Surgical repair of pelvic-floor prolapse: lessons learned from longitudinal follow-up of quality-of-life survey.
BACKGROUND
Scant evidence has been reported on the evaluation of quality-of-life (QOL) in patients who had undergone surgical treatment due to pelvic floor prolapse including cystocele. The aim of this study is to evaluate the impact of surgical intervention on patients' QOL before and after surgery.


METHODS
Between 1997 and 2007, 135 patients (median age: 66.6 years) with pelvic floor prolapse including cystocele underwent bladder neck suspension with anterior/posterior colporrhaphy. The follow-up period was 39.6 months. Seventy-two patients (53 %) had urinary incontinence. The cystocele was graded as mild (grade 2), moderate (grade 3), and severe (grade 4) in 35, 60, and 40, respectively, according to the Baden-Walker classification. A urodynamic study was performed in 69 patients (51 %) who had obstructive symptoms with 100 ml or more of postvoid residual urine. Postoperative QOL was longitudinally assessed in 114 patients by scoring three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL), and compared with corresponding baseline scores.


RESULTS
A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow-up of 62.2 months. HR-QOL was significantly associated with vitality assessed by SF 36 (p = 0.036). Multivariate analysis revealed that update urinary incontinence, pre-operative HR-QOL was independent prognostic factors for predicting postoperative patient's satisfaction.


CONCLUSIONS
Although surgical repair of pelvic floor prolapse can achieve acceptable results with intermediate-term durability as well as improving the QOL, preoperative patients' HR-QOL may be considered in the decision making process for treatment.
Matsuyama
H
H
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan. hidde@yamaguchi-u.ac.jp
Tomimatsu
T
T
Tatsumura
M
M
Sugino
N
N
Naito
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000601:surgery; D011183:Postoperative Complications / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D020047:Rectocele / Q000523:psychology* / Q000601:surgery*; D014549:Urinary Incontinence / Q000523:psychology* / Q000601:surgery*; D014596:Uterine Prolapse / Q000523:psychology* / Q000601:surgery*