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Kayondo M, Kaye DK, Migisha R, Tugume R, Kato PK, Lugobe HM, Geissbüehler V. Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study. BMC WOMENS HEALTH 2021; 21:258. [PMID: 34172043 PMCID: PMC8228931 DOI: 10.1186/s12905-021-01397-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
- Musa Kayondo
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda. .,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda.
| | - Dan Kabonge Kaye
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Rodgers Tugume
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Paul Kalyebara Kato
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
| | - Henry Mark Lugobe
- Faculty of Medicine, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.,Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, P.O.BOX 40, Mbarara, Uganda
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Roa L, Kent S, Yaskina M, Schulz J, Poirier A. Knowledge of pelvic floor disorders amongst immigrant women in Canada. Int Urogynecol J 2021; 32:3077-3084. [PMID: 33620531 DOI: 10.1007/s00192-020-04662-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor disorders (PFD) have a detrimental effect on quality of life. Despite the available treatments, women often do not seek medical care. Patient knowledge has been identified as a major barrier to accessing care. The objective of this study was to assess knowledge on PFD amongst women in Edmonton, hypothesizing that immigrant women are less knowledgeable about PFD than Canadian-born women. METHODS A cross-sectional study of immigrant women and Canadian-born women was conducted. Immigrant women were recruited at the Multi-Cultural Health Brokers Co-op (MCHB) and Canadian-born women at a colposcopy clinic. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was administered. Scores for UI and POP were calculated and compared using a Mann-Whitney U test and a t test. A subgroup analysis of immigrants was carried out according to length of stay in Canada and ethnicity. Ethics approval was obtained from the University of Alberta Human Research Ethics Office. RESULTS A total of 106 immigrants and 102 Canadian-born women completed the PIKQ. The overall PIKQ scores were 12.7 for immigrant women and 14.4 for Canadian-born women (p = 0.04). Immigrant women who had lived in Canada for >10 years had higher scores (mean = 13.2) compared with women with less than 10 years in Canada (mean = 11.8). Women from South Asia had higher overall PIKQ scores (mean = 14.6) whereas women from sub-Saharan Africa had the lowest scores (mean = 12.1). CONCLUSIONS Immigrant women in Edmonton were found to have less knowledge on PFD than Canadian-born women.
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Affiliation(s)
- Lina Roa
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Sarah Kent
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Jane Schulz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Annick Poirier
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada. .,Pelvic Floor Clinic-Lois Hole Hospital for Women, RAH Hallway C & D, 10240 Kingsway Avenue NW, Edmonton, Alberta, T5H 3V9, Canada.
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Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Gjerde JL, Ayele TA. Pelvic organ prolapse surgery and health-related quality of life: a follow-up study. BMC WOMENS HEALTH 2021; 21:4. [PMID: 33388056 PMCID: PMC7778798 DOI: 10.1186/s12905-020-01146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. METHODS A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. RESULTS In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant's mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. CONCLUSIONS Surgical repair for prolapse effectively improves patient's HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.
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Affiliation(s)
- Tadesse Belayneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gebeyehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Guri Rortveit
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway
| | - Janne Lillelid Gjerde
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tadesse Awoke Ayele
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Toye F, Pearl J, Vincent K, Barker K. A qualitative evidence synthesis using meta-ethnography to understand the experience of living with pelvic organ prolapse. Int Urogynecol J 2020; 31:2631-2644. [PMID: 32870341 PMCID: PMC7459259 DOI: 10.1007/s00192-020-04494-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) affects the lives of many people. We aimed to systematically search for, identify and synthesize qualitative research that explores what it is like to live with POP and make this knowledge available for healthcare improvement. METHODS We systematically searched Medline, PsychInfo, Embase and CINAHL, from inception to March 2020, for qualitative research exploring the experience of living with POP. We used meta-ethnography to synthesize findings. This is a conceptual approach to qualitative evidence synthesis. We used the recent guidelines for reporting meta-ethnography. RESULTS We screened 3103 titles and 255 abstracts and included 37 primary studies. These incorporated the experience of 777 women, (aged 18 to 95 years) from a range of countries. We organized 162 ideas into 27 conceptual categories and 10 themes. We developed a conceptual model that helps us to understand the experience of pelvic organ prolapse. This model indicates that (1) the physical losses of POP are intricately linked to loss of identity; (2) women conceptualized POP as part of womanhood, yet also its thief; (3) there is a vicious cycle of taboo, silence and misunderstanding about POP and its treatment; (4) this silence is exacerbated by a feeling that POP is not taken seriously in healthcare. CONCLUSIONS This meta-ethnography helps us to understand the experience of living with a POP. Our model illustrates the complex process of healthcare decision making. Further studies to explore the complexity of decision making from the perspective of patient and health professional are timely.
