A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery.

Abstract

To compare patient goal achievement in prolapse and continence surgery with objective/subjective outcomes; secondarily, to compare patient goal achievement with overall satisfaction and with that of the surgeon. Prospective longitudinal observational study, over 2 years. Tertiary urogynaecology centre. Women with prolapse or stress incontinence due for surgery. Patients and surgeons listed five goals that they hoped to achieve following surgery. Objective assessment was with Pelvic Organ Prolapse Quantification System (POP-Q) and videocystourethrography (VCU). Quality of life (QoL) was assessed with a Prolapse QoL questionnaire (PQoL), Kings Health questionnaire (KHQ) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I). Goal achievement was measured on a 100-mm visual analogue scale (VAS); objective cure of prolapse by POP-Q and of stress incontinence by VCU; QoL was assessed by KHQ, PQoL and GRISS; and satisfaction by PGI-I. Complete data were available for 112 women. POP-Q scores significantly improved (P<0.05); objective cure of incontinence (from VCU) was 88.8%. All QoL questionnaires and PGI-I scores showed significant improvement (P<0.01). Mean goal achievement was 85.1% for patients and 89.6% for surgeons. Patient goal achievement for prolapse surgery was observed sooner and correlated more with other measures of success than continence surgery. Continence-related goals based on symptom relief were achieved more than those based on body image and sexuality. Surgeons reported a high achievement rate in anatomical restoration and functional improvement goals. Patient goal achievement correlates significantly with other measures of 'success' as well as with overall satisfaction. Surgeons and women have varying expectations of the outcome of surgery. Nearly 90% of goals are still achieved 2 years following surgery.