Validation of the prolapse quality of life questionnaire (P-QOL) in a Turkish population

Validation of the Lithuanian version of the Prolapse Quality-of-Life questionnaire

INTRODUCTION AND HYPOTHESIS

We aimed to translate and validate the Lithuanian version of the Prolapse Quality-of-Life (P-QOL) questionnaire.

METHODS

The P-QOL questionnaire was translated into Lithuanian and administered to women recruited from a gynaecology outpatient clinic at a tertiary referral centre. The scores of the final version were compared in symptomatic (n = 137) and asymptomatic (n = 137) women and with findings on vaginal examination using the Pelvic Organ Prolapse Quantification system. The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis.

RESULTS

There was a significant difference in median score for each P-QOL domain between symptomatic and asymptomatic women (p < 0.001). P-QOL scores correlated significantly with the stage of urogenital prolapse in most domains. High internal consistency was shown in all domains with a Cronbach's alpha range of 0.775 to 0.958, except for the "social limitations" domain, which was shown to be acceptable (0.647). Test-retest reliability was also high in all domains (p < 0.05).

CONCLUSION

The Lithuanian version of the P-QOL questionnaire has proven to be a valid, reliable and easily comprehensible instrument for assessing symptom severity and impact on the quality of life of Lithuanian-speaking women with urogenital prolapse.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Prolapse Quality of Life Questionnaire in the United Arab Emirates

BACKGROUND

Given the extensive translation of the Prolapse Quality of Life Questionnaire (P-QoL) into many languages, it is imperative to develop an Arabic version to facilitate the study of pelvic organ health within the Arabian culture.

OBJECTIVE

The aim of this study was to investigate, cross-culturally adapt, and validate the Arabic version of the P-QoL.

STUDY DESIGN

This study involved cross-cultural adaptation and psychometric testing.

METHODS

A total of 90 participants were included in the study. This cross-sectional study was carried out in two phases; during phase I, the P-QoL was translated and adapted from English into Arabic. The Arabic version was psychometrically validated during phase II using the test-retest reliability and internal consistency with Cronbach's alpha coefficient, convergent construct (CC) validity among the four study tools using Spearman's coefficient (r), and discriminative validity using Mann-Whitney test to find the differences between the means of the two samples.

RESULTS

A satisfactory level of semantic, conceptual, idiomatic, and content comparability was reached in the cross-cultural adaptation of the Arabic version of the P-QoL. The internal consistency was high in terms of psychometric validation, with a Cronbach's alpha coefficient of 0.971 for the P-QoL. The test-retest results showed high reliability, with the interclass correlation coefficient (ICC) of the P-QoL determined as 0.987. The convergent construct validity was highly acceptable (moderately strong), reflecting a positive correlation between the Arabic version of the P-QoL and the Australian Pelvic Floor Dysfunction Questionnaire (APFD) (r = 0.68; p < 0.001). Similarly, a significant convergent validity of the Arabic version of the P-QoL and the Visual Analogue Scale (VAS) (r = 0.47; p < 0.001) was observed, as well as a correlation between the APFD and the VAS (r = 0.46; p < 0.001). However, there was no significant correlation between the 12-Item Short-Form Survey (SF-12), the P-QoL, the APFD, and the VAS.

CONCLUSION

Based on the significant correlation found between the Arabic APFD and the VAS, the results reveal good reliability, internal consistency, and construct validity. It is recommended that Arabic-speaking females with pelvic organ prolapse use the Arabic version of the P-QoL. More research is needed to assess the responsiveness of the P-QoL.

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.

Spanish Questionnaires for the Assessment of Pelvic Floor Dysfunctions in Women: A Systematic Review of the Structural Characteristics and Psychometric Properties

BACKGROUND

Pelvic floor dysfunctions affect a third of the adult female population, including a large number of clinical conditions, which can be evaluated through validated questionnaires that inform us of the status and perception of women both objectively and subjectively. The main objective of this study was to review and explain the topics of the validated questionnaires in Spanish on pelvic floor dysfunctions and to review their psychometric properties.

METHODS

A systematic review was carried out in the PUBMED and WOS databases. The keywords used were in PUBMED: (((((((("Fecal Incontinence" [Mesh]) OR "Urinary Incontinence" [Mesh]) OR "Pelvic Organ Prolapse" [Mesh]) OR "Pelvic Floor Disorders" [Mesh]) OR "Sexual Dysfunction, Physiological" [Mesh]) OR "Pelvic Girdle Pain" [Mesh]) OR "sexual function" [Title/Abstract]) OR "Prolapse" [Title/Abstract]) AND "Surveys and Questionnaires" [Mesh] AND "Validation" [Title/Abstract] combined with the Boolean operators "AND"/"OR". In contrast, in WOS, a segregated search was carried out with each of the terms of pelvic floor dysfunction together with "Validation" and "Surveys and Questionnaires". All articles published up to 19 November 2021 were considered. Methodological quality was assessed with the COSMIN scale.

