Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis

Hungarian Translation and Validation of the Pelvic Organ Prolapse Symptom Score

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse (POP) significantly affects women's quality of life, making the availability of validated, culturally adapted tools for reliable symptom evaluation essential. In this study, the Pelvic Organ Prolapse Symptom Score (POP-SS) was translated into Hungarian and validated, with the assessment of its psychometric properties for clinical and research use.

METHODS

In total, 125 women diagnosed with symptomatic POP (Pelvic Organ Prolapse Quantification Score-POP-Q stage ≥ 2) completed the Hungarian POP-SS (POP-SS-H), the Hungarian version of the Australian Pelvic Floor Questionnaire (AFPQ-H), and the short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). Exploratory factor analysis was performed, McDonald's ω was used to assess internal consistency, and intraclass correlation coefficients (ICCs) were used to examine test-retest reliability over a 2-week interval.

RESULTS

The POP-SS-H demonstrated strong psychometric properties (overall ICC = 0.96, p < 0.001). Item ICCs were 0.69-0.99, with "difficulty in emptying the bladder" being the most stable. The scale has a two-factor ("prolapse and urinary distress" and "abdominal strain and bowel discomfort") structure. McDonald's ω was 0.75, confirming its good internal consistency. The scale's convergent validity was demonstrated through correlations with AFPQ-H and WHOQOL-BREF subscale scores.

CONCLUSIONS

The POP-SS-H is a reliable and valid instrument for the assessment of prolapse-related symptoms. Its high degrees of test-retest reliability and internal consistency make it suitable for clinical follow-up and research. The tool addresses a significant gap in pelvic-floor disorder management in Hungary, although further research is recommended to assess its sensitivity in the tracking of symptom changes after treatment.

Quality of Life Assessment After Pelvic Prolapse Surgery With and Without Mesh: A Literature Review

Background/Objectives: The quality of life (QoL) in patients undergoing pelvic prolapse surgery is a critical area of research in urogynecology. Pelvic organ prolapse (POP) is a prevalent condition affecting a significant number of women, leading to various physical and psychological symptoms that can severely impact their quality of life. Surgical intervention aims not only to correct the anatomical defects but also to enhance the overall well-being of patients. Methods: A comprehensive literature search in the main databases was conducted for studies evaluating quality of life after surgical treatment using techniques with and without mesh. Results: A total of 35 studies met the inclusion criteria, involving a total of 4603 patients. Twenty-two distinct patient-reported outcomes (PRO) questionnaires have been identified as post-surgical QoL assessment tools. Conclusions: Quality of life is significantly improved by surgical treatment of pelvic organ prolapse. Post-surgical PRO scores do not seem to be influenced by the surgical technique used, with no significant differences between methods using mesh or not.

Vaginal erbium laser versus pelvic floor exercises for the treatment of pelvic organ prolapse: A randomised controlled trial

OBJECTIVES

To compare the efficacy of Er:YAG laser for mild to moderate pelvic organ prolapse (POP) to that of pelvic floor exercises (PFE).

DESIGN

Single center randomised controlled trial.

SETTING

Tertiary center, Belgium.

PARTICIPANTS

Forty-six women with mild to moderate prolapse were enrolled (23 in each group). There were no missing data for the primary outcome; three patients were lost to follow-up at 24-months.

INTERVENTIONS

Comparison of vaginal laser treatment (3-6 applications) to PFE (9-18 sessions).

MAIN OUTCOME MEASURES

Subjective change in prolapse symptoms at four months from baseline measured by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) (primary), adverse events, other subjective outcomes and independent anatomical assessment up to 24 months.

RESULTS

The mean difference in POPDI-6 scores at 4 months was 1.09 (95 %CI = -6.02;8.12), showing non-inferiority of laser to PFE (p = 0.004). Within groups, the difference in mean POPDI-6 four months following the start of therapy tended to be lower for laser-treatment (65.2 % (15/23) of laser-participants were 'better' or 'much better') than for PFE (60.9 % (14/23) in the PFE group), yet without difference between groups (OR = 1.21; 95 %CI = 0.39-3.23). There were no obvious between group differences in any other subjective nor objective outcomes. At 24 months, 50 % (11/22) of laser-patients and 43 % (9/21) of PFE-patients requested additional, yet alternative treatment. There were no serious adverse events at any time-point.

