Pelvic organ support, symptoms and quality of life during pregnancy: a prospective study

Introduction and hypothesis

Prevalence studies show an increase in lower urinary tract and pelvic floor symptoms during pregnancy. The aim of our prospective study was to evaluate changes in pelvic organ support, pelvic floor symptoms and their effect on quality of life (QOL) during the first pregnancy using validated measures. We hypothesised that pregnancy is associated with worsening of pelvic floor function.

Methods

Objective assessment of pelvic organ support using the Pelvic Organ Prolapse Quantification (POP-Q) system and subjective evaluation of symptoms of pelvic floor disorders and related QOL with the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) were performed in the second trimester and then repeated at 36 weeks gestation.

Results

A total of 182 nulliparae attended the first visit at 20 weeks and 150 (82.4 %) women returned for follow-up at 36 weeks gestation. There were no significant changes in POP-Q points or stage between the two visits except for a significant increase in genital hiatus (p?=?0.0001) and perineal body length (p?=?0.0001). The vaginal symptoms did not show any changes. Symptoms and bother with voiding difficulties and stress urinary incontinence increased during pregnancy. Constipation (p?=?0.02) and evacuation subdomains improved significantly (p?=?0.009). In the sexual domain, the only subdomain that worsened significantly (p?=?0.03) was “sex and vaginal symptoms”. None of the pelvic floor symptoms impacted the QOL.

Conclusions

In our group of nulliparae, pelvic floor-related QOL and prolapse stage did not change significantly from the second to the third trimester of pregnancy.     

Pessary treatment for pelvic organ prolapse and health-related quality of life: a review

Pessaries have been used to treat women with pelvic organ prolapse (POP) since the beginning of recorded history. This review aims to assess the effect of pessary treatment on the disease-specific, health-related quality of life in women with pelvic organ prolapse. After a Medline search using the Mesh term ‘pessary’ and critical appraisal, 41 articles were selected and used in this review. Pessaries are widely used to treat pelvic organ prolapse. It is minimally invasive and appears to be safe. Although there is evidence that the use of pessaries in the treatment of pelvic organ prolapse is effective in alleviating symptoms and that patient satisfaction is high, the follow-up in many published papers is short, and the use of validated urogynaecological questionnaires is limited. Comparison with surgical treatment of pelvic organ prolapse is rare and not assessed in a randomised controlled trial.     

Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis

Introduction and hypothesis

One of the main outcomes in the assessment of the treatment of pelvic organ prolapse in women is quality of life. Using quality of life as an outcome measure is increasing in the majority of clinical trials. The aim of current study was to determine the effects of the treatment of pelvic organ prolapse on patients’ quality of life using systematic review and meta-analysis.

Methods

A systematic search for finding randomized controlled studies on pelvic organ prolapse published before October 2012 was conducted. The JAMA users’ guide to the medical literature quality assessment scales for randomized clinical trials was used to assess the quality of included articles. The mean difference in total quality of life score between before and after intervention (surgical or pelvic floor training) with 95 % confidence interval (CI) was considered as a primary summary measure. Egger’s test was used to evaluate the publication bias. Heterogeneity was assessed using I² Index.

Results

Fifty-seven RCT were critically appraised. Thirty-two articles were eligible after critical evaluation. Mean difference in change in the total quality of life score with 95 % CI for surgical treatment was 74.03 (66.3–81.6) by PFDI-20 and was 44.57 (22.53–66.65) by PFIQ-7. The mean difference in changed in the total quality of life score with 95 % CI was 1.32 (?2.8–5.4) for pelvic floor training (PFT).

Conclusion

We found that surgical interventions on prolapse can improve the quality of life of women. There was a relative effect of PFT on the quality of life of women with prolapse in systematic review. This effect was not seen in meta-analysis, probably because of finding few eligible studies to pool the effect size.     

The impact of childbirth on pelvic floor morphology in primiparous Black South African women: a prospective longitudinal observational study

Introduction and hypothesis

There is a lack of prospective studies evaluating the impact of childbirth on the pelvic floor in non-white populations. We intended to study delivery-related changes in pelvic floor morphology in Black South African primiparae. We also intended to determine the impact of anatomical changes on symptoms in the postpartum period.

Methods

A total of 153 nulliparous women between 35 and 39 weeks gestation were recruited from a district antenatal clinic. All women had a standardized interview, completed the International Consultation on Incontinence Vaginal Symptoms questionnaire followed by three/four dimensional transperineal ultrasonography. This was repeated at 3–6 months postpartum.