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Affiliation(s)
- Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | | | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health (NDWRH), University of Oxford, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Rada MP, Jones S, Falconi G, Milhem Haddad J, Betschart C, Pergialiotis V, Doumouchtsis SK. A systematic review and meta-synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets. Neurourol Urodyn 2020; 39:880-889. [PMID: 32040864 DOI: 10.1002/nau.24297] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
AIMS In the current climate of evidence-based health care, the aim of this meta-synthesis was to collect and systematically analyse data from primary qualitative studies on pelvic organ prolapse (POP), to identify patient-centered perspectives on the natural course of POP. Information acquired in this study may be useful for ongoing research towards the development of core outcome sets (COS) in pelvic floor disorders. METHODS A CHORUS Working Group performed a standardized search of three different databases (Medline, Embase, Scopus), from inception to October 2019. We selected qualitative studies on women's perspectives on POP that were published in the English language. Three reviewers independently evaluated the quality of eligible papers and highlighted recurrent themes based on patient perspectives. RESULTS Eighteen qualitative studies including a total of 497 patients were assessed in this analysis. Our study revealed five superordinate themes, recurrently encountered in qualitative studies on POP: awareness of POP (6 studies), communication (9 studies), treatments (10 studies), effects on quality of life (6 studies), and self-image (3 studies). Five out of 10 quality criteria were met by all the studies included, based on an assessment performed using the critical appraisal skills program. CONCLUSIONS This is the first synthesis of qualitative studies that address POP-related experiences of women, highlighting five superordinate themes, of which treatment was the most commonly reported one. This synthesis' findings may guide quantitative research priorities and will hopefully contribute to the development of a COS for POP.
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Affiliation(s)
- Maria Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stephanie Jones
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Urogynaecology Division, Department of Obstetrics and Gynaecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,School of Medicine, American University of the Caribbean, Pembroke Pines, Florida.,Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece.,Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Nardos R, Ayenachew F, Roentgen R, Abreha M, Jacobson L, Haile A, Berhe Y, Gold K, Gregory WT, Spitznagle T, Payne CK, Wall LL. Capacity building in female pelvic medicine and reconstructive surgery: Global Health Partnership beyond fistula care in Ethiopia. Int Urogynecol J 2020; 31:227-235. [DOI: 10.1007/s00192-019-04197-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/19/2019] [Indexed: 01/01/2023]
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Pelvic Organ Prolapse Symptoms in American Samoan Women. Female Pelvic Med Reconstr Surg 2018; 26:677-681. [PMID: 30489340 DOI: 10.1097/spv.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES American Samoa has one of the highest rates of obesity worldwide, making it a population at high risk for pelvic organ prolapse (POP). The primary objective of this study was to describe the presence of POP symptoms and associated degree of bother in American Samoan women. The secondary objective was to determine which characteristics are associated with POP symptoms in this cohort. METHODS We performed a cross-sectional survey of women presenting to the waiting room of the emergency department of the Lyndon B. Johnson Tropical Medical Center in Faga'alu, American Samoa from February to March 2017. Questions included self-described characteristics and the Pelvic Organ Prolapse Distress Inventory 6. Univariate distributions were described and comparisons of social and health characteristics were made between women without POP symptoms and those with at least 1 POP symptom. RESULTS Two hundred eighty-four women were approached and 225 women completed the survey (79% response rate). The mean (SD) age was 40.5 (14.7), the mean (SD) body mass index was 36.4 (8.7), and the median (range) number of vaginal births was 2 (0-14). A total of 44.2% endorsed at least 1 POP symptom, most commonly pelvic pressure (29.9%) and feeling of incomplete bladder emptying (26.7%). The number of vaginal births was associated with lower abdominal pressure (P = 0.04) and hysterectomy was associated with pelvic heaviness (P = 0.05). CONCLUSIONS This is the first study investigating POP in American Samoa. Almost half of women reported at least 1 pelvic floor symptom, demonstrating the need for further research on pelvic floor disorders within this high-risk population.
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