Prolapse Quality Of Life Questionnaire Research Articles

Validation of the Lithuanian version of the Prolapse Quality-of-Life questionnaire.

We aimed to translate and validate the Lithuanian version of the Prolapse Quality-of-Life (P-QOL) questionnaire. The P-QOL questionnaire was translated into Lithuanian and administered to women recruited from a gynaecology outpatient clinic at a tertiary referral centre. The scores of the final version were compared in symptomatic (n = 137) and asymptomatic (n = 137) women and with findings on vaginal examination using the Pelvic Organ Prolapse Quantification system. The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis. There was a significant difference in median score for each P-QOL domain between symptomatic and asymptomatic women (p < 0.001). P-QOL scores correlated significantly with the stage of urogenital prolapse in most domains. High internal consistency was shown in all domains with a Cronbach's alpha range of0.775to0.958, except for the "social limitations" domain, which was shown to be acceptable (0.647). Test-retest reliability was also highin all domains (p < 0.05). The Lithuanian version of the P-QOL questionnaire has proven to be a valid, reliable and easily comprehensible instrument for assessing symptom severity and impact on the quality of life of Lithuanian-speaking women with urogenital prolapse.

Randomized Trial of Single-incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). The aim of this study was to compare single-incision midurethral sling (SIMS), and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. This is a prospective randomised study. A university tertiary hospital PATIENTS: Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. Patients were treated with SIMS and LBC operations. Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire (KHQ) form, Female Sexual Function Index (FSFI) and Prolapse Quality of Life Questionnaire (P-QoL) form, postoperative Day 1 Visual Analogue Scale (VAS) score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, while the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs. 85%, p=0.633) or subjective success (85% vs. 75%, p=0.695) between the two groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, while this improvement was significant in the SIMS group, it was not significant in the LBC group. Additionally, surgery time, catheterization time and hospitalization time were shorter in the SIMS group than in the LBC group. The VAS score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of peroperative and postoperative complications. This preliminary study is the first randomized study which compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

Validation of the Russian Version of the Prolapse Quality-of-life Questionnaire and its Application to Assess the Impact of Pelvic Organ Prolapse on Quality of Life and the Effect of Treatment in Women Undergoing Reconstructive Surgery.

The objective was to validate the translated Russian version of the prolapse quality-of-life (P-QoL) questionnaire and test its applicability to assess the impact of pelvic organ prolapse (POP) on QoL and the effect of treatment in women undergoing reconstructive surgery. Following a forward- and back-translation of the original English P-QOL questionnaire into Russian, the translated questionnaire was reviewed by a group of patients as well as an expert panel. Women with POP who were admitted to a university hospital for reconstructive surgery were recruited. All the women completed the P-QoL questionnaire, Pelvic Floor Distress Inventory (PFDI-20) and 36-Item Short Form Survey (SF-36) questionnaires before surgery. Clinical data and POP Quantification (POP-Q) Index according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed. A total of 303 women with POP were included in the study. Most patients presented with POP-Q >2. The P-QoL questionnaire demonstrated good psychometric properties. High internal consistency was shown in all domains (Cronbach's alpha coefficient from 0.65 to 0.92). The test-retest reliability confirmed a highly significant stability between the total scores for each domain. Significant correlations of the P-QoL domains with the PFDI-20 and SF-36 scales (p < 0.05) were obtained, demonstrating satisfactory convergent validity. Discriminative construct validity was proved by the differences in the mean scores for P-QoL domains across POP-Q stages (p < 0.05): general health perceptions, role limitations, physical limitations, social limitations and severity measures were significantly higher for POP-Q stages 3 and 4 than for POP-Q stage 2 (p < 0.01); general health perceptions and severity measures were higher for POP-Q stage 4 than for POP-Q stage 3 (p < 0.05); sleep/energy was higher for POP-Q stage 3 than for POP-Q stage 2 (p < 0.05). Significant improvement of QoL in the 2months after surgery (p < 0.05) indicated that the P-QoL questionnaire is sensitive to change. The Russian version of the P-QoL questionnaire is characterized by appropriate psychometric properties. The P-QoL questionnaire is a useful tool for describing the QoL profile in women with POP before reconstructive surgery and evaluating treatment outcomes after the procedure.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Prolapse Quality of Life Questionnaire in the United Arab Emirates.