RESULTS

A total of 687 articles were identified, of which 13 were included. The evaluated questionnaires and the structural characteristics and psychometric properties of each of them were collected.

CONCLUSION

The Spanish versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with pelvic floor dysfunctions and that they resemble other versions of the same questionnaire published in other languages.

Translation and linguistic validation of the Persian version of the International consultation on Incontinence Questionnaire Vaginal Symptoms

Background:

There is no validated measurement tool to assess vaginal symptoms (VS), sexual matter (SS), and quality of life (QOL) among Persian-speaking women. This study aimed at translating and assessing the validity and reliability of the Persian version of the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (PICIQ-VS).

Materials and Methods:

In this cross-sectional study, after obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ) Advisory Board, the English version of ICIQ-VS was translated into Persian per a standard translate and back translate process, and the validity and reliability were studied. Two hundred women with and without pelvic organ prolapse were asked to complete the PICIQ-VS (mean age: 52.1, range: 22–84 years). A panel of 10 experts evaluated the content and face validity of the questionnaire. Cronbach's alpha examined the internal consistency reliability of the measure. To evaluate the test–retest reliability, we redistributed the questionnaire among 30 patients 2 weeks after their initial visit using intra-class correlation coefficient (ICC).

Results:

Content and face validity of the questionnaire was confirmed after some light modification (content validity ratio ranged from 0.69 to 1.00, and content validity index ranged from 0.79 to 1.00). PICIQ-VS showed an acceptable internal consistency and stability reliability (VS: α = 0.64, ICC = 0.84; SM: α = 0.69, ICC = 0.88; and total scale: α = 0.72, ICC = 0.91, respectively). Significant differences were observed between the asymptomatic and symptomatic groups for VS and the total score (P < 0.05).

Conclusion:

In the light of the results, interestingly, PICIQ-VS could be utilized as a valid and reliable tool to assess the VS among Persian-speaking women, both in research and clinical practice.

Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

Background

Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.

Methods

Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used.

Results

The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery.

Conclusions

In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

The effect of reconstructive vaginal surgery on quality of life and sexual functions in postmenopausal women with advanced pelvic organ prolapse in intermediate-term follow-up

OBJECTIVE

To compare sexual function and quality of life in women who underwent McCall culdoplasty versus sacrospinous ligament fixation for pelvic organ prolapse.

MATERIALS AND METHODS

This study was conducted in our urogyanecology clinic between July 2015 and June 2019. We included sexually active postmenopausal women who had undergone either McCall culdoplasty (n:80 patients) or sacrospinous ligament fixation (n:38 patients) procedure for threatened POP. Patients in both groups were matched according to age and body mass index. Sexual function between both groups was evaluated with the pelvic organ prolapse/urinary incontinence sexual function 12 patient-reported outcome measures (PROMs) and quality of life with the prolapse quality of life (PQOL) PROMs.

RESULTS

Emotional domain was low in the McCall culdoplasty group (21.4 ± 10.1 vs. 30.8 ± 15.2; p = 0.03). There were no significant differences in other P-QOL domains. Pain during intercourse was more in the sacrospinous ligament fixation group (2.9 ± 1.6 vs. 1.3 ± 1.1; p = 0.04). The mean operation time in the McCall culdoplasty group was shorter than the sacrospinous ligament fixation group (p = 0.03). There was no difference between the two surgical procedures performed in terms of intraoperative blood loss and hospital stay. The prevalence of recurrence in the McCall culdoplasty group was 6.2%, and that of sacrospinous ligament fixation was 5% (p = 0.75) in one year follow-up.

CONCLUSION

Our study demonstrated that McCall culdoplasty has a more positive effect on QOL and sexuality than sacrospinous ligament fixation in appropriately selected patients. McCall culdoplasty could be considered as a good option in the treatment of advanced pelvic organ prolapse in elderly patients.

3D high frequency endovaginal ultrasound evaluation of urethral and pelvic morphology in stress urinary incontinence in first pregnancy

OBJECTIVE

We aimed to compare the morphological characteristics of pelvis and urethra in nulliparous pregnant women with and without stress urinary incontinence (SUI) by 3D high-frequency endovaginal ultrasound (3D-EVUS).