Results

Of the 153 women, 84 (54.9%) returned at a mean of 4.8 months postpartum. Of these women, 60 (71.4%) had a vaginal delivery and the remainder a caesarean section (20 emergency and 4 elective). Overall, there were statistically significant increases in bladder neck descent (P?=?0.003), pelvic organ descent and levator hiatal distensibility (all P?<?0001) at the postpartum assessment. Levator avulsion was diagnosed in nine (15%) of those delivered vaginally. Postpartum vaginal laxity was the commonest bothersome vaginal symptom, reported by 51 women (60.7%).

Conclusions

There is significant alteration in pelvic organ support and levator hiatal distensibility postpartum, with more marked effects in women after vaginal delivery. Of Black primiparous women, 15% sustained levator trauma after their first vaginal delivery.

     

Impact on quality of life after ring pessary use for pelvic organ prolapse

Introduction and hypothesis

The purpose of this study was to evaluate symptoms associated with pelvic organ prolapse (POP) and quality of life (QOL) improvement in patients who continue ring pessary use at 1?year.

Methods

Seventy-seven symptomatic POP patients had successful fitting, and 64 patients (83.1%) continued use at 1?year. The Thai version of Prolapse Quality of Life (P-QOL) questionnaire was used to evaluate symptoms associated with POP and impact on QOL. A higher score represents a greater impairment on the QOL, whereas a lower score represents a better QOL.

Results

Mean age was 66.7?±?8.6?years, median parity was 4 (range 0–10), 59 patients (92.2%) were menopausal, and none had received hormone treatment. Only nine patients (14.1%) were sexually active. Most patients were in the advanced stage of POP—32.8% stage 3 and 29.7% stage 4. Improvement of prolapse symptoms and voiding difficulty were reported in 100% and 85.7% of the patients, respectively. Among patients who had lower urinary tract symptoms at pre-treatment, about half of patients improvement in frequency, urgency, and urgency urinary incontinence. Only 9.1% of the patients had improvement in stress urinary incontinence (SUI), and 23.8% of the patients reported new onset of SUI (de novo SUI). The median score from all P-QOL domains except personal relationships were significantly decreased after 1?year of ring pessary use. The median total scores at baseline and at 1?year were 40 and 8, respectively (P?Conclusions Ring pessary is an effective non-surgical treatment to alleviate symptoms associated with POP. It can improve QOL in symptomatic POP patients.     

Effect of Colpexin Sphere on pelvic floor muscle strength and quality of life in women with pelvic organ prolapse stage I/II: a randomized controlled trial

Introduction and hypothesis  

Colpexin Sphere was effective for advanced pelvic organ prolapse. The aim of this study was to assess the effect of Colpexin Sphere in women with pelvic organ prolapse (POP) stage I or II on pelvic floor muscle strength, quality of life, and POP stage.     

Health-related quality of life after pancreatic islet transplantation: a longitudinal study

BACKGROUND: Pancreatic islet transplantation (PIT) has proven effective in achieving insulin independence, but to date, the impact of PIT on health-related quality of life (HRQL) has not been studied. METHODS: Ten patients who have undergone PIT at our institution were administered three HRQL questionnaires: the Hypoglycemia Fear Survey, the 36-Item Short Form Health Survey (SF-36), and a fatigue questionnaire. HRQL was assessed before PIT, then 3, 6, and 12 months after PIT. Responses were compared by analysis of variance and paired Student's t tests. RESULTS: Hypoglycemia Fear Survey responses demonstrated that hypoglycemia-related anxiety and hypoglycemia-related behavior modification occurred less frequently after PIT (P=0.003 and 0.0001, respectively). The total scores of the hypoglycemia questionnaire were also significantly improved after PIT, from a median score of 156 points before transplantation to 55 points 3 months after PIT (P=0.004), 38 points 6 months after PIT (P=0.001), and 69 points 12 months after PIT (P=0.04). The median scores of all SF-36 components also improved after PIT. No significant changes were seen in the fatigue symptoms as assessed by the fatigue questionnaire. CONCLUSION: PIT recipients have less anxiety about the symptoms and consequences of hypoglycemia. PIT recipients also indicate that their behavior requires significantly less modification to prevent or treat hypoglycemia after PIT compared with before PIT. Further investigation is needed to determine whether PIT improves generic measures of HRQL.     

Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study

This study was conducted to evaluate the effects of pregnancy and childbirth on postpartum sexual function. Nulliparous, English-literate women were enrolled who had presented to the UNC Hospitals obstetrical practice; these women were 18 years of age and older and at 30–40 weeks gestation. Questionnaires were completed regarding sexual function prior to pregnancy, at enrollment, and at 2, 6, 12, and 24 weeks postpartum. Demographic and delivery data were abstracted from the departmental perinatal database. One hundred and fifty women were enrolled. At 6, 12, and 24 weeks postpartum, 57, 82, and 90% of the women had resumed intercourse. At similar postpartum timepoints, approximately 30 and 17% of women reported dyspareunia; less than 5% described the pain as major. At these times, 39, 60, and 61% of women reported orgasm. Orgasmic function was described as similar to that prior to pregnancy or improved by 71, 77, and 83%. Delivery mode and episiotomy were not associated with intercourse resumption or anorgasmia; dyspareunia was only associated with breast-feeding at 12 weeks (RR=3.36, 95% CI=1.77–6.37). Most women resumed painless intercourse by 6 weeks and experienced orgasm by 12 weeks postpartum. Function was described as similar to or improved over that prior to pregnancy.     

Changes in coping strategies, social support, optimism and health-related quality of life following traumatic brain injury: a longitudinal study

PRIMARY OBJECTIVE: To study longitudinal changes in psychological coping strategies, social support, life orientation and health-related quality of life in the late period after traumatic brain injury (TBI). SUBJECTS: Thirty-one patients with TBI who were first investigated on average 2.3 years after injury and were prospectively followed on average 5.7 years later. METHODS: Estonian versions of the COPE-D Test, the Brief Social Support Questionnaire, the Life Orientation Test and the RAND-36 questionnaire. RESULTS: During the late follow-up period health-related quality of life and resuming work did not improve significantly. Persons with TBI reported an increase in seeking social/emotional support (p<0.05), frequent use of avoidance-oriented styles and reduced use of task-oriented styles. This was accompanied by low social support and low satisfaction with support, both of which were associated with health-related quality of life and resuming work after TBI. Although the patients had become more optimistic (p<0.05), this did not correlate with their health status and social well-being. CONCLUSIONS: This prospective study revealed maladaptive changes in the profile of coping strategies and an increase in optimism. As social support, satisfaction with support and health-related quality of life did not improve, then rehabilitation, social and psychological support are continuously needed.     

Is there a difference in patient and physician quality of life evaluation in pelvic organ prolapse?

Quality of life (QoL) assessment is important in the evaluation of women with urogenital prolapse. The aim of this study was to investigate the relationship between physician and patient-assessed QoL using the Prolapse Quality of Life questionnaire (PQoL). Patients with symptomatic prolapse were recruited and asked to complete a PQoL. A second PQoL was filled in by the physician blinded to the patient responses, on the basis of a detailed urogynaecological history. These data were analysed by an independent statistician assessing concordance between patient and physician assessment (weighted kappa analysis: individual questions, Wilcoxon’s signed rank test: QoL scores). Weighted kappa showed poor concordance between the patient and physician responses; mean Kappa: 0.46, range 0.020–0.83. The physician underestimated QoL score in five out of nine domains (mean 8.8%) and overestimated QoL score in four out of nine domains (mean 4.3%). This study confirms that QoL outcomes based on the physicians’ perspective may not be valid.     

Comparison of two trocar-guided trans-vaginal mesh systems for repair of pelvic organ prolapse: a retrospective cohort study

Introduction and hypothesis

The aim of this study was to compare failure and complication rates in patients who underwent a trocar-guided vaginal mesh repair with either a non-absorbable or a partially absorbable mesh.

Methods

Retrospective analysis of prospectively collected data from consecutive women undergoing either non-absorbable or partially absorbable mesh for symptomatic stage 2 prolapse or higher were evaluated at 12 months. Outcome measures included objective and subjective failure rates, patient’s satisfaction, complications and perioperative outcomes.

Results

Five hundred and sixty-nine women (347 with non-absorbable mesh, 222 with partially absorbable mesh) were included. Failure rates were similar in the two groups; the re-operation rate in the untreated compartments was higher in the non-absorbable mesh group compared with the partially absorbable mesh group (5 % vs 1 %). Mesh exposure rate in the non-absorbable mesh group was 12 % and in the partially absorbable mesh group it was 5 %. Other complication and patient satisfaction rates were similar.

Conclusions

Non-absorbable and partially absorbable mesh demonstrated similar outcome rates at 12 months. The risk of reoperation was lower for partially absorbable mesh. The mesh exposure rate was significantly lower for the partially absorbable mesh group compared with the non-absorbable mesh group.     

