High satisfaction with concurrent prolapse, SUI surgery

June 1, 2012

Analyses of data collected in a large series of women who underwent concurrent anti-incontinence and prolapse surgery show the patients achieved a high rate of satisfaction overall.

Atlanta-Analyses of data collected in a large series of women who underwent concurrent anti-incontinence and prolapse surgery show the patients achieved a high rate of satisfaction overall.

However, there is little correlation between patient overall satisfaction or improvement after surgery and outcome measures that are commonly used to gauge surgical success, researchers reported at the AUA annual meeting in Atlanta.

The relationships between subjective and objective outcomes measures and patient satisfaction ratings were assessed in a retrospective review that included data from baseline and a 12-month follow-up visit for 97 women operated on by senior author David E. Rapp, MD, co-director of Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction in Richmond. Surgical success was defined by Pelvic Organ Prolapse (POP) Quantification stage <2 for POP repair and by subjective cure for stress urinary incontinence (SUI) repair. Questionnaires were used to determine patient satisfaction (yes or no) and level of improvement (0 to 100%), and data from a 3-day bladder diary and validated questionnaires (International Consultation on Incontinence Modular Questionnaire [ICIQ]-Vaginal Symptoms, ICIQ-Female Lower Urinary Tract Symptoms, and Incontinence Impact Questionnaire short form [IIQ-7]) were analyzed for their associations with reports of improvement and satisfaction.

With women categorized based on their anatomic success, those who achieved complete cure of both SUI and POP (n=67) had a very high satisfaction rate (96%) that was superior to that of their counterparts who achieved SUI cure only (n=9), POP cure only (n=19), or who were complete failures (n=2). Nevertheless, a majority of women who achieved only a partial cure were still satisfied with their outcome (78% for SUI cure only and 58% for POP cure only), and even one of the two women who was a complete surgical failure reported being satisfied overall, reported first author Jeffrey P. Wolters, MD, urology chief resident at Virginia Commonwealth University Health System, Medical College of Virginia, Richmond.

In addition, in statistical analyses performed to determine associations between five outcome measures for POP repair and five for SUI repair, only a score of 0 on the ICIQ-VS domain for vaginal bulge demonstrated a statistical association with both satisfaction and improvement level at 1 year follow-up. No other variables correlated with satisfaction and only three correlated with improvement: a score of 0 on the ICIQ-VS out domain for POP repair, and for SUI repair, a score of 0 on the ICIQ-FLUTS stress domain and a report of zero to one pads per day in the bladder diary.

"Since Dr. Rapp maintains a rigorous follow-up system on his pelvic floor repair patients, we were interested in probing his databank to learn more about outcomes after concomitant prolapse and SUI repair, which is becomingly increasingly more common," Dr. Wolters said.

"Our findings are consistent with previous studies that have failed to find specific, accurate predictors of patient satisfaction after SUI and/or prolapse surgery and highlight the complexity of assessing postoperative satisfaction. They might also be reassuring to surgeons who have been mystified by the disconnect they sometimes encounter between a patient's anatomic and objective outcomes and personal satisfaction."

In an interview with Urology Times, Dr. Rapp observed that given the inability of the validated questionnaires to predict patient satisfaction and their perceptions of improvement, it may be reasonable to combine existing outcome measures into a simpler format.

"The comprehensive validated questionnaires we use in evaluating outcomes of patients who've undergone anti-incontinence and/or POP surgery may be good for research purposes. However, they are probably less applicable in routine practice because no matter how many different endpoints are looked at, we don't seem able to identify clear markers of satisfaction and improvement," he said.