STUDY DESIGN

At 36-38 weeks of gestation, 40 nulliparous pregnant women with and without SUI underwent 3D-EVUS assessment. The anteroposterior and transverse diameters of levator hiatus (LH), pubovisceral muscle thicknesses at 3,9 and 12 o'clock, right and left paravaginal areas, symphysis angle, bladder-symphysis distance (BSD), uretral complex thickness (Ut), urethral complex width (Uw), urethral complex volume (UV), urethral length (UL), intramural urethra, rhabdosphincter thickness (Rt), rhabdosphincter width (Rw), rhabdosphincter length (RL), and rhabdosphincter volume (RV) were measured by 3D-EVUS.

RESULTS

Longer LH transverse diameter (34.8 ± 3.8 mm vs 31.1 ± 2.1 mm), shorter LH anteroposterior diameter (47.8 ± 6.2 mm vs 52.4 ± 2.6 mm), and wider symphysis angle (116.3 ± 5.6 vs 111.5 ± 5.3 degrees) were detected in nulliparous pregnant women with SUI compared those without SUI (p = 0.001, p = 0.001 and p = 0.013; respectively). RV of less than 1.26 cm³ was found to have a sensitivity of 100 % and a specificity of 100 % for the presence of SUI in nulliparous pregnant women.

CONCLUSIONS

Constitutionally different pelvic shape and decreased urethral rhabdosphincter measurements can be used to predict SUI in nulliparous pregnant women.

Comparison of the Quality of Life and Female Sexual Function Following Laparoscopic Pectopexy and Laparoscopic Sacrohysteropexy in Apical Prolapse Patients

Objectives:

We sought to compare the surgical outcomes, safety, effectiveness, and mid-term outcomes in patients who had undergone laparoscopic hysterosacropexy and laparoscopic pectopexy due to apical prolapse.

Materials and Methods:

This prospective randomized study was conducted on a total of 62 women who underwent apical prolapse surgery (32 undergoing a pectopexy and 30 undergoing a sacrohysteropexy) between June 2015 and June 2017. Patients with symptomatic uterine or vaginal vault prolapse with stage 2 or worse were included in the sudy. Before and after the operation, we used the Pelvic Organ Prolapse Quantification System (POP-Q) and questionnaires, which are the Prolapse Quality of Life Questionnaire (P-QOL) and Female Sexual Function Index (FSFI), to evaluated cases. Baseline characteristics, perioperative and postoperative complications, and follow-up results at 12 months were also evaluated.

Results:

All domains of POP-Q, P-QOL, and FSFI scores improved significantly after surgery both in pectopexy and sacrohysteropexy group. The postoperative complications of both procedures were similar except for constipation after surgery (3.2% in the pectopexy group and 20% in the hysterosacropexy group [P = 0.036]).

Conclusion:

Both sacrohysteropexy and pectopexy are effective surgical options for apical prolapse patients. The pectopexy is an acceptable alternative to laparoscopic sacrohysteropexy because of its less complexity and not reducing pelvic space for the rectum to exist. We suggest that the laparoscopic pectopexy may be widely used in clinical routine.

Le Fort colpocleisis: An evaluation of results and quality of life at intermediate-term follow-up

OBJECTIVES

To assess postoperative complications, intermediate-term anatomic and subjective success rates, and quality of life following obliterative Le Fort colpocleisis (LFC) for advanced pelvic organ prolapse (POP).

STUDY DESIGN

We conducted a retrospective cohort study with 53 subjects who underwent LFC surgery between January 2012 and April 2019. Demographic and treatment data were retrieved from a hospital database. Data on postoperative anatomic results were gathered from individual examinations of study subjects. The Clavien-Dindo classification was used to evaluate the complications. The Prolapse-Quality of Life (P-QoL) questionnaire was administered in person or over the telephone before and after the operation. Low scores on the P-QoL reflect a high quality of life.

RESULTS

The mean age at operation was 73 ± 7.1 years. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12-82). Ninety-two percent of subjects had at least one comorbidity. When subjects were classified using the Pelvic Organ Prolapse (POP) Quantification System, seven (13.2 %) had Stage 3 POP and 46 (86.8 %) had Stage 4 POP. The overall rate of minor peri-operative complications rate was 11.3 % (six subjects). The objective success rate of LFC at intermediate-term follow-up was 98.1 %, and the subjective success rate was 96.2 %. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12-82). There was a statistically significant decrease in the postoperative P-QoL score (p < 0.001).

CONCLUSIONS

Based on positive intermediate-term anatomic and subjective outcomes, including a significant decrease in P-QoL questionnaire scores and a lack of regret, obliterative LFC should be considered a first-choice procedure for elderly and sexually inactive women with advanced POP.

Validation of the Malay version of the p-QOL questionnaire

INTRODUCTION

This study aimed to translate and validate the P-QOL questionnaire in the Malay language.

METHODS

The P-QOL questionnaire was translated into the Malay language and subsequently back-translated to English. Test-retest reliability and internal consistency were tested. All patients who visited the gynecology outpatient clinic of UKMMC, UMMC and IIUM between January 2016 and May 2017 completed the P-QOL questionnaires and were assessed for POP-Q staging.

RESULTS

One hundred twenty patients with symptomatic pelvic organ prolapse and 180 asymptomatic patients were included. The Cronbach's alpha for each domain was > 0.70, which confirmed that there was a highly acceptable internal consistency. The value varied between 0.88 (role limitation) and 0.912 (sleep/energy). Test-retest reliability showed a significant correlation between the total scores for each domain (p < 0.001). There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q). With a higher POP-Q stage, a higher impact on the quality of life was detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients.

CONCLUSION

The Malay translated version of the P-QOL questionnaire is a reliable, consistent, and valid instrument for assessing the severity of the symptoms and impact on the quality of life among women with uterovaginal prolapse. It is easily understood, administered, and self-completed by patients.

Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fi xation: a comparative study

Objective

To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fixation procedures.

Materials and Methods

Forty-three women who had vaginal sacrospinous fixations(SSF) using Dr. Aksakal’s Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women.

Results

The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not significantly different between the surgery groups.

Conclusion

The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up

Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than - 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

Validation of the Turkish version of the International Consultation on Incontinence Questionnaire-vaginal symptoms (ICIQ-VS)

INTRODUCTION AND HYPOTHESIS

The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) was developed and validated in 2006 to evaluate vaginal symptoms, sexual matters, and quality of life of patients. This study aimed to validate the Turkish version of ICIQ-VS.

METHODS

The English version of the questionnaire was translated into Turkish. On the basis of the pelvic organ prolapse quantification (POP-Q) system, symptomatic women with ≥ 2 grade pelvic organ prolapse (POP) were included in the symptomatic (patient) group and asymptomatic women with ≤ 1 grade POP in the asymptomatic (control) group. The questionnaire was administered three times: after the first examination of the women (T1), 3 weeks after T1 (T2), and 3 months after the POP surgery (T3).

RESULTS

A total of 111 women were included in the study (symptomatic group, n = 53; asymptomatic group, n = 58). The missing data were ˂ 2%; the test-retest reliability was between 0.807 and 0.963, and the differences between the symptomatic and asymptomatic women were significant (p ˂ 0.001). A significant positive correlation existed between POP-Q and the vaginal symptom score, sexual matter score, and quality-of-life score (r_s = 0.844, 0.393, and 0.698, respectively; p < 0.001). The Cronbach's alpha was 0.72 for the vaginal symptom score and 0.73 for the sexual matter score. The sensitivity to change was significant (p ˂ 0.05). The effect size values of the vaginal symptom score, sexual matter score, and quality-of-life score were 2.55, 2.33, and 1.56, respectively.

CONCLUSION

The Turkish version of ICIQ-VS was successfully validated in this study, and a newer version of the questionnaire was made available for assessing vaginal symptoms, sexual matters, and quality of life of patients with POP.

A systematic review of the psychometric properties of the cross-cultural adaptations and translations of the Prolapse Quality of Life (P-QoL) questionnaire

INTRODUCTION AND HYPOTHESIS

Due to linguistic and cultural differences, there is a need to test the psychometrics of the translated versions of any patient-reported outcome measures. We investigated the psychometric properties of the Prolapse Quality of Life (P-QoL) questionnaire for non-English-speaking populations by conducting a systematic review of studies that examined the psychometric properties of non-English versions.

METHODS

We searched PubMed, Latin American and Caribbean Health Science Information Center (LILACS), and Science Direct databases for articles published in English up to February 2018. Methodological quality and quality of psychometric properties were assessed by two independent reviewers using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and validated quality assessment criteria. The two assessments were combined to produce the best level of evidence per language/translation.

RESULTS

Sixteen articles in 13 languages were retrieved. Most (n = 9; 56.3%) were not rigorously translated or reported, and there was poor evidence for structural validity. Internal consistency was reported in all studies, and all studies had good methodological quality. There was fair evidence for construct and good to fair for criterion validity. Evidence for responsiveness was good, although this was evaluated only in three studies.

CONCLUSIONS

There is limited evidence supporting the psychometric robustness of the original validation and translated versions of P-QoL. Cross-cultural adaptations are insufficient. Given this variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error, and cutoff values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions.

Dysfunction, activity limitations, participation restriction and contextual factors in South African women with pelvic organ prolapse

Background

Pelvic organ prolapse (POP) is a multifactorial, poorly understood condition impacting quality of life (QOL). The pathology and aetiology might imply population-specific differences in domains of the International Classification of Function, Disability and Health (ICF). There is, however, a lack of research in this regard in South Africa.

