title: Quality of life and pelvic floor dysfunction symptoms after hysterectomy with or without pelvic organ prolapse.
abstract: OBJECTIVE
  To assess the effect of hysterectomy with or without pelvic organ prolapse (POP) on health-related quality of life (HRQoL) and pelvic floor disorders.
  
  
  METHODS
  Prospective clinical study at two central hospitals in Finland. During one year 322 women underwent elective hysterectomy for benign conditions with or without vaginal wall repair. The study population was divided in two groups, patients with and without POP. The HRQoL questionnaires RAND-36 and 15D, and questionnaires assessing urinary and bowel dysfunction symptoms were obtained preoperatively and 12 months postoperatively. POP was defined as the descent of apical, anterior or posterior compartment of vaginal wall grade ≥2 in the Baden-Walker classification at any site. Main outcome measures were HRQoL, improvement of symptoms and de novo symptoms.
  
  
  RESULTS
  At baseline the mean 15D score of all patients was lower than that of the age-standardized population sample (p<0.001). At one year postoperatively, the mean 15D score of the patients had improved (p=0.001), this resulting mainly on dimensions of excretion (voiding and defecation), usual activities, discomfort and symptom, distress, vitality and sexual activity. HRQoL improved especially in patients with POP. They reported improvement of symptoms in urinary incontinence, urinary frequency, constipation and sense of bulging but surgery had no effect on anal incontinence. Patients without POP reported improvement in pain dimension, urinary frequency and feeling of bulging. Urinary incontinence was the most common (15.4% and 13.8%) de novo symptom in both groups.
  
  
  CONCLUSIONS
  Hysterectomy with or without concomitant pelvic organ prolapse surgery improves health-related quality of life and reduces pelvic floor symptoms in one-year follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland. Electronic address: niina.humalajarvi@fimnet.fi.
authors.forename: Niina
authors.initials: N
authors.lastname: Humalajärvi
authors.affiliation: Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Aukee
authors.affiliation: Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Matti V
authors.initials: MV
authors.lastname: Kairaluoma
authors.affiliation: Department of Obstetrics and Gynecology, South Carelia Central Hospital, Lappeenranta, Finland.
authors.forename: Beata
authors.initials: B
authors.lastname: Stach-Lempinen
authors.affiliation: Hjelt Institute/Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Sintonen
authors.affiliation: Department of Obstetrics and Gynecology, South Carelia Central Hospital, Lappeenranta, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Valpas
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Pentti K
authors.initials: PK
authors.lastname: Heinonen
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059952:Pelvic Floor Disorders / Q000209:etiology*; D056887:Pelvic Organ Prolapse / Q000150:complications*; D011446:Prospective Studies; D011788:Quality of Life; D019529:Sexuality; D012890:Sleep; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology
keywords: Hysterectomy; Incontinence; Pelvic floor dysfunction; Pelvic organ prolapse; Quality of life