CONCLUSIONS

Vaginal laser application and PFE improve symptoms of mild and moderate prolapse to a similar extent. Both treatments had a measurable yet not durable effect. There were no adverse events in either arm.

TRIAL REGISTRATION

ClinicalTrials.gov(NCT04523298).

FUNDING

The laser device was provided by Fotona, Slovenia for the duration of this trial.

Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis

INTRODUCTION AND HYPOTHESIS

Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing.

METHODS

We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I).

RESULTS

Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive.

CONCLUSIONS

The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.

Pelvic Organ Prolapse Surgery: Postoperative Quality of Life in Ethiopian Women

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse (POP) has a profound influence on a woman's quality of life (QoL). Assessment of QoL using patient-reported outcome (PRO) measures in pelvic organ prolapse surgery is common practice in developed countries, but despite the burden of POP in developing countries, such as Ethiopia, the use of PROs to record preoperative and postoperative QoL scores is limited. This study is aimed at assessing the QoL among Ethiopian women with POP before and after surgery using the validated Pelvic Organ Quality of Life (P-QoL) questionnaire. Additionally, we will compare postoperative QoL measurements of reconstructive procedures with those of obliterative procedures.

METHODS

This is a prospective observational study conducted at a single hospital in Ethiopia on women who were scheduled for surgery for symptomatic POP. Patients' QoL was assessed preoperatively using the P-QoL questionnaire and at each subsequent follow-up visit for 1 year (3, 6, 9, and 12 months). Patients undergoing an obliterative procedure were evaluated and compared with those having reconstructive procedures.

RESULTS

The mean score for general health perceptions, prolapse impact, role limitations, physical limitations, social limitations, and emotions was 0 at 12 months postoperatively. Despite significant improvements from baseline, personal relationships, sleep or energy disturbance, and symptom severity measures continued to negatively impact QoL at 12 months postoperatively.

CONCLUSIONS

Quality of life among Ethiopian women with POP is poor across all domains. Native tissue repair employing either reconstructive or obliterative methods significantly improves QoL across all domains up to 12 months postoperatively. The use of validated tools to assess PROs is essential to provide evidence-based care that improves QoL in ways that are meaningful to patients.

Validation of the Russian Version of the Prolapse Quality-of-life Questionnaire and its Application to Assess the Impact of Pelvic Organ Prolapse on Quality of Life and the Effect of Treatment in Women Undergoing Reconstructive Surgery

INTRODUCTION AND HYPOTHESIS

The objective was to validate the translated Russian version of the prolapse quality-of-life (P-QoL) questionnaire and test its applicability to assess the impact of pelvic organ prolapse (POP) on QoL and the effect of treatment in women undergoing reconstructive surgery.

METHODS

Following a forward- and back-translation of the original English P-QOL questionnaire into Russian, the translated questionnaire was reviewed by a group of patients as well as an expert panel. Women with POP who were admitted to a university hospital for reconstructive surgery were recruited. All the women completed the P-QoL questionnaire, Pelvic Floor Distress Inventory (PFDI-20) and 36-Item Short Form Survey (SF-36) questionnaires before surgery. Clinical data and POP Quantification (POP-Q) Index according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed.

RESULTS

A total of 303 women with POP were included in the study. Most patients presented with POP-Q >2. The P-QoL questionnaire demonstrated good psychometric properties. High internal consistency was shown in all domains (Cronbach's alpha coefficient from 0.65 to 0.92). The test-retest reliability confirmed a highly significant stability between the total scores for each domain. Significant correlations of the P-QoL domains with the PFDI-20 and SF-36 scales (p < 0.05) were obtained, demonstrating satisfactory convergent validity. Discriminative construct validity was proved by the differences in the mean scores for P-QoL domains across POP-Q stages (p < 0.05): general health perceptions, role limitations, physical limitations, social limitations and severity measures were significantly higher for POP-Q stages 3 and 4 than for POP-Q stage 2 (p < 0.01); general health perceptions and severity measures were higher for POP-Q stage 4 than for POP-Q stage 3 (p < 0.05); sleep/energy was higher for POP-Q stage 3 than for POP-Q stage 2 (p < 0.05). Significant improvement of QoL in the 2 months after surgery (p < 0.05) indicated that the P-QoL questionnaire is sensitive to change.

