Patient goals after operation in the posterior vaginal compartment

OBJECTIVE

Success after operation for a pelvic organ prolapse in the posterior vaginal compartment is often related to restoration of anatomy, but success for the patient is linked to achievement of patient-reported goals. We investigated patient-reported goals after an operation in the posterior compartment and to which extent the goals had been achieved.

STUDY DESIGN

A prospective case series study including 87 women undergoing operation in the posterior compartment at Aalborg University Hospital. The women were asked to list up to three goals they wished to fulfil with the operation. Three months after surgery a telephone interview was conducted in which the women were asked whether each single goal was fulfilled, partly fulfilled or not fulfilled and to estimate the extent to which the goals had been achieved on a VAS scale from 1 to 10.

RESULTS

All patient-reported goals were divided into eight groups: 1: bulging, 2: bowel problems, 3: urinary problems, 4: sexual problems, 5: psychological problems, 6: physical activity, 7: pain and 8: others. A total of 233 goals were stated. Most goals were related to bowel problems (37.3%) and bulging (21.0%). Median total VAS score was 9. Overall 58.8% of all goals were categorized as fulfilled and 22.3% as partly fulfilled. Fulfilled goals were 83.7% in the group with bulging problems, sexuality problems 65%, and bowel problems 57.5%. Urinary problems had fewest fulfilled goals (18.5%). Bowel problems were further divided into evacuation problems, incontinence, constipation and others. Goals concerning evacuation problems were most often fulfilled (76.1%), and goals concerning anal incontinence were rarely fulfilled (25.0%).

CONCLUSIONS

Approximately 80% of the patient-reported goals after posterior compartment operation were fulfilled or partly fulfilled. Most goals were related to bowel problems and bulging. Bowel problems in the form of evacuation problems were more often solved than incontinence and constipation, and women should be advised about this. All goals should be discussed with the patient prior to an operation.

What are patient goals after an anterior colporrhaphy operation?

OBJECTIVES

The aim of this study was to describe patient-reported goals after an anterior colporrhaphy operation for anterior vaginal wall prolapse, the fulfilment of goals, and the correlation with subjective patient-reported outcomes.

STUDY DESIGN

A prospective study involving 100 women. Preoperatively, patients completed three modified questions from the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) named ICIQ-VS short form (ICIQ-VS SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively.

RESULTS

A Visual Analogue Scale (VAS) score from one to 10 estimated the extent to which goals were achieved. Goals were divided into eight groups: 1: mechanical symptoms (bulging), 2: voiding symptoms, 3: quality of life (physical), 4: quality of life (emotional), 5: avoidance of urinary tract infection, 6: cure of incontinence, 7: sexual function and 8: others. ICIQ-VS SF preoperatively was mean 13.6 and postoperatively mean 1.7 (p<0.001). A total of 276 goals were stated, 63.4% of the goals were fulfilled with a VAS score of 10. The majority of the goals (27%) were in group 1 concerning symptoms of bulging. Mean VAS score for all goals was 8.6 (SD 2.5). Group 1 concerning mechanical symptoms of bulging had most goals fulfilled with a VAS of 10 (76%), and group 6 concerning cure of incontinence had fewest goals fulfilled with a VAS of 10 (31%). Forty patients (40%) fulfilled all their goals.

CONCLUSIONS

Patient-described goal achievement was high. The majority of the fulfilled goals concerned mechanical symptoms of bulging, and goals concerning incontinence were the least fulfilled.

Fulfilment of patient goals after tension-free vaginal tape operation for stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

The aim of this study was to investigate patient-reported goals after a tension-free vaginal tape operation for stress urinary incontinence and the correlation with postoperative incontinence.

METHODS

A prospective study involving 70 women was carried out. Preoperatively, patients completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively.

RESULTS

A Visual Analogue Scale (VAS) score from zero to ten estimated the extent to which goals were achieved. Goals were divided into five groups: 1, symptoms; 2, quality of life (physical); 3, quality of life (emotional); 4, sexual function; 5, avoidance. ICIQ-UI SF preoperative mean was 14.9 and postoperative mean was 1.5 (p < 0.05). A total of 210 goals were stated. The majority of the goals (38 %) were in group 2 concerning quality of life in the physical domains. Mean VAS score for all goals was 9.1 (SD 2). Thirty-seven patients (53 %) fulfilled all their goals. Twenty-one patients (30 %) did not have a VAS score of 10, although continent with an ICIQ-UI SF score of zero. Reasons for not achieving a full VAS score were that some still used pads out of fear (n = 10), that their mental focus was still on incontinence (n = 7) or that they had not yet tried some of the physical aims (n = 7).