Objectives

To describe the dysfunction, activity limitations, participation restrictions and contextual factors in South African women with POP.

Method

One hundred women were conveniently sampled in a primary health care setting. They completed a self-compiled medical and exercise history questionnaire, the standardised Prolapse-Quality of Life (P-QOL) questionnaire and the Visual Faces Scale. The stage of prolapse was determined by the Pelvic Organ Prolapse Quantification (POP-Q) Scale. Means, medians, standard deviations, percentages and frequencies were calculated.

Results

Eighty-six per cent had a stage III POP, 57% had overactive bladder, 50% had constipation, 37% had stress urinary incontinence, 31% had urge urinary incontinence, 32% had incomplete emptying and 30% had anal incontinence. Comorbidities included cardiovascular disease (65%), depressive symptoms (12%) and hypothyroidism (18%). Other contextual factors included limited physical activity (80%), an increased body mass index (29 kg/m²), older age (59 years) and unemployment (80%). Quality of life was affected in the severity, social, emotional and sleep/energy domains (median scores were 66.7% – 33.3%).

Conclusion

The dysfunction domain of the ICF was similar to other populations with POP. Activity and participation restrictions included social, emotional and sleep/energy aspects. Contextual factors seem to be population-specific, possibly leading to differences comparing QOL amongst different populations.

Clinical implications

Activity and participation restrictions, as well as contextual factors, may differ in different populations with POP. Interactions between contextual factors and movement impairment should be considered during management and be further investigated.

Translation, transcultural adaptation, reliability and validation of the pelvic organ prolapse quality of life (P-QoL) in Amharic

BACKGROUND

The Prolapse Quality of Life (P-QoL) is a disease-specific instrument designed to measure the health-related quality of life in women with prolapse; however, there is no Amharic version of the instrument. The aim of this study were to translate the P-QoL into Amharic and evaluate its psychometric properties among adult women.

METHODS

We followed an intercultural adaptation procedure to translate and adapt the P-QoL. A forward-backward translation, face validity interviews with experts and cognitive debriefing of the translated version with ten adults from the target group were performed. The Amharic version was then completed by 230 adult women with and without POP symptoms. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system. We examined internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient = ICC). Confirmatory factor analysis (CFA) was conducted and model fit was discussed. We extracted a new factor structure by exploratory factor analysis (EFA). Criterion validity was also assessed against the SPOP-Q stage.

RESULTS

The translated measure was found acceptable by the experts and target group, with only minor adaptations required for the Amharic context. It had high internal consistency (α = 0.96) and test-retest reliability (ICC = 0.87; p <  0.001). In CFA results, the model fit indices were unacceptable (CFI = 0.69, RMSEA = 0.17, SRMR = 0.43, TLI = 0.65, and PCLOSE = 0.00). EFA extracted three-factor with satisfactory convergent and discriminant validity. The P-QoL median scores were significantly higher in symptomatic women (Mann-Whitney U Test; p <  0.001). The score was also significantly correlated with stage of prolapse (Spearman's correlation coefficient = 0.42 to 0.64, p <  0.001).

CONCLUSIONS

The P-QoL scale was successfully translated to Amharic and appears feasible, reliable and valid for Amharic-speaking women. Factor analysis confirmed a three-factor structure, inconsistent with the original English version. Further studies are needed to evaluate responsiveness of the Amharic P-QoL score.

Modified laparoscopic pectopexy: short-term follow-up and its effects on sexual function and quality of life

INTRODUCTION AND HYPOTHESIS

This study examined the early outcomes of laparoscopic (LS) pectopexy and evaluated its effects on female sexual function and quality of life (QoL).

METHODS

Twenty-two patients with apical prolapse who underwent LS pectopexy were included. Outcomes of the procedure were noted; the Female Sexual Function (FSFI) and Prolapse Quality of Life (P-QOL) questionnaires were completed preoperatively and 6 months postoperatively.

RESULTS

There was no evidence of recurrent prolapse or constipation; the percentages of exacerbation of cystocele, rectocele, de novo stress urinary incontinence (SUI), and de novo urgency (UUI) were 4.5%, 9.0%, 4.5%, and 4.5%, respectively (mean follow-up 10.41 months). FSFI and P-QOL scores improved significantly (p < 0.05) postoperatively.

CONCLUSIONS

LS pectopexy shows promising results for pelvic organ prolapse (POP) surgery with comparable outcomes. It also improved the FSFI and P-QOL scores in POP patients.