Weight loss and quality of life after bariatric surgery: a 2-year longitudinal study

BackgroundBariatric surgery is currently recognized as being an effective technique for weight loss and the improvement of patients’ postoperative well-being.ObjectivesThe objective of the study was to measure changes in quality of life (QoL) and body mass index (BMI) according to patients’ sex and 2 types of surgical procedures.SettingLongitudinal cohort study using an online platform from a private hospital in West France.MethodsTwo hundred six patients (38 men and 168 women) undergoing one-anastomosis gastric bypass or sleeve gastrectomy surgery provided online information concerning their QoL and weight both before the operation and then every 3 months over a postoperative period of 24 months.ResultsBMI clinically decreased on average by 19.6% in the first 3 months and up to 39.2% 24 months after surgery. Slight differences between men and women appeared as from 18 months after the operation, with men experiencing increased BMI between 18 and 24 months, contrary to women whose BMI remained unchanged during the same period. QoL also improved significantly. The average level of women’s quality of life increased between 3 and 15 months after surgery, then decreased between 15 and 24 months. As for men, no change was observed in their improved QoL between 3 and 24 months after the operation.ConclusionsThis study highlights the importance of optimizing patients’ monitoring, notably around 15 to 18 months after bariatric surgery. This period can be identified as a first “critical” period during which weight regain (especially for men) and diminished self-perceived quality of life (especially for women) appear.     

Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study

BackgroundWe investigated the impact of incisional hernia (IH) on quality of life and body image.MethodsOpen abdominal surgery patients were included in a prospective cohort study performed between 2007 and 2009 in an academic hospital. Main outcomes were incidence of IH after approximately 12 months and Short-Form 36 and body image questionnaire results.ResultsThere were 374 patients who were examined after a median follow-up period of 16 months (range, 10–24 mo). Seventy-five patients had developed IH (20%); 63 (84%) were symptomatic. Adjusted for age, sex, and Charlson Comorbidity Index score, patients with IH reported significantly lower mean scores for components physical functioning (P = .033), role physical (P = .002), and physical component summary (P = .010). A trend toward significance was found for general health (P = .061). Patients with IH reported significantly lower mean cosmetic scores (P = .002), and body image and total body image scores (both P < .001).ConclusionsPatients with IH reported lower mean scores on physical components of health-related quality of life and body image.     

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study

Introduction and hypothesis

To compare the efficacy and safety of the Elevate? anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse.

Methods

A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system.

Results

Two hundred and one patients (100 in the Elevate? repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate? repair group than in the traditional repair group (98 % vs 87 %, p?=?0.006), but not for the apical (99 % vs. 6 %, p?=?0.317) or posterior (100 % vs 97 %, p?=?0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p?=?0.04), operative time (p?<?0.001), and greater estimated blood loss (p?=?0.05). Other complications were comparable with no statistical difference.

Conclusions

The Elevate? prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.     

Quality of recovery following childbirth: a prospective,multicentre cohort study

To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK-based multicentre cohort study. This study was performed during a 2-week period in October 2021 to assess in- and outpatient post-delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10-item measure (ObsQoR-10); EuroQoL (EQ-5D-5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self-reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR-10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR-10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.     

阴道封闭术对老年盆腔器官脱垂患者生活质量改善的效果观察

目的:了解阴道封闭术对老年盆腔器官脱垂(POP)患者相关症状和生活质量的影响.方法:在2005年10月-2010年2月期间,采用盆底困扰量表简表(PFDI-20)及生活质量问卷盆底影响问卷简表(PFIQ-7),对解放军总医院第一附属医院妇产科60例因POP-Q Ⅲ～Ⅳ期重度POP实施阴道封闭手术患者,分别于术前、术后2...     

Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair

The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment. Presentation information: British Society of Urogynaecology Annual Scientific Meeting, Royal College of Obstetricians and Gynaecologists, London, UK. November 17th 2006.     

Case of longitudinal vaginal septum with pelvic organ prolapse

Longitudinal vaginal septum is a rare mullerian anomaly and its association with pelvic organ prolapse (POP) is unusual. A case of longitudinal vaginal septum with stage IV POP in a 35-year-old multiparous woman is being reported. Examination revealed an incomplete longitudinal vaginal septum (9 × 6 × 2 cm) with stage IV POP. Vaginal hysterectomy with repair and reconstruction was done along with excision of the longitudinal vaginal septum which was technically challenging due to proximity to rectum. This is the only case report of stage IV pelvic organ prolapse associated with a thick longitudinal vaginal septum in a multiparous woman without any obstetric complications. Surgery required increased caution per operatively while dissecting the septum from the vaginal wall and the adjacent organs.