CONCLUSIONS

Most patients achieved their goals. The majority of the goals concerned quality of life in the physical domains.

A retrospective study on telephone follow-up of anterior colporrhaphy by a specialized nurse

INTRODUCTION AND HYPOTHESIS

The aim of the study was to evaluate a new follow-up practice after anterior colporrhaphy for central cystocele involving nurse telephone follow-up.

METHODS

A retrospective follow-up of all 84 patients with an anterior colporrhaphy operation during 2011 was performed. Standard postoperative procedure in uncomplicated cases of cystocele operation (first-time cystocele operation, no preoperative incontinence or voiding difficulties, and no immediate postoperative complications) was a telephone interview performed by a continence nurse 3 months after patient surgery. A local checklist comprising questions concerning complications, voiding dysfunction, and sexual life, as well as questions from the International Consultation on Incontinence Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used. Complex cases were followed by the surgeon with a consultation including gynecological examination after 3 months.

RESULTS

Out of 84 patients with a cystocele operation, 59 were uncomplicated and had a telephone follow-up. Forty-four (75 %) were satisfied and needed no further consultation in the hospital. One patient could not be contacted. Fourteen patients had a consultation, three before the telephone consultation because of bleeding, five because of anxiety, and one each because of voiding dysfunction and prolapse symptoms. Four patients had persisting urinary incontinence and were incorrectly scheduled for a telephone interview.

CONCLUSIONS

Selecting uncomplicated cases for a nurse telephone follow-up after cystocele operation is feasible in a majority of cases. This allows doctors to see more new patients and focus on difficult cases, as well as saving time and money.

Follow-up of the tension-free vaginal tape operation in everyday practice

A retrospective study was performed on clinical follow-up after tension-free vaginal tape (TVT) operations for urinary stress incontinence in our department. Uncomplicated cases of TVT were followed with a telephone interview performed by a specialized nurse three months postoperatively and complex cases with a clinical examination after three months. During one year, 85/117 (73%) were followed by telephone interview and 32/117 (27%) clinically. Of those with a scheduled telephone interview, 73 (86%) were satisfied and without complications, while 12 had a clinical consultation either before or after the interview. Two patients with a scheduled telephone interview developed voiding dysfunction and contacted the operating department. Selecting uncomplicated cases for telephone interview after TVT operation is feasible for the majority of cases.

A prospective study on whether a tension-free urethropexy procedure affects the residual urine and flow up to 4 years after the operation

BACKGROUND

Sling procedures performed for urinary stress incontinence can be complicated by urinary retention and flow problems. The aim of this study was to evaluate the flow and the residual urine before and after a tension-free vaginal urethropexy procedure performed for stress urinary incontinence.

METHODS

A total of 72 women were included in the study. For voiding phase assessment, patients had spontaneous flow and residual urine measurements performed before the operation and 3 months and 1, 2, 3, and 4 years after the operation.

RESULTS

The patients experienced an increase in residual urine 3 months postoperatively, but returned toward preoperative values in the following 4 years. A statistically significant decrease in maximum flow, average flow, and corrected maximum flow was observed 3 months after the operation, which was unchanged in time and thus did not increase over the years.

CONCLUSION

The tension-free urethropexy operation had an influence on flow which did not deteriorate over the years. Whether this change in flow will have any influence on the detrusor function or create voiding problems in years to come is unknown.

Incidence and treatment of urinary retention postpartum

The aim of this clinical study was to examine the incidence of postpartum urinary retention, to investigate the relationship between different obstetric parameters, and to find out whether our proposed treatment program fulfilled our needs. The incidence of urinary retention postpartum was 0.7%. The incidence of instrumental delivery, sphincter rupture, and larger lacerations of the perineum was significantly increased in the group with urinary retention. Our program for detecting and treating patients with postpartum urinary retention seemed to work efficiently.