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Leah Lillmars ACF Abstract FY11

"Quality of Life Outcomes After Sacrocolpopexy"

Impact 2011-American Academy of Physician Assistants (AAPA)'s 39th Annual PA Conference

Leah Lillmars, Renae Conner; Beth Wiegand; Theresa Bacon-Baguley, PhD, Samir Hamati, MD

Purpose: Uterine prolapse is a common condition in females and has been reported to have an incidence of 50% in females older than 50 years of age. Sacrocolpopexy is a surgical procedure to reposition vaginal vault prolapse into the correct anatomical position. To assess the success of sacrocoplopexy, it is important to consider both the objective outcomes (i.e. complications) as well as the subjective quality of life outcomes, which are assessed from the patients point of view. The purpose of this study was to compare pre-surgical and post-surgical quality of life outcomes pertaining to bladder, bowel and vaginal symptoms after sacrocolpopexy.

Materials and Methods: One-hundred patients who underwent daVinci robotic sacrocolpopexy between October- 2007 and March-2010 were identified and mailed questionnaires which assessed quality of life: the PFIQ-20 and two versions of the PFIQ-7. One version of the PFIQ-7 was used to assess quality of life measures before the surgery. The second version was used to assess quality of life measures after the surgery. Two additional questions were included in the mailings. The two questions were: Overall, how do you feel in terms of your prolapse since your surgery? and Would you choose to have the surgery again? In addition, there was a qualitative question that allowed the subject to elaborate on why they would not choose to have the surgery again.

Results: Fifty-seven patients (57%) returned the completed surveys. Age range at the time of surgery was between 40 and 83 years old and the average BMI was 27.5. The pre-and post-surgical PFIQ-7 scores were compared to determine if there was a change in the quality of life. Using the Wilcoxon SignedRank test, a significant decrease in symptoms was found when comparing the pre-surgical to post-surgical summary scores of the PFIQ-7, 58.98 and 19.88 respectively(p<0.001). The pre-surgical mean bladder symptoms (mean 25.42) showed a significant decrease when compared to the post-surgical bladder symptoms (mean 10.37) (p<.001). Also, a significant decrease was found between the pre-surgical (12.33) and post-surgical (5.10) bowel symptoms (p=.007). Lastly, a significant decrease was found between the pre-surgical (21.89) and post-surgical (4.69) vaginal symptoms (p<.001). The result of the PFIQ-20 identified that 51.8% of the subjects had no complaints of vaginal prolapse symptoms following surgery, 30.4% had no colorectal symptoms, and 26.8% had no urinary complaints. According to the added questions, 96.4% identified that they had improvement or marked improvement after the surgery. No patients reported to be worse or markedly worse after the surgery, and 94.7% reported that they would have the surgery all over again.

Conclusion: This study found a significant increase in the quality of life (measured by a decrease in symptoms) after undergoing sacrocolpopexy in all three areas assessed by the PFIQ-7: bladder, bowel and vaginal symptoms, as well as a significant overall improvement. In addition, an overwhelming amount of patients (95%) stated that they would have the surgery again.