Defining success after surgery for pelvic organ prolapse.
OBJECTIVE
To describe pelvic organ prolapse surgical success rates using a variety of definitions with differing requirements for anatomic, symptomatic, or re-treatment outcomes.


METHODS
Eighteen different surgical success definitions were evaluated in participants who underwent abdominal sacrocolpopexy within the Colpopexy and Urinary Reduction Efforts trial. The participants' assessments of overall improvement and rating of treatment success were compared between surgical success and failure for each of the definitions studied. The Wilcoxon rank sum test was used to identify significant differences in outcomes between success and failure.


RESULTS
Treatment success varied widely depending on definition used (19.2-97.2%). Approximately 71% of the participants considered their surgery "very successful," and 85.2% considered themselves "much better" than before surgery. Definitions of success requiring all anatomic support to be proximal to the hymen had the lowest treatment success (19.2-57.6%). Approximately 94% achieved surgical success when it was defined as the absence of prolapse beyond the hymen. Subjective cure (absence of bulge symptoms) occurred in 92.1% while absence of re-treatment occurred in 97.2% of participants. Subjective cure was associated with significant improvements in the patient's assessment of both treatment success and overall improvement, more so than any other definition considered (P<.001 and <.001, respectively). Similarly, the greatest difference in symptom burden and health-related quality of life as measured by the Pelvic Organ Prolapse Distress Inventory and Pelvic Organ Prolapse Impact Questionnaire scores between treatment successes and failures was noted when success was defined as subjective cure (P<.001).


CONCLUSIONS
The definition of success substantially affects treatment success rates after pelvic organ prolapse surgery. The absence of vaginal bulge symptoms postoperatively has a significant relationship with a patient's assessment of overall improvement, while anatomic success alone does not.


METHODS
II.
Barber
Matthew D
MD
From the Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; Departments of Obstetrics & Gynecology and Urology, Loyola University Chicago, Illinois; Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama; Department of Obstetrics and Gynecology, University of Texas-Southwestern, Dallas, Texas; Data Coordinating Center, University of Michigan, Ann Arbor, Michigan.
Brubaker
Linda
L
Nygaard
Ingrid
I
Wheeler
Thomas L
TL
Schaffer
Joeseph
J
Chen
Zhen
Z
Spino
Cathie
C
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D017773:Pelvic Floor; D011788:Quality of Life; D019233:Retreatment; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000601:surgery*; D014782:Visceral Prolapse / Q000601:surgery*
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