapse Impact Questionnaire: -29.0 compared with 3.5, P<.01). Complication rates were low and similar in both groups.

CONCLUSION

We provided further evidence in nonsurgical treatment for POP. Prolapse symptoms and quality of life were improved in women using a vaginal pessary in addition to pelvic floor exercises.

CLINICAL TRIAL REGISTRATION

Centre for Clinical Research and Biostatistics-Clinical Trials Registry, https://www2.ccrb.cuhk.edu.hk/web/?page_id=746, ChiCTR-TRC-11001796.

Vaginal pessaries for treatment of pelvic organ prolapse in elderly women

PURPOSE OF REVIEW

Pelvic organ prolapse (POP) is a common clinical condition that is highly prevalent in the geriatric female population. The condition can have substantial negative influence on multiple symptom and quality-of-life parameters. There are various treatment options for POP, including observation, pessary placement, and surgical treatments with either vaginal reconstruction or colpocleisis resulting in vaginal vault closure. This review examines current literature about pessary use for treatment of POP in elderly women.

RECENT FINDINGS

Pessary use appears to be successful for many women and is often associated with improvements in various clinical parameters, including decreased sensation of vaginal bulge and enhanced quality of life. Some patients may experience improvements in bladder or bowel symptoms, although a small percentage may develop new urinary incontinence, constipation, or other defecation problems. Complications of pessary use are generally minor and can usually be successfully treated with targeted therapy such as vaginal estrogen supplementation. Continuity of clinical care is important to help maintain clinical success and prevent potential complications.

SUMMARY

Pessaries are a viable conservative form of treatment for POP for many older women. Pessary use can lead to substantial improvements in quality of life and other clinical outcomes in geriatric patients.

Patient characteristics associated with treatment choice for pelvic organ prolapse and urinary incontinence

INTRODUCTION AND HYPOTHESIS

Women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI) frequently undergo more than one treatment prior to settling on their final strategy. We hypothesize that women who are younger, with worse POP and SUI symptoms will desire and choose surgical treatment.

METHODS

A retrospective cohort study was performed over 1 year identifying new patients presenting with POP and/or SUI at a university hospital. Our aim was to determine patient desire for either surgical or conservative treatment, as well as the actual treatment chosen and received after the first visit and 1 year later. To identify predictors of choice, baseline demographic characteristics were obtained.

RESULTS

Of the 203 women who met the inclusion criteria, 44.3 % (90/203) desired surgery and 55.7 % (113/203) desired conservative treatment at their first visit. Women who desired surgery were more likely to be younger (p = 0.003), sexually active (p = 0.001), have more advanced prolapse (p = 0.006), and have more bothersome symptoms (p = 0.05). Of the women who desired surgery at their first visit, 12.2 % (11/90) actually chose conservative treatment. These women were less likely to be insured (p = 0.01). By 1 year, of the women who initially desired and subsequently chose conservative treatment, 26.5 % (30/113) had undergone surgery. The women who changed from conservative to surgical treatment were more likely to be younger (p = 0.01), non-White (p = 0.03), and sexually active (p = 0.04).

CONCLUSIONS

In this study, younger, sexually active women were more likely to either opt for surgery initially or to change their treatment plan from conservative to surgical.

Tension-free polypropylene mesh-related surgical repair for pelvic organ prolapse has a good anatomic success rate but a high risk of complications

BACKGROUND

Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications. We aimed to report the short-term results and complications of tension-free polypropylene mesh (PROSIMA™) surgical repair of pelvic organ prolapse (POP) using the standard category (C), timing (T), and site (S) classification system.

METHODS

A prospective cohort study of 48 patients who underwent PROSIMA™ mesh kit-related surgical repairs were followed for two years at Peking Union Medical College Hospital. Recurrence was defined as symptomatic POP quantification (POP-Q) Stage II or higher (leading edge ≥ -1 cm). The Patient Global Impression of Change Questionnaire, the Chinese version of the Pelvic Floor Impact Questionnaire short-form-7 and POP/Urinary Incontinence Sexual Questionnaire short-form-12 were used to evaluate the self-perception and sexual function of each patient. Mesh-related complications conformed to the International Urogynecological Association/International Continence Society joint terminology. The paired-sample t-test, one-way analysis of variance, Fisher's exact test, Kaplan-Meier survival analysis and log-rank test were used to analyze data.

RESULTS

All patients were followed up for ≥12 months; 30 (62.5%) patients completed the 24 months study. We observed a 93.8% (45/48) positive anatomical outcome rate at 12 months and 90.0% (27/30) at 24 months. Recurrence most frequently involved the anterior compartment (P < 0.05). Pelvic symptoms improved significantly from baseline (P < 0.05), although the patients' impressions of change and sexual function were not satisfying. Vaginal complication was the main complication observed (35.4%, 17/48). The survival analysis did not identify any relationship between vaginal complication and anatomical recurrent prolapse (POP-Q ≥ Stage II) (P = 0.653).

CONCLUSIONS

Tension-free polypropylene mesh (PROSIMA™ )-related surgical repair of POP has better short-term anatomical outcomes at the apical and posterior compartments, but a low patient satisfaction rate. The mesh complications were not the definitive cause of recurrence.

The management of pelvic organ prolapse in England: a 4-year analysis of hospital episode statistics (HES) data

The aim of this study was to establish the number and trend of surgical procedures and pessary management of pelvic organ prolapse in England, using Hospital Episode Statistics (HES) data. An online search ( www.hesonline.nhs.uk ) was carried out. The number of various surgical procedures, as well as pessary insertions and removals for pelvic organ prolapse was obtained. Data were available for the 4-year period March 2002 to June 2005. Over 20,000 procedures performed and 600 pessaries inserted annually. The total number of patients having treatment for pelvic organ prolapse as well as the number of patients having surgery and pessary in English hospitals increased by < 10% over the previous year in 2 of the 4 years included and decreased by < 1% in one. Anterior vaginal wall repair was the commonest performed procedure for pelvic organ prolapse and sacrocolpopexy appears to be the most frequent procedure for post-hysterectomy vaginal vault prolapse. There was no change in trends between surgery and pessary over the studied 4-year interval (p < 0.05). The lack of specific codes precluded providing more detailed information. The availability of data sooner and for longer periods as well as the use of more specific codes are needed to provide more useful information.