Women with symptomatic pelvic organ prolapse have a lower quality of life than same-aged peers. Pelvic organ prolapse surgery leads to an improvement of both their symptoms and quality of life, according to the doctoral dissertation of Nina Mattsson, Lic Med.
Bothersome descent of pelvic organs is a common condition among parous women, and more than one in ten women undergo pelvic organ prolapse surgery during their lifetime. In Finland, about 4,200 operations for POP are performed annually and it is one of the most common gynecological operations. Studies that compare the different surgical methods have previously focused mainly on anatomical outcome of the surgey. However, the patient’s satisfaction and experience of improvement of pelvic distress symptoms and quality of life are the most important outcomes of surgical treatment.
The study was conducted as a national multicenter 1-year cohort study in which 41 out of 45 hospitals that performed POP surgery in Finland participated. Altogether 3,535 operations covering 83% of all operations for POP in Finland during the study period year 2015 were registered, and the surgical details were documented in electronic registry by the doctors.
Altogether 81% of the POP operations were performed by using patient’s own tissue. Mesh augmentation was performed transvaginally in 12% and abdominally in 7% of the operations. Predictive factors for the use of mesh were previous surgery for POP and hysterectomy, bothersome bulge and advanced prolapse beyond hymen. A large variation in the rates of mesh surgery between different hospitals and hospital districts was detected.
Generic HRQoL was significantly lower among the study population of women with symptomatic POP than in age-standardized population. An improvement in prolapse-related dimensions such as sexual activity, excretion and discomfort and symptoms persisted during the 2-year follow-up. Seven out of ten patients reported a meaningful improvement in condition-specific quality of life measured with PFDI-20 and altogether 84% of patients were satisfied with surgical outcome at two years. Nine out of ten patients felt their condition to be better than before the operation. Predictive factors for favorable outcome of surgery were advanced prolapse beyond hymen and bothersome bulge. At two-year follow-up, altogether 5% of the patients felt their condition worse compared to the preoperative situation and this was associated with smoking.
The Finnish versions of PFDI-20 and PISQ-12 showed to be valid tools to assess the outcome of POP surgery in both research and clinical use.
The doctoral dissertation of Nina Mattsson, Licentiate of Medicine, entitled The Effect of Pelvic Organ Prolapse Surgery on Quality of Life will be examined at the Faculty of Health Sciences, University of Eastern Finland. The public examination will be held in Finnish in Hämeenlinna on 21 August 2020. The Opponent in the public examination will be Docent Maarit Mentula of the University of Helsinki, and the Custos will be Professor Anna-Maija Tolppanen of the University of Eastern Finland.
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Mattsson, Nina. The effect of pelvic organ prolapse surgery on quality of life