Patient and surgeon goal achievement 10 years following surgery for pelvic organ prolapse and urinary incontinence.

Abstract

Assessment of outcomes after pelvic floor surgery remains controversial. The primary aim of our study was to compare patient goal achievement in prolapse/continence surgery with objective/subjective outcomes. The secondary aim was to compare patient goal achievement with overall satisfaction and with that of the surgeon. This was a prospective longitudinal observational study, over 10 years, in a tertiary urogynaecology centre. Women with prolapse/stress incontinence undergoing surgery and surgeons listed five goals they hoped to achieve following surgery. The Pelvic Organ Prolapse Quantification System (POP-Q) and videocystourethrography (VCU) were used for objective assessment. Quality of life (QoL) was assessed using the Prolapse QoL (PQoL) questionnaire, the King's Health Questionnaire (KHQ) and Golombok Rust Inventory of Sexual Satisfaction (GRISS) and satisfaction with Patient Global Impression of Improvement (PGII). Complete data were available for 96 women (47.76%). POP-Q scores significantly improved (p < 0.05); objective cure of incontinence (VCU) was 84.7%. QoL questionnaires and PGII scores showed significant improvement (p < 0.01). Mean goal achievement was 83.2.1% for patients and 82% for surgeons. Patient goal achievement for prolapse surgery was observed sooner and correlated better with other measures of success than continence surgery. Continence-related goals based on symptom relief were achieved more frequently than those on body image and sexuality. Surgeons reported a high achievement rate in anatomical restoration and functional improvement goals. Patient goal achievement correlates significantly with other measures of "success" as well as with overall satisfaction. Surgeons and patients have varying expectations of the outcome of surgery. Nearly 83% of goals are still maintained 10 years following surgery.