Patient goal attainment in vaginal prolapse repair with and without mesh

Abstract

The objective of this study was to describe patient-centered goals and their attainment in vaginal prolapse repair, with and without mesh. A secondary analysis of a multicenter randomized controlled trial of prolapse repair with or without vaginal mesh was performed. Participants (n = 65) selected three preoperative goals ranked by importance. At 3 and 12 months postoperatively, patients graded their goal attainment on a scale of 1 (not at all) to 5 (100 % attainment). Goal attainment was compared with anatomical outcome, symptoms, quality of life, and satisfaction scores. Nonparametric tests and the log-rank test were used to determine statistical significance (p < 0.05). A total of 176 goals were selected. The first goal in 37 women (57 %) was improving prolapse symptoms, in 15 (23 %) urinary symptoms, in 7 (11 %) appearance, activity, and self-image, in 2 (3.1 %) bowel symptoms, and in 2 (3.1 %) sexual function. At 3 and 12 months postoperatively, goal achievement for prolapse symptoms was 96.1 and 93.6 %, for urinary symptoms 75.6 and 70.0 %, and for appearance, activity, and self-image 90.5 and 94.7 %, respectively. The effect of anatomical outcome, mesh use, or the presence of mesh erosion on goal attainment could not be demonstrated. Women who achieved their first goal had significantly better symptoms, quality of life, and satisfaction scores than women who did not. Patient goal attainment after vaginal prolapse repair was high and not consistently related to objective anatomical outcome or mesh use. It persisted between 3 and 12 months postoperatively and was associated with better satisfaction, quality of life, and symptom scores.