Validation of the traditional Chinese version of the prolapse quality of life questionnaire (P-QOL) in a Mandarin-speaking Taiwanese population

OBJECTIVE

To validate the traditional Chinese translated version of the prolapse quality of life questionnaire (P-QOL).

MATERIALS AND METHODS

The P-QOL questionnaire was translated into traditional Chinese characters and administered to women recruited from gynecologic outpatient clinics of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. After the test-retest reliability and internal consistency were established in a pilot study, all participants completed the P-QOL questionnaire and were examined in the lithotomy position using the Pelvic Organ Prolapse Quantification System (POP-Q). The construct validity was assessed by comparing symptom scores and quality-of-life domain scores between symptomatic and asymptomatic women.

RESULTS

Of the 244 women recruited, 159 were symptomatic for pelvic organ prolapse, and 85 were asymptomatic. The test-retest reliability confirmed a significant positive monotonic correlation between the total scores of each domain (n = 30, Spearman's rho was from 0.411 to 0.888, p < 0.05 of all). All items achieved a Cronbach α > 0.80 showing good internal consistency. Among the 18 symptom questions, the scores differed significantly between symptomatic and asymptomatic women for 12/18 symptom questions. These 12 questions referred to the prolapse/vaginal symptoms. All the quality of life domains differed significantly (p < 0.05) between symptomatic and asymptomatic women except for the domain of sleep/energy (p = 0.108).

CONCLUSION

The traditional Chinese language version of the P-QOL is a reliable instrument for the assessment of symptom severity and impact on quality of life in women with pelvic organ prolapse.

Response validity of Persian version of P-QOL questionnaire in patients with prolapse

BACKGROUND AND OBJECTIVE

Pelvic organ prolapse (POP) refers to drop of any pelvic organs into or outside of the vaginal canal or anus. This is a disabling condition that results in limitations in all aspects of women's lives, especially quality of life. The evaluation of quality of life in women with POP requires the use of a valid and reliable measure. An important aspect of validity is responsiveness. The aim of current study is to evaluate the responsiveness of P-QOL questionnaire in patients with prolapse.

METHODS

Women with confirmed diagnosed POP by gynecologist who were scheduled to undergo POP's treatment enrolled in the study. Quality of life as an outcome measure was evaluated before and six month after treatment besides assessing of physical index of treatment's effect (pelvic organ prolapse quantification; POP-Q). Responsiveness was evaluated using calculation of standardized response mean (SRM) and effect size (ES).

RESULTS

Fifty women were evaluated in current study. Mean age was 43.5±11.8 years old. The range of Cronbach's alpha was between 0.60 and 0.89 for all domains of P-QOL. The range of SRM for all domains was between 0.60 and 0.88. The range of ES was between 0.54 and 0.96. Score of all domains of P-QOL was statistically different between pre and post-treatment (P<0.0001).

CONCLUSION

The findings of current study showed the P-QOL questionnaire has a good responsiveness in Persian language and could use to assess the impact of interventions on quality of life in patients with prolapse.

Validation of the Spanish-language version of the Prolapse Quality of Life questionnaire in Chilean women

INTRODUCTION AND HYPOTHESIS

The Prolapse Quality of Life (P-QOL) questionnaire is a specific health-related quality of life (HRQL) instrument to assess the impact of POP on women. It has been validated in English-speaking women and to date has been translated into several other languages. However, currently there is no Spanish translation of the P-QOL questionnaire. The aim of this study was to translate the P-QOL questionnaire into Spanish and to assess its feasibility, validity, and reliability.

METHODS

Following a forward- and back-translation of the original English P-QOL questionnaire into Spanish language, the translated questionnaire was reviewed by a group of patients as well as an expert panel to assess its comprehensibility. In this cross-sectional study women with POP symptoms were recruited from a tertiary referral teaching hospital. Women were defined as symptomatic if they report feeling a lump/bulge/pressure in the vagina. The Spanish translated P-QOL questionnaire was self-administered to all women. Reliability, content, and construct validity were evaluated using the Cronbach's alpha coefficient, ANOVA, and Spearman's correlation tests.

RESULTS

One hundred and twenty-eight women were studied. There were no missing items. The Cronbach's alpha ranged from 0.626 to 0.866 across domains, demonstrating the good reliability of the Spanish P-QOL. The severity of symptoms was related to the worst quality of life, but the severity of POP was not related to poorer QoL.

CONCLUSIONS

The Spanish translated version of the P-QOL is a reliable, consistent and valid instrument to assess symptom severity and QoL impact in Chilean women with POP.

Quality of life scores improve in women undergoing colpocleisis: a pilot study

OBJECTIVE

To evaluate the quality of life and surgical outcomes in women who had undergone colpocleisis.

