The Subjective Effect Of Surgery For Severe Pelvic Organ Prolapse

Objective: To study the subjective therapeutic effect of surgery for severe pelvicorgan prolapse.Methods: Part one：From Oct.2005to Feb.2010，60severe POP patients withstage Ⅲ and Ⅳ by POP-Q system underwent colpocleisis. Patients completed thepelvic floor distress inventory short form(PFDI-20) and pelvic floor impactquestionnaire short form(PFIQ-7) before operation and repeated them at2months,6months and1year after operation. During the same period, patients received bodyimage evaluation before and1year after operation with modified body image sacle.Parttwo：From May2004to March2011，114severe POP patients underwent transvaginalRPS with polypropylene mesh.They completed PFDI-20and PFIQ-7questionnairebefore operation and repeated them at2months,6months and1year after operation.Atthe same time, they received gynecological spectrum examination to identify vaginalmesh exposure.Results:1.Fifty-six(93％,56/60),53(88%,53/60) and52(87％,52/60) patientscompleted questionnaires at2months,6months and1year after colpocleisis,respectively.Mean PFDI-20and PFIQ-7score improved significantly at2months,6months and1year after colpocleisis（p＝0.000）.At1year, the ratio of answer “Not atall” of questions such as “Have you felt less physically attractive as a result of yourvaginal prolapse?”,“Have you been feeling less feminine as a result of your vaginalprolapse?”,“Did you find it difficult to look at yourself naked?”,“Have you beenfeeling less sexually attractive as a result of your vaginal prolapse?”,“Have you feltdissatisfied with your body?” improved significantly （P＜0.05）.2.Ninety-six(84％,96/114),85(75%,85/114) and77(68％,77/114) patients completedquestionnaires at2months,6months and1year after transvaginal RPS withpolypropylene， respectively.All patients had POP-Q staging score≤Ⅰat1year afteroperation. Most symptoms associated with PFD improved significantly at2months and this improvement was maintained until one year after operation. Mean score of PFDI-20and PFIQ-7all improved significantly after operation at the2,6months and1yearfollow-up (p＜0.01). Nineteen(19.8%，19/96),13(15.3%，13/85) and6(7.8%，6/77)patients were found vaginal mesh exposure at the same time respectively. Mean score ofPFDI-20and PFIQ-7of patients with vaginal mesh exposure had improved significantlyafter operation at the2,6months and1year follow-up (p＜0.001).There was nosignificant difference between mean score of PFDI-20and PFIQ-7of patients withvaginal mesh exposure and without (P＞0.05). Fifty percent(48/96) patients hadpostoperative de novo symptoms at the2months follow-up predominantly presentedwith bothersome vaginal discharge(35.4%,34/96) and pelvic musclesymptoms(20.8%,20/96).Patiens with de novo symptoms had higher postoperative meanPOPDI-6and POPIQ-7scores (p＜0.05) than those without at the2monthsfollow-up,but no significant difference at the6months and1year follow-up.Patienswith bothersome vaginal discharge had higher vaginal mesh exposure rate(41.2%,14/34)than patients without (8.1%,5/62)(P=0.0003).Conclusions:1.Colpocleisis effectively resolved symptoms associated with PFD andsignificantly improved patients’ quality of life.Women underwent colpocleisis for severePOP didn’t decrease their body image as a result of the disability of vaginal intercourse.2.Transvaginal RPS with polypropylene mesh can effectively resolve bothersomesymptoms associated with PFD and improve the quality of life of patients with POP.3.Vaginal mesh exposure was common after transvaginal RPS with polypropylenemesh,but most of them were moderate and didn’t have significant impact on patients’quality of life.4.De novo symptoms were not seldom after transvaginal RPS with polypropylenemesh,but most of them were resolved within6months postoperatively and not severeenough to have long-term negative impact on their quality of life...