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Keywords:

  • pelvic organ prolapse;
  • PISQ-12;
  • laparoscopic sacrocolpopexy;
  • PFDI-20;
  • PFIQ-7

Objective

  • To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life (HRQL) and sexuality among women with symptomatic urogenital prolapse (UGP).

Patients and Methods

  • A prospective analysis was carried out including 148 women with symptomatic UGP.
  • Baseline characteristics, medical and obstetric history were recorded.
  • The Pelvic Organ Prolapse Quantification (POP-Q) classification was used to stage the UGP. Validated tools were used to evaluate symptoms (Pelvic Floor Distress Inventory, PFDI-20) and HRQL (Pelvic Floor Impact Questionnaire, PFIQ-7). Sexual function was evaluated using the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12).
  • Measurements were recorded at the preoperative examination, then at 3 and 12 months after surgery. We compared the follow-up results with preoperative data.

Results

  • The anatomical results at 3 months showed a significant correction (P < 0.05) relative to the preoperative values, on the three pelvic floor parameters measured, with a clinical relapse rate of 6.3%. This improvement remained significant after 12 months (P < 0.05). There was no difference between the results obtained at 3 months and those at 12 months.
  • At 3 months compared with the preoperative data, there was a significant improvement in PFDI-20 total mean score (32.24 vs 94.31, P < 0.05). At 12 months, the improvement remained significant (38.06 vs 94.31, P < 0.05) for all scores compared with the preoperative scores. Again, there was no difference between results at 3 months, and those at 12 months.
  • The results showed a significant improvement in the PFIQ-7 score at 3 (16.61 vs 64.04, P < 0.05) and 12 months (18.21 vs 64.04, P < 0.05). There was no significant difference between the scores at 3 months and those at 12months.
  • The total PISQ-12 score was linked significantly to urinary symptoms (P < 0.05), pelvic symptoms (P < 0.05) but not with ano-rectal ones.
  • At 3 months, the total mean PISQ-12 score had improved significantly compared with the preoperative score (35.42 vs 32.07, P < 0.05). At this time, only two items of the PISQ-12 questionnaire were significantly increased: ‘existence of negative emotions during sexual activity’ (P < 0.05) and ‘the avoidance of sexual activity because of prolapse’ (P < 0.05). The total mean score remained significantly improved at 12 months (36.56 vs 32.07, P < 0.05) and there was no statistical difference compared with the results at 3 months.

Conclusions

  • Laparoscopic sacrocolpopexy resulted in the early improvement (primarily during the first 3 months) of all symptoms, HRQL and sexual function. This improvement was persistent in the medium term.
  • Symptoms linked with UGP had different effects on sexuality fields.
  • Anatomical improvement was not related to an improvement in all sexual fields.