PELVIC FLOOR MUSCLE FUNCTION BEFOREAND AFTER PELVIC ORGAN PROLAPSE SURGERY: A CROSS-SECTIONAL STUDY
M. F. BONACIN 1, L.BRITO2, T. B. DUARTE 1, E. A. THOMAS 3,P. L. DWYER 4, C. H. FERREIRA 5;
1Rehabilitation and Functional Development, RibeiraoPreto Med. Sch., Univ. of Sao Paulo, Ribeirao Preto, Brazil,2Gynecology and Obstetrics, Univ. of Campinas, Campinas,Brazil, 3Urogynaecology, Mercy Hosp. for Women, Melbourne,Australia, 4Mercy Hopsital for Women, Melbourne,Australia, 5Univ. of Sào Paulo, Ribeirào Preto, Brazil.
Introduction: Several studieshave assessed the impact of different surgical techniques for POPcorrection regarding a number of variables, but few of them evaluatedthe PFM strength and its possible association with other objectiveand subjective variables. We hipothetized that POP could represent anoverload to the PFM; that said, once the genital prolapse is repairedthe maximal voluntary contraction capacity would improve.
Objective:To assess pelvic floor muscle (PFM) maximum voluntary contraction(MVC) before and after surgical treatment for pelvic organ prolapse(POP). Secondary aims were to assess POP stage, symptoms before andafter surgical treatment and patient´s perception ofimprovement.
Methods: This is a prospective observationalstudy with women submitted to surgical correction of POP. Assessmentsoccurred 15 days before and 40 days after surgery. The primaryoutcome was measured using the perineometer PeritronTM. Toassess the secondary endpoints the following measurements were used:the Pelvic Organ Prolapse Quantification (POP-Q) score, the PelvicFloor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire(PFIQ-7) and the Patient Global Impression of Improvement (PGI-I)questionnaires. Data were tabulated into Microsoft Excel and analyzedin Intercooled Stata 13.0.
Results: There were included 67women, 65 completed the study. Mean age of participants was 62.08 (±10.27). There was no statistical difference (-1.97±12.93; p=.22)between peak MVC before (27.10±17.00) and after surgery(29.07±17.87). The average contraction was higher after surgery.There was improvement in PFM function after surgery, the mean of MVCwas -2.356 cm H2O (± 8.6797; p = .03). There was a significantdifference in the total score of PFDI-20 36.901 (± 27.05; p <.05), and PFIQ-7 36.901 (± 27.05; p<.05) after surgery and therewas a correlation between the severity of POP and the mean MVC 27,34cm H2O (±15.81; p =.042). Most women (86.15%) reported much betterafter surgery.
Conclusions: There was improvement in PFMfunction after surgery, POP symptoms, quality of life and perceptionof improvement.
References: 1 - BJOG.2009;116(13):1706-14.2 -Am J Obstet Gynecol. 2010;203(2):170.e1-7.3 -Int Urogynecol J. 2010;21(3):311-9.