CONCLUSIONS

The Russian version of the P-QoL questionnaire is characterized by appropriate psychometric properties. The P-QoL questionnaire is a useful tool for describing the QoL profile in women with POP before reconstructive surgery and evaluating treatment outcomes after the procedure.

Quality-of-life improvements in patients after various surgical treatments for pelvic organ prolapse

OBJECTIVE

To compare the improvements in quality of life of patients with pelvic organ prolapse (POP) treated using various surgical methods.

MATERIALS AND METHODS

The PUBMED, MEDLINE and Cochrane Library online databases were searched using the keywords "pelvic organ prolapse", "surgery", "PFDI-20" and "PFIQ-7" for articles published from January 2010 to December 2022 that included quality-of-life scores before and after surgery.

RESULTS

Forty-nine articles were include. The mean postoperative PFDI-20 and PFIQ-7 scores decreased by 67.50% and 76.98%, respectively, compared with those before surgery. In 76.9% of patients, this change did not decrease with increased postoperative time. The improvement rate in PFDI-20 scores after colpocleisis did not differ statistically from that after sacrocolpopexy and was significantly higher than that after other procedures. The improvement rate in PFIQ-7 scores after colpocleisis did not statistically differ from that after high uterosacral ligament suspension and was significantly higher than that after other procedures. The improvement rate in PFDI-20 scores after transvaginal mesh-based repair (TVM) did not significantly differ from that after sacrospinous ligament fixation and was significantly lower than that after other procedures except traditional vaginal wall repair. The improvement rate in PFIQ-7 scores after TVM did not significantly differ from that after new procedures and was significantly lower than that after other procedures.

CONCLUSIONS

Surgical treatment can significantly improve the quality of life of patients with POP. Colpocleisis may offer more advantages than those of other surgical procedures, and improvement was lower after TVM than after other procedures.

Effect of anterior repair on sexual function in heterosexual couples

INTRODUCTION AND HYPOTHESIS

Little is known about the impact of native tissue repair techniques on heterosexual intercourse. This study was aimed at investigating the effect of anterior colporrhaphy on women's and their partners' sexual function.

METHODS

Sexually active women with a male partner who were diagnosed with anterior wall prolapse without any incontinence were prospectively recruited from a single academic center. Demographic data were collected and a Pelvic Organ Prolapse Quantification examination was performed. Before and 3 months post-operatively, women completed two validated questionnaires to assess sexual function, the International Consultation on Incontinence Questionnaire Vaginal Symptoms short form (ICIQ-VS SF) 55, and the Female Sexual Function Index (FSFI), and their male partners completed the International Index of Erectile function-5. Pre- and post-operative results were compared using a paired t test.

RESULTS

This study was conducted in the gynecology department of a university hospital between May 2022 and June 2023, where 50 heterosexual couples were enrolled and underwent isolated anterior repair. The mean age of women and their partners were 44.3 ± 5.12 and 48.1 ± 5.81 respectively. Overall, female sexual function improved significantly from pre- to 3 months postoperatively with a decrease in ICIQ-VS SF scores from 13.3 ± 3.27 to 1.7 ± 1.1 (p < 0.05) and an increase in FSFI scores from 21.74 ± 9.37 to 29.28 ± 9.97 (p < 0.05). The only domain that did not improve was sexual pain. For their male partners, there was a similar significant improvement in sexual function with an increase in scores from 48.71 ± 8.71 to 60.68 ± 8.63 (p < 0.05).

CONCLUSIONS

Isolated anterior repair was associated with improved short-term sexual function amongst heterosexual couples.