STUDY DESIGN

This was a prospective small cohort study conducted between August 2010 and September 2011. Twelve women with pelvic organ prolapse were offered obliterative vaginal surgery and were informed about the surgical procedure. Ten women accepted this operation and were included in the study. Before and after colpocleisis, cases were evaluated by urogynecological examination, and quality of life was assessed by the Turkish language validated prolapse quality of life questionnaire (P-QOL), in which a low total score indicates a good quality of life.

RESULTS

The mean age was 74.9±4.5 (range 68-85). The general score of the P-QOL was reduced during the follow-up period, reflecting a significant effect on quality of life and clinical improvement in women with the colpocleisis operation. There was no morbidity due to colpocleisis or recurrent pelvic organ prolapse in follow-up period.

CONCLUSION

In our small cohort including elderly women, colpocleisis provided high levels of surgical outcomes as well as a significant improvement in quality of life without significant morbidity.

Effects of single vaginal incision technique on quality of life in women with stress urinary incontinence

STUDY OBJECTIVE

To estimate the short-term effects of a minimally invasive single vaginal incision technique without passing through the abdomen or groin (ContaSure Needleless System) on the quality of life in women with incontinence.

DESIGN

Prospective cohort study (Canadian Task Force classification II-2).

SETTING

Tertiary referral urogynecology clinic.

PATIENTS

50 consecutive patients with urodynamically proved stress urinary incontinence from October 2008 to March 2009.

INTERVENTIONS

Preoperative and postoperative scores on the short forms of the IIQ-7 (Incontinence Impact Questionnaire, UDI-6 (Urinary Distress Inventory) PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function), and long form of the P-QOL (Prolapse Quality of Life) were evaluated in 50 patients with urodynamically proved stress urinary incontinence. Scores were compared with postoperative urodynamic findings.

MEASUREMENTS AND MAIN RESULTS

Mean (SD) follow-up was 433.5 (44.1) days (95% CI, 420.1-445.1). Patients showed statistically significant improvement insofar as preoperative and postoperative scores on the IIQ-7, P-QOL, and PISQ-12 and the irritative and stress subgroups of UDI-6. Obstructive score of UDI-6 worsened, consistent with the findings of pressure-flow studies. Postoperatively, 40 patients (80%) were urodynamically continent. Eight patients (16%) were still incontinent; however, their quality of life scores (IIQ-7 and UDI-6 stress) improved. Two patients (4%) continued to experience leakage, with equal or worsened quality-of-life scores.

CONCLUSION

Early clinical results of the present trial demonstrate that the ContaSure Needleless System seems to be capable of improving significantly all aspects of quality of life in women with incontinence. To improve the willingness for treatment of women with stress incontinence, this minimally invasive technique should be encouraged after confirming its efficacy in larger prospective, randomized, comparative trials.

Validation of Persian version of the Prolapse Quality-of-Life questionnaire (P-QOL)

INTRODUCTION AND HYPOTHESIS

The aim of this study was to evaluate the validity and reliability of a Persian translation of the Prolapse Quality-of-Life (P-QOL) questionnaire in women with pelvic organ prolapse (POP).

METHODS

One hundred and twenty-four women with POP symptoms and 125 asymptomatic women were studied. The asymptomatic group was used for discriminant validity.

RESULTS

Seventy-two percent (89/124) of the symptomatic women had stage ≥ 2 POP while 86% (108/125) of the asymptomatic women had a stage <2 POP. All domains of the Persian P-QOL have a Cronbach's alpha coefficient greater than 0.7 (0.78-0.97) and were significantly different between symptomatic and asymptomatic women indicating a good discriminant validity (<0.01). The test-retest reliability confirmed a highly significant correlation. All items of P-QOL questionnaire correlated significantly with the objective vaginal examination findings (construct validity) except for personal relationship and emotions.

CONCLUSION

The Persian version of the P-QOL is a valid and reliable tool to assess QOL of women with POP.

Validation of the Prolapse Quality of Life (P-QOL) questionnaire in Thai version

INTRODUCTION AND HYPOTHESIS

The aim of this study was to validate the Thai version of the Prolapse Quality of Life (P-QOL) questionnaire.

METHODS

The P-QOL questionnaire was translated into Thai. Test-retest reliability and internal consistency were tested. All patients who visit the gynecologic outpatient clinic of King Chulalongkorn Memorial Hospital between March 2008 and September 2009 completed the P-QOL questionnaires.

RESULTS

One hundred fifteen patients with symptomatic pelvic organ prolapse and 60 asymptomatic patients were included. There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q stage). A higher POP-Q stage and a higher impact on quality of life were detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients.