Given the extensive translation of the Prolapse Quality of Life Questionnaire (P-QoL) into many languages, it is imperative to develop an Arabic version to facilitate the study of pelvic organ health within the Arabian culture. The aim of this study was to investigate, cross-culturally adapt, and validate the Arabic version of the P-QoL. This study involved cross-cultural adaptation and psychometric testing. A total of 90 participants were included in the study. This cross-sectional study was carried out in two phases; during phase I, the P-QoL was translated and adapted from English into Arabic. The Arabic version was psychometrically validated during phase II using the test-retest reliability and internal consistency with Cronbach's alpha coefficient, convergent construct (CC) validity among the four study tools using Spearman's coefficient (r), and discriminative validity using Mann-Whitney test to find the differences between the means of the two samples. A satisfactory level of semantic, conceptual, idiomatic, and content comparability was reached in the cross-cultural adaptation of the Arabic version of the P-QoL. The internal consistency was high in terms of psychometric validation, with a Cronbach's alpha coefficient of 0.971 for the P-QoL. The test-retest results showed high reliability, with the interclass correlation coefficient (ICC) of the P-QoL determined as 0.987. The convergent construct validity was highly acceptable (moderately strong), reflecting a positive correlation between the Arabic version of the P-QoL and the Australian Pelvic Floor Dysfunction Questionnaire (APFD) (r = 0.68; p < 0.001). Similarly, a significant convergent validity of the Arabic version of the P-QoL and the Visual Analogue Scale (VAS) (r = 0.47; p < 0.001) was observed, as well as a correlation between the APFD and the VAS (r = 0.46; p < 0.001). However, there was no significant correlation between the 12-Item Short-Form Survey (SF-12), the P-QoL, the APFD, and the VAS. Based on the significant correlation found between the Arabic APFD and the VAS, the results reveal good reliability, internal consistency, and construct validity. It is recommended that Arabic-speaking females with pelvic organ prolapse use the Arabic version of the P-QoL. More research is needed to assess the responsiveness of the P-QoL.

Patient-reported goal achievements after pelvic floor muscle training versus pessary in women with pelvic organ prolapse. A randomised controlled trial

The aim was to assess the achievement by self-determined goals in pelvic organ prolapse (POP) participants receiving pelvic floor muscle training (PFMT) compared to vaginal pessary. Forty participants with POP stage II to III were randomly allocated to pessary or PFMT. Participants were asked to list up 3 goals they expected from treatment. Thai version of Prolapse Quality of Life Questionnaire (P-QOL) and Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) were completed at 0 and 6-week period. At 6-week post-treatment, they were asked if their goals had been achieved. The totally achieved goals in the vaginal pessary group were 70% (14/20) significantly higher than PFMT group at 30% (6/20) (p = 0.01). The mean ± SD of the post-treatment P-QOL score in the vaginal pessary group was significantly lower than the PFMT group (13.90 ± 10.83 vs 22.04 ± 5.93, p = 0.01), but not different in all PISQ-IR subscales. Pessary treatment for POP yielded better total goal achievements and better quality of life than PFMT for POP treatment at a 6-week follow-up. Impact statement What is already known on this subject? Pelvic organ prolapse (POP) can severely affect the quality of life, causing physical, social, psychological, occupational, and/or sexual dysfunction. Individual patient goal setting and goal achievement scaling (GAS) offers a new method of patient-reported outcome measurement (PRO) in therapeutic success such as pessary or surgery in patient with POP. But there is no randomised controlled trial comparing pessary vs pelvic floor muscle training (PFMT) using GAS as the outcome measurement. What do the results of this study add? The results showed that women with POP stage II to III who received vaginal pessary had higher totally goal achievements and better quality of life than the women received the PFMT at 6-week follow up. What are the implications of these findings for clinical practice and/or further research? The information about the better goal achievements by using pessary can be used as the tools for counselling for patients with POP for selecting the choices for the treatment in the clinical setting.

Biopsychosocial profile of women with pelvic organ prolapse: A systematic review.

Female pelvic organ prolapse is a common condition associated with significant impact on women's lives from a biopsychosocial perspective. The aim of this systematic review is to identify, appraise and summarize the biopsychosocial profile of women with pelvic organ prolapse. Searches were completed from inception to October 2022 from PubMed, Web of Science, EMBASE, CINAHL, Cochrane, PsycINFO and PEDro using a search string and in line with the Preferred Reporting Information for Systematic reviews and Meta-Analyses protocol. English language studies (randomized controlled trials, cohort studies, case-control studies, qualitative research) investigating female pelvic organ prolapse and using a validated patient-reported outcome measure and validated pelvic organ prolapse objective measurement were examined. Two reviewers independently screened titles, abstracts and full articles for eligibility. Data extraction included participant characteristics, pelvic organ prolapse grading and outcome measures. Risk of bias was assessed using the appropriate Joanna Briggs Institute Tool. Baseline mean score for each questionnaire or questionnaire domain in each category was presented in tertiles (low, moderate and high impact) to allow simple classification of impact. Of 8341 articles identified, 18 were included (n = 2075 women, age range = 22-85 years, parity range = 0-10). One objective outcome measure graded pelvic organ prolapse: Pelvic Organ Prolapse Quantification measurement. Eleven validated patient-reported outcome measures were utilized; two pelvic organ prolapse-specific (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Pelvic Organ Prolapse Quality of Life Questionnaire), the remainder pelvic health (International Consultation on Incontinence Questionnaire-Vaginal Symptoms, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Pelvic Floor Distress Inventory-20, Incontinence Impact Questionnaire-7, Female Sexual Function Index, Urinary Distress Inventory-6, Kings Health Questionnaire, Pelvic Floor Impact Questionnaire-7) or general health questionnaires (Short Form-36). Patient-reported outcome measures included in the review reported moderate levels of pain with sexual intercourse and low levels of bodily pain. Pelvic organ prolapse had a low to moderate impact in sleep/energy and quality of life and sexual function domains. Its impact on physical symptoms and general health perception domains was low. Patient-reported outcome measures results for physical functioning varied from low to high impact. More impact was demonstrated when using pelvic organ prolapse-specific patient-reported outcome measures. There are opportunities for improvement in the use of patient-reported outcome measures in clinical research which would facilitate increased understanding of the biopsychosocial profile of women with pelvic organ prolapse.

Intermediate-term follow-up of laparoscopic pectopexy cases and their effects on sexual function and quality of life: a cross-sectional study.

ABSTRACTBACKGROUND:Apical prolapsus refers to downward displacement of the vaginal apex, uterus or cervix. Pelvic organ prolapse (POP) can significantly affect women’s daily activities and sexuality.OBJECTIVE:To investigate, at the mid-term follow-up after laparoscopic pectopexy surgery, whether this procedure improved the patients’ quality of life and sexual function.DESIGN AND SETTING:In this cross-sectional study, data on patients who underwent laparoscopic pectopexy in the Gazi Yasargil Education and Research Hospital were evaluated.METHODS:Thirty-five patients with symptomatic apical prolapse and POP quantification stage II and higher were included in this study. We used the Turkish version of the female sexual function index (FSFI) questionnaire to assess preoperative and postoperative sexual dysfunction, and the Turkish version of the Prolapse Quality of Life Questionnaire (P-QOL) to evaluate the severity of POP and its impact on quality of life.RESULTS:The mean age, parity and length of follow-up of the patients were 36.08 ± 9.04 years, 4.00 ± 1.86 and 28.88 ± 5.88 months, respectively. The most common complications were de novo rectocele in three patients (8.6%) and de novo cystocele in two patients (5.7%). All the FSFI and P-QOL scores were statistically significantly improved in the postoperative period (P < 0.001 for all scores of both FSFI and P-QOL).CONCLUSION:The quality of life and sexual function of the patients who underwent laparoscopic pectopexy were found to have become statistically improved at the midterm follow-up. Laparoscopic pectopexy was found to be a viable, effective and safe procedure.

Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study.

The objective was to investigate the rate of adherence to pessary treatment for pelvic organ prolapse (POP), to identify factors associated with long-term (longer than 1 year) use of vaginal pessaries in Brazilian women with POP and its impact on quality of life (QoL). A prospective observational study assessed 247 consecutive women candidates for a pessary to manage symptomatic POP. Patients were fitted with a ring pessary and follow-up visits were performed at 1, 6, and 12months. Pessary complications and reasons for discontinuation were recorded. Prolapse Quality of Life Questionnaire (P-QoL) was applied at baseline and after 1 year of treatment. We used a logistic regression model for the analyses, with p < 0.05 for significance. A total of 236 women were included in the study, of whom 110 (46.6%) maintained the pessary treatment for longer than 12months. The main reason for pessary discontinuation was the patient opting for surgery (50.8%). Vulvovaginitis was the main long-term complication (44.5%), followed by vaginal ulceration (16.4%) and urinary urgency (10%). No prior hysterectomy (OR = 2.26; 95% CI 1.19-4.31), vaginal estrogen use (OR = 1.94; 95% CI 1.06-3.52), and mean age (OR = 1.03; 95% CI 1.01-1.06) were variables associated with long-term use of vaginal pessary (p < 0.05 for all). Total P-QoL score significantly changed with pessary use (519.1 at baseline and 260 after 12-month treatment, p < 0.00). Our study suggests that no prior hysterectomy, the local estrogen therapy, and age might be factors associated with use of a ring vaginal pessary for longer than 1 year. Long-term pessary users had a significant improvement in their quality of life.

A blind spot: Manchester Fothergill operation for cervical elongation without uterine descensus

ObjectiveTo evaluate the anatomical results of Manchester Fothergill operation performed due to cervical elongation cases without uterine descensus and its effects on quality of life and sexual function. Materials and methodsThirty-six women who underwent Manchester Fothergill operation for cervical elongation without uterine descensus were analyzed retrospectively. Pre- and postoperative Pelvic Organ Prolapse-Quantification (POP-Q) measurements, Prolapse Quality of Life (P-QoL) Questionnaire and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores were collected. ResultsThere were significant improvements in POP-Q measurements, P-QoL Questionnaire and PISQ-12 scores postoperatively. There was no relationship between the change in POP-Q measurements and the changes in questionnaires scores. Reoperation was performed in only one patient due to anterior compartment prolapse. No serious complications were detected. ConclusionManchester Fothergill operation is an effective and safe surgical option in the surgical treatment of cervical elongation cases without uterine descensus. It provides anatomical improvement, increases the quality of life and improves sexual function in women.

Comparison of life quality between geriatric patients who underwent reconstructive surgery and obliterative surgery for pelvic organ prolapse.

Pelvic organ prolapse (POP) adversely affects women's quality of life. The aim of this study is to compare the life quality after obliterative surgery and reconstructive surgery for geriatric patients with advanced pelvic organ prolapse. This matched case control study included sexually inactive women aged 65 years or older who had vaginal surgery for pelvic organ prolapse in Tepecik Education and Research Hospiltal between August 2012 and June 2019. Life quality of women who had undergone obliterative or reconstructive vaginal surgery were evaluated and then compared by Turkish validated prolapse quality of life questionnaire (P-QOL). Patients in obliterative and recontructive surgical procedures were matched according to age, body mass index and POP stage and each group included 49 women. P-QOL scale domains, including prolapse impact (26.6 ± 12.1 vs 34.1 ± 16.2; p = 0.01), physical/social limitations (28.3 ± 12.8 vs 34.8 ± 14.4; p = 0.02) and severity measures (24.9 ± 12.6 vs 30.5 ± 13,4; p = 0.035) revealed significantly lower postoperative deterioration in the obliterative group. No significant difference was found in other P-QOL domains. The mean operation time in the obliterative group was shorter than the reconstructive group (respectively; 69.2 ± 21.5 min, 79.7 ± 29.4, p = 0.04). There were no significant differences in estimated blood loss, length of hospital stay and intraoperative complications. Obliterative surgery is a suitable option in the treatment of advanced pelvic organ prolapse in elderly patients.

Comparison of effectiveness between modified transvaginal mesh surgery and vaginal pessary treatment in patients with symptomatic pelvic organ prolapse

This study aimed to compare the efficacy of modified transvaginal mesh (TVM) surgery and vaginal pessary in patients with symptomatic pelvic organ prolapse (POP). We retrospectively analyzed 130 patients with symptomatic POP treated with either modified TVM (n=62) or vaginal pessary (n=68). To evaluate the prolapse, lower urinary tract, bowel, and sexual symptoms and prolapse-related quality of life (QOL) were assessed using the prolapse QOL questionnaire. All questionnaires were completed before treatment and 1 year after the treatment. One year after the treatment, the prolapse and voiding symptoms and all prolapse-related QOL domains, except for the personal relationships and sleep/energy, were significantly improved in the pessary group. The prolapse, urinary storage, voiding, bowel, and sexual symptoms and all QOL domains significantly improved in the modified-TVM group. Both the modified TVM surgery and vaginal pessary effectively treated prolapse and voiding symptoms and improved most of the prolapse-related QOL domains. Modified TVM surgery was more effective in improving urinary storage, bowel, and sexual symptoms than the pessary treatment. Modified TVM seemed to position the organs more correctly to improve bladder, bowel, and sexual function than pessary insertion.

Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

BackgroundLaparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.MethodsData from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used.ResultsThe median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery.ConclusionsIn advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial.

Purpose: Postoperative physiotherapy in conjunction with pelvic organ prolapse (POP) surgery is still under-investigated and controversial. In this randomized controlled trial, pelvic floor muscle training (PFMT) and abdominal training were compared with a control condition (standard in-hospital treatment). Method: Eighty-one women were randomized to one of three groups. The Prolapse Quality of Life questionnaire, two-dimensional ultrasound, Pelvic Organ Prolapse Quantification System scale, the PERFECT (power, endurance, repetitions, fast contractions, every contraction timed) scheme, electromyography, Sahrmann scale, and pressure biofeedback unit (PBU) were used to measure quality of life (QOL), POP, and pelvic floor and abdominal muscle function. A mixed-model analysis of variance and the Kruskal-Wallis test was used for analysis. Results: Beneficial effects (p<0.05) were found for the PFMT group - increased power, number of fast contractions, amount of movement, endurance, and Sahrmann and PBU measures - compared with the control group. Abdominal training led to a significant (p<0.05) increase in bulging and discomfort, number of pelvic floor muscle contractions, and Sahrmann and PBU measures compared with the control condition; both groups showed significantly increased urinary frequency (p<0.05). Conclusions: Postoperative physiotherapy did not have a beneficial effect on QOL or POP symptoms. PFMT and abdominal training had beneficial effects on pelvic floor muscle function and abdominal muscle measures. Additional abdominal training led to increased symptoms.

Le Fort colpocleisis: An evaluation of results and quality of life at intermediate-term follow-up

ObjectivesTo assess postoperative complications, intermediate-term anatomic and subjective success rates, and quality of life following obliterative Le Fort colpocleisis (LFC) for advanced pelvic organ prolapse (POP). Study DesignWe conducted a retrospective cohort study with 53 subjects who underwent LFC surgery between January 2012 and April 2019. Demographic and treatment data were retrieved from a hospital database. Data on postoperative anatomic results were gathered from individual examinations of study subjects. The Clavien-Dindo classification was used to evaluate the complications. The Prolapse-Quality of Life (P-QoL) questionnaire was administered in person or over the telephone before and after the operation. Low scores on the P-QoL reflect a high quality of life. ResultsThe mean age at operation was 73 ± 7.1 years. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12–82). Ninety-two percent of subjects had at least one comorbidity. When subjects were classified using the Pelvic Organ Prolapse (POP) Quantification System, seven (13.2 %) had Stage 3 POP and 46 (86.8 %) had Stage 4 POP. The overall rate of minor peri-operative complications rate was 11.3 % (six subjects). The objective success rate of LFC at intermediate-term follow-up was 98.1 %, and the subjective success rate was 96.2 %. The mean time between LFC and the postoperative questionnaire and interview was 30.8 ± 15.7 months (range: 12–82). There was a statistically significant decrease in the postoperative P-QoL score (p < 0.001). ConclusionsBased on positive intermediate-term anatomic and subjective outcomes, including a significant decrease in P-QoL questionnaire scores and a lack of regret, obliterative LFC should be considered a first-choice procedure for elderly and sexually inactive women with advanced POP.

Comparison of the Quality of Life and Female Sexual Function Following Laparoscopic Pectopexy and Laparoscopic Sacrohysteropexy in Apical Prolapse Patients.

Objectives:We sought to compare the surgical outcomes, safety, effectiveness, and mid-term outcomes in patients who had undergone laparoscopic hysterosacropexy and laparoscopic pectopexy due to apical prolapse.Materials and Methods:This prospective randomized study was conducted on a total of 62 women who underwent apical prolapse surgery (32 undergoing a pectopexy and 30 undergoing a sacrohysteropexy) between June 2015 and June 2017. Patients with symptomatic uterine or vaginal vault prolapse with stage 2 or worse were included in the sudy. Before and after the operation, we used the Pelvic Organ Prolapse Quantification System (POP-Q) and questionnaires, which are the Prolapse Quality of Life Questionnaire (P-QOL) and Female Sexual Function Index (FSFI), to evaluated cases. Baseline characteristics, perioperative and postoperative complications, and follow-up results at 12 months were also evaluated.Results:All domains of POP-Q, P-QOL, and FSFI scores improved significantly after surgery both in pectopexy and sacrohysteropexy group. The postoperative complications of both procedures were similar except for constipation after surgery (3.2% in the pectopexy group and 20% in the hysterosacropexy group [P = 0.036]).Conclusion:Both sacrohysteropexy and pectopexy are effective surgical options for apical prolapse patients. The pectopexy is an acceptable alternative to laparoscopic sacrohysteropexy because of its less complexity and not reducing pelvic space for the rectum to exist. We suggest that the laparoscopic pectopexy may be widely used in clinical routine.

Quality of Life in POP: Validity, Reliability and Responsiveness of the Prolapse Quality of Life Questionnaire (P-QoL) in Spanish Women.

The Prolapse Quality of Life Questionnaire (P-QoL) is a specific questionnaire created to assess the impact of pelvic organ prolapse on women’s quality of life. The aim of the present study was to cross-culturally adapt and assess the psychometric properties of the P-QoL for Spanish women. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Psychometric analysis was performed by assessing the validity, reliability, responsiveness and feasibility. A total of 200 Spanish women were recruited and assigned to symptomatic and asymptomatic groups. The Spanish P-QoL version demonstrated good content validity. Convergent validity showed high intercorrelations with the Pelvic Floor Distress Inventory short form and the Pelvic Floor Impact Questionnaire short form. The discriminant validity showed statistically significant differences between the symptomatic and the asymptomatic groups. The internal consistency was high and of acceptable values. The test-retest reliability was shown to be high in all the cases. Regarding responsiveness, the effect size and standardized response mean demonstrated moderate values. The average time for administration was 10 (3) min. The Spanish P-QoL showed considerable support for the appropriate metric properties of validity, reliability, responsiveness and feasibility to evaluate the symptom severity and its impact on the quality of life in Spanish women with urogenital prolapse.

Impact of an informational flipchart on lifestyle advice for Nepali women with a pelvic organ prolapse: a randomized controlled trial.

Pelvic floor muscle training (PFMT) and lifestyle advice are effective at improving the symptoms and severity of pelvic organ prolapse (POP) in a range of populations; however, the impact of these interventions in Nepali women is unknown. We aimed to evaluate the impact of an informational flipchart on PFMT and lifestyle advice on the quality of life (QOL)for Nepali women with a POP. This prospective randomized controlled trial recruited 140 women with a stage I-III POP from Kathmandu Valley. The intervention group were instructed on PFMT and lifestyle advice through an informational flipchart and the control group were provided usual care. The primary outcome measure was the Prolapse Quality of Life questionnaire (P-QOL) and was completed at baseline, 6 weeks, 12 weeks and 6 months. The secondary outcome measure was the Pelvic Organ Prolapse Quantification (POP-Q) system and Modified Oxford Scale (MOS) assessed by clinical examination at baseline and 6 months. Differences in mean P-QOL scores for each domain were evaluated using analysis of covariance. Compared with usual care, the women in the informational flipchart group experienced significant improvement in six of the nine P-QOL domains and for the prolapse, bladder and bowel symptoms. Only a small percentage (20%) of women were able to attend the 6-month clinical assessment so we were unable to assess the secondary outcomes. A one-time intervention of an informational flipchart on PFMT and lifestyle advice is effective at improving QOL and symptoms for Nepali women with a stage I-III POP.

How does laparascopic lateral suspension affect the quality of life (QOL) and sexual activity?

Background: The affect of Laparascopic Lateral Suspension on quality of life and sexual activity in POP patients. Objective: This study aimed to investigate the quality of life (QOL) and sexual activity after Laparascopic Lateral Suspension (LLS) for pelvic organ prolapse (POP) in Turkish women. The practical success rate and complications related surgery were also analyzed. Study design: Prolapse Quality of Life Questionnaire (P-QOL) was used for investigate QOL in study group. Female Sexual Function Index (FSFI) was wielded for evaluating sexual function. Both tests were asked before the surgery and 12 months later. The results were recorded and retrospectively analyzed. Results: 237 patients were included in this study. Every P-QOL parameter was markedly recovered postoperatively. The complications detected after the surgery were; side pain 13 (5.5%), POP recurrence 4 (1.6%),de novo stress urinary incontinence 2 (0.8%), mesh erosion 1 (0.4%), and de novo dyspareunia 1 (0.4%).Cause of haven’t got any partner, 124 of the 237 patients (52.3%) reject to finish the FSFI. The rest 113 patients fulfilled the FSFI before and 79 patients completed the FSFI after the surgery. While 13 (5.4%) were sexually active before the surgery, 18 (7.5%) were sexually active after the surgery. The significantly increased domain after surgery was sexual function score with arousal. Conclusion: In this study, low frequency of sexual intercourse was found in Turkish POP population before and also after the operation. However, LLS technic proved fine QOL resuts with a high success rate. Its complications rate is also low. LLS is safe and effective for both sexually active and inactive POP patients.

The use of one-piece U-shaped mesh and barbed sutures in laparoscopic sacrocolpopexy

IntroductionLaparoscopic Sacrocolpopexy (LS) is considered a safe and effective surgery for the treatment of Pelvic Organ Prolapse (POP), but it requires expertise in laparoscopic surgery. The complexity of the intervention is due to the requirements of intracorporeal sutures and the manipulation of the mesh inside the cavity, which may be cumbersome. The barbed sutures (BS) simplify intracorporeal suturing and do not require knotting. Additionally, one-piece U-mesh (OP-UM) may facilitate handling, stabilization and tension adjustment. We describe our LS surgical technique using both materials to assess its feasibility, safety and effectiveness in a prospective series of patients. Materials and methodsA total of 7 patients with symptomatic POP were included. Urogynecological history, classification of the POP according to Baden-Walker and the application of the Prolapse Quality of Life questionnaire were performed in all cases. The non-absorbable polypropylene OP-UM (Uplift™) was used. The posterior side of the single sling is sutured to the elevator anus muscles with two non-absorbable stitches. Two strands of BS (V-Loc™), tied at their ends, were used to attach the mesh to the vagina in two lines of continuous sutures in opposite directions. Self-anchoring tackers were used for promontofixation and BS for peritoneal closure. ResultsThe median age was 60 years, the median time of the anterior branch mesh BS fixation was 23 minutes (range 2130–2640 min), intraoperative bleeding was minimal, and the median hospital stay was 3 days. No intraoperative complications were recorded, and no mesh erosions or recurrences were observed at a median follow-up of 14 months (range 3–25 months). All patients presented clinical improvement of the prolapse and were satisfied with surgery. We observed that the OP-UM self-stabilizes when it extends longitudinally into the abdominal cavity, reducing the need of the surgical assistant. The independent promontofixation of each part of the mesh (posterior and anterior) allows a more anatomical tension adjustment. Fixing the mesh to the vagina is fast and simple with our BS technique. ConclusionsThe use of OP-UM and BS during LS is feasible, safe, effective and could simplify this surgical technique.

Empleo de malla en U de una pieza y sutura barbada durante la colposacropexia laparoscópica

IntroductionLaparoscopic sacrocolpopexy (LS) is considered a safe and effective surgery for the treatment of pelvic organ prolapse (POP), but it requires expertise in laparoscopic surgery. The complexity of the intervention is due to the requirements of intracorporeal sutures and the manipulation of the mesh inside the cavity, which may be cumbersome. The barbed sutures (BS) simplify intracorporeal suturing and do not require knotting. Additionally, one-piece U-mesh (OP-UM) may facilitate handling, stabilization and tension adjustment. We describe our LS surgical technique using both materials to assess its feasibility, safety and effectiveness in a prospective series of patients. Materials and methodsA total of 7 patients with symptomatic pelvic organ prolapse were included. Urogynecological history, classification of the pelvic organ prolapse according to Baden-Walker and the application of the Prolapse Quality of Life questionnaire were performed in all cases. The non-absorbable polypropylene OP-UM (Uplift ™) was used. The posterior side of the single sling is sutured to the elevator anus muscles with two non-absorbable stitches. Two strands of BS (V-Loc™), tied at their ends, were used to attach the mesh to the vagina in two lines of continuous sutures in opposite directions. Self-anchoring tackers were used for promontofixation and BS for peritoneal closure. ResultsThe median age was 60 years, the median time of the anterior branch mesh BS fixation was 23minutes (range 21,30 - 26,40min), intraoperative bleeding was minimal, and the median hospital stay was 3 days. No intraoperative complications were recorded, and no mesh erosions or recurrences were observed at a median follow-up of 14 months (range 3-25 months). All patients presented clinical improvement of the prolapse and were satisfied with surgery. We observed that the OP-UM self-stabilizes when it extends longitudinally into the abdominal cavity, reducing the need of the surgical assistant. The independent promontofixation of each part of the mesh (posterior and anterior) allows a more anatomical tension adjustment. Fixing the mesh to the vagina is fast and simple with our BS technique. ConclusionsThe use of OP-UM and BS during LS is feasible, safe, effective and could simplify this surgical technique.