K Kenton, T Pham, L Brubaker

Loyola University Medical Center, Maywood, IL

Introduction: Patient satisfaction after reconstructive pelvic surgery (RPS) is associated with achievement of self-described surgical goals; however, 1-year after surgery, dissatisfaction is associated with overactive bladder symptoms regardless of goal achievement.

Objective: To determine rates of new pelvic symptoms after RPS and how new pelvic symptoms impact surgical outcomes.

Methods: After IRB approval, consecutive women scheduling RPS for symptomatic prolapse (POP) and/or incontinence were invited to participate. Women underwent standardized preoperative assessment, including urodynamics and pelvic organ prolapse quantification (POPQ). All women also completed the short form of the Pelvic Floor Distress Inventory, including urinary (UDI) and prolapse (POPDI) subscales. Women underwent standardized follow up 3 months after RPS:

* Pelvic organ prolapse quantification (POPQ)

* Cystometrogram (CMG)

* Questionnaire eliciting overall satisfaction and new pelvic symptoms

* PFDI

* Patient Global Impression of Improvement (PGI)

We defined objective cure conservatively: POP cure=stage 0 or I support; Urodynamic Stress Incontinence (USI) cure=no leakage on CMG. An answer of “very much better” or “much better” on the PGI was considered “improved”. An answer of “completely satisfied” on a 5 point Likert scale (“completely satisfied” to “completely dissatisfied”) was considered “satisfied”. Chi² test of association was used to compare nominal data, and Mann Whitney test was used to compare independent groups and continuous variables.

Results: Seventy nine women had RPS during the study period. Baseline mean+SD UDI and POPDI scores were 44+31 and 36+24. Half of participants (54%) had combined POP/USI procedures; 34% only USI; 12% only POP. Three months after surgery, nearly half (42%) of women reported new pelvic symptoms. New incontinence symptoms were most common (27%), followed by urinary urgency (25%) and frequency (23%), difficulty with defecation (22%), voiding difficulty (10%) and POP (2%). Baseline UDI and POPDI scores were not significantly different amongst women with and without new pelvic symptoms (p=.12 and p=.51) nor was type of surgery (p=.11). Women with new symptoms had lower postoperative mean UDI scores (23±21 vs 6±11, p<.0005) and POPDI scores (11±12 vs 4±9, p=.02) than those without new symptoms. Objective cure rates were 71% for USI, and 64% for POP. Neither objective cure of POP (p=.306) or USI (p=.07) was associated with new pelvic symptoms. Only 58% of women with new symptoms were improved on PGI compared to 83% without new symptoms (p=.014). Likewise, 33% with new symptoms were completely satisfied compared to 83% without new symptoms (p<.0005). In multivariate analysis, satisfaction was significantly associated with new pelvic symptoms (p=.008), but not postoperative UDI or POPDI scores (p=.07 and p=.09).

Conclusion: Women undergoing RPS report high rates of new pelvic symptoms after surgery. Not surprisingly, new pelvic symptoms are associated with decreased self-reported improvement and satisfaction despite objective cure and improvement on validated quality of life (QOL) measures. Given this strong association between decreased satisfaction, new pelvic symptoms, and QOL, further investigation is necessary to determine optimal methods for assessing surgical success.

UroToday.com Coverage of SUFU 2007

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