Preoperative quality of life questionnaires are an adequate tool to select women with genital prolapse for laparoscopic sacrocolpopexy.

Abstract

No clear consensus exists on the selection of patients with pelvic organ prolapse (POP) for surgery. There is a need to preoperatively identify candidates who will benefit from surgery as there is no strict correlation between POP anatomical abnormalities and changes in symptoms and quality of life (QOL) after surgical treatment. Therefore, our objectives were to evaluate the changes in QOL after laparoscopic sacrocolpopexy (LSC) for POP using validated questionnaires and to assess their relevance in selecting women for surgery. This was a prospective study of 48 women with advanced stages of POP treated by LSC from March 2005 to January 2015. We developed a recursive partitioning model from QOL PFDI-20 and PFIQ-7 questionnaire scores to determine a preoperative cut-off score for predicting improvement after surgery. The model was then validated in 84 consecutive women. Optimal anatomical results were obtained in 129 of the 132 women (97.7%). Both questionnaires revealed a significant improvement after LSC (p<0.01). The probability of improvement after surgery was 0% in women with a preoperative PFIQ-7 score of <45.25, and 84% in women with a PFIQ-7 score of ≥45.25. The probability of improvement after surgery was 0% in women with a preoperative PFDI-20 score of <52.15, 88.2% in those with a PFDI-20 score of ≥98.45, and 42.9% in those with a PFDI-20 score between 52.15 and 98.45. In the validation set, the discriminatory accuracies of the model were 0.96 (95% CI 0.925-0.998) and 0.75 (95% CI 0.64-0.85) for the PFIQ-7 and PFDI-20 questionnaires, respectively. The performance was accurate with a significant difference between observed outcome frequencies and predicted probabilities (p=1). Our results support the use QOL questionnaires to select women for LSC.