CONCLUSION

The Thai version of the P-QOL questionnaire is a valid, reliable, and simple instrument to assess the symptoms' severity and the quality of life in Thai-speaking patients with pelvic organ prolapse.

Validity, reliability and responsiveness of a Dutch version of the prolapse quality-of-life (P-QoL) questionnaire

INTRODUCTION AND HYPOTHESIS

We aimed to test validity, reliability and responsiveness of a Dutch version of a prolapse quality-of-life questionnaire (P-QoL).

METHODS

P-QoL was translated into Dutch and adjusted by a panel of five experts. The scores of the final version were compared between symptomatic (n = 160) and asymptomatic (n = 80) patients and with findings on vaginal examination (pelvic organ prolapse quantification (POP-Q)). In terms of reliability, Cronbach's alpha was calculated, and a test-retest (n = 20) was performed. Responsiveness to treatment was assessed by comparing pre- and postoperative scores in 45 patients.

RESULTS

Total scores for each P-QoL domain were different between symptomatic and asymptomatic women (p < 0.001). Severity according to P-QoL correlated well with POP-Q findings. Cronbach's alphas showed internal consistency within the domains. Test-retest reliability was high. Pre- and postoperative scores for each domain were significantly different (p < 0.001).

CONCLUSION

The Dutch version of P-QoL is valid, reliable and responsive to assess quality-of-life and symptoms in Dutch-speaking patients with urogenital prolapse.

Validation of the Slovakian version of the P-QOL questionnaire

INTRODUCTION AND HYPOTHESIS

This study aimed to validate the Slovakian version of the prolapse quality-of-life (P-QOL) questionnaire.

METHODS

The P-QOL questionnaire was translated into the Slovakian language and administered to women recruited from a urogynecology outpatient clinic at a tertiary referral teaching hospital. After completing a questionnaire, all women were examined in supine position using the Pelvic Organ Prolapse (POP-Q) Quantification system. The reliability was assessed by using a 2-week test-retest analysis.

RESULTS

Fifty symptomatic and 79 asymptomatic women were included. The score of P-QOL was strongly correlated with the vaginal examination findings among the symptomatic group (p < 0.001 in eight domains). P-QOL domain scores were significantly different between symptomatic and asymptomatic women. The test-retest reliability confirmed a highly significant correlation between the total scores for each domain (p < 0.001).

CONCLUSION

The Slovakian version of the P-QOL questionnaire is a valid, reliable, and easily comprehensible instrument to assess quality of life of women with uterovaginal prolapse.

Validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in a Turkish population

OBJECTIVE

To validate the Turkish translated version of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

STUDY DESIGN

After the test-retest reliability and internal consistency were established in a pilot study, 270 patients were enrolled and general and subscale scores of the questionnaire were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q) and urodynamic assessment. Main scores and scores of Prolapse Quality of Life questionnaire (PQoL) and Incontinence Impact Questionnaire (IIQ-7) were compared between patients with incontinence+/-prolapse and asymptomatic women.

RESULTS

62.24% of the participants showed urodynamic abnormality and/or leakage with or without prolapse. 28.91% had prolapse stage 3 or higher diagnosed by the POP-Q system. PISQ-12 showed a high internal consistency (Cronbach's alpha was 0.89). For test-retest reliability Spearman's rho was 0.72-0.79 for all domains. The mean scores of PISQ-12 were significantly better in asymptomatic women compared with the incontinence+/-prolapse group. Sexual function was negatively affected by prolapse and/or incontinence as assessed with PQoL and IIQ-7 questionnaires.

CONCLUSION

The Turkish translated version of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual functioning in women with urinary incontinence and/or pelvic organ prolapse. It is easy to understand that it may be easily administered and self-completed by the women.

The Portuguese validation of the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse

The aim of this study is to validate the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) in Portuguese. Two hundred four women (108 symptomatic, 94 asymptomatic, and two with no data) with mean age of 55.4 years received a Portuguese version of the ICIQ-VS. Clinical data and pelvic organ prolapse quantification index (POP-Q) were obtained. Retest was performed 3 weeks later. Responsiveness was assessed after 20 weeks of postsurgical follow-up. Overall, most patients presented POP-Q > 2. ICIQ-VS demonstrated good psychometric properties (validity, reliability and responsiveness). The test-retest reliability was moderate to excellent for all questions. The construct validation distinguished differences in ICIQ-VS scores between symptomatic (ICIQ-VS5a > 0) and asymptomatic (ICIQ-VS5a = 0) women. ICIQ-VS was highly responsive to surgical treatment and discriminated between levels of change in the vaginal symptoms score, sexual matters score, quality-of-life score, and POP-Q. The Portuguese version of ICIQ-VS was successfully validated.