This study was a retrospective cohort study of women undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair was performed. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient’s PFDI and PFIQ-7 post-operative score by 70%.
Total of 205 patients from November 2010 to June 2015 were included in this review with a mean follow-up time of 23 months. Complete pre- and post-operative survey data were available in 180 patients. Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p=0.011) and a higher pre-operative AUA Quality of Life score (OR 1.42, p=0.46) were associated with clinical improvement. Within the PFQI, 35.6% of patients saw clinical improvement within the bowel category, compared to the bladder category (54.1%, p<0.001) and the pelvis category (45.6%, p=0.053). Similarly, within the PFDI, 45.5% of patients saw clinical improvement within the CRADI-8, compared to the UDI-6 (56.7%, p=0.035) and the POPDI-6 (62.6%, p<0.001). Of the patients who had a concomitant rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score and 51% saw clinical improvement in the bowel portion of the PDFI.
This study was considered the largest series to analyze pre- and post-operative PFIQ and PFDI scores per authors. Most patients undergoing RALS saw clinical improvement based on the PFDI and PFIQ following RALS. However, there were significantly fewer patients reached the clinical improvement definition within the portions of the surveys that focus on bowel symptoms and functions compared to the portions of the surveys that ask about symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement their bowel symptoms. This information might helpful when counseling patients pre-operatively regarding expectations of improving pre-existing bowel symptoms after RALS
Presented by: Annah Vollstedt, MD1
Co-Authors: Paholo Barboglio MD, MPH², William Meeks MS³ and Veronica Triaca MD⁴,⁵
1. Dartmouth-Hitchcock Medical Center
2. University of Michigan, Ann Arbor, MI
3. Department of Data Management & Statistical Analysis, American Urological Association, Linthicum, MD
4. Concord Hospital Center for Urologic Care, Concord, NH
5. Clinical Associate Professor of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas