WHAT ARE PATIENT GOALS AFTER ANANTERIOR COLPORRHAPHY OPERATION?
K. GLAVIND, J. BJOERK, S.KOUSGAARD;
Gyn. Obst. dept., Aalborg Univ. Hosp., Aalborg,Denmark.
Introduction: The most commonsurgical technique for anterior vaginal wall prolapse is anteriorcolporrhaphy. Evaluation of treatment success after anteriorcolporrhaphy operation is traditionally based on a clinicalgynaecological examination using Pelvic Organ Prolapse Quantification(POP-Q). Satisfaction with the operation however can be related toelements, which cannot be evaluated by an objective examination. Inrecent years, more focus has been on finding evaluation tools basedon the subjective evaluation of the treatment by the patient orPatient Reported Outcome Measures (PROM). Based on PROM, treatmentsatisfaction could be measured on the achievement of personal goals.
Objective: The primary aim of this study was toinvestigate individual self-reported patient goals before surgery andto find out to what extent these goals were met after surgery in agroup of women operated with an anterior colporrhaphyoperation.
Methods: This prospective study involved 103women who underwent anterior colporrhaphy solely for a centralcystocele between June 2015 and July 2016. No exclusion criteriaexisted. Patients underwent a standard anterior colporrhaphy withmidline plication of the anterior fascia using slowly absorbablesutures. All operations were performed in local anaesthesia withsedation. Preoperatively the women completed three questions from theInternational Consultation on Incontinence Questionnaire - VaginalSymptoms (ICIQ-VS) (maximum score 17 for worst symptoms) and theInternational Consultation on Incontinence Questionnaire-UrinaryIncontinence Short Form (ICIQ-UI SF) (maximum score 21 for worstincontinence) .The patients were asked to write down in their ownwords three goals, that they wanted to achieve from the operation. Aspecified incontinence and prolapse nurse performed a telephoneinterview 3 months after the operation. The patients once againcompleted ICIQ-VS and ICIQ-UI SF and were asked on a Visual AnalogueScale (VAS) from one to ten to what extend the different goals wereachieved. The patients’ goals were divided into 8 categories: 1:mechanical symptoms (bulging), 2: voiding symptoms, 3: quality oflife (physical), 4: quality of life (emotional), 5: urinary tractinfection, 6: incontinence, 7: sexual function and 8: others. Pairedt-test was used to compare ICIQ-VS and ICIQ-UI SF before and aftersurgery. Statistical significance was reached when the p value wasless than 0.05.
Results: A total of 276 goals were stated,63.4% of the goals were fulfilled with VAS 10. Mean VAS for all goalswas 8.6 (SD 2.5). Forty patients (40%) fulfilled all their goals. Themajority of the goals (27% of all goals) were in group 1 concerningsymptoms of bulging and group 1 also had most goals fulfilled withVAS of 10 (76%). Group 6 (10% of all goals) concerning incontinencehad fewest goals fulfilled with VAS of 10 (31 %). Mean ICIQ-VSpreoperatively was 13.6 and postoperatively 1.7 (p<0.001). Dataconcerning incontinence showed that ICIQ-UI SF pre-operatively wasmean 5.7 and post-operatively mean 3.1 (p<0.001) showing anoverall improvement in incontinence.
Conclusions: Thisstudy showed that women had an overall high achievement of personalgoals after an anterior colporrhaphy operation. Most patients hadgoals relating to the mechanical symptoms of bulging and these goalswere fulfilled completely in 76% of the goals. The patient and thephysician should discuss expectations preoperatively.