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Satisfaction in Patients Undergoing Concurrent Pelvic Floor Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse

Wolters, Jeff P. MD*; King, Ashley B. MD*; Rapp, David E. MD*†

Female Pelvic Medicine & Reconstructive Surgery: January/February 2014 - Volume 20 - Issue 1 - p 23–26
doi: 10.1097/SPV.0000000000000051
Original Articles

Objective: Simultaneous repair of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) is common. In these cases, determinants of patient satisfaction are complicated given that surgical success may be achieved in one component but not the other. We sought to assess satisfaction in patients undergoing multiple pelvic surgeries.

Methods: We performed a review of 89 women undergoing concomitant POP repair and midurethral sling (MUS) placement. Focus was placed on patient-reported satisfaction rates. Validated measures were used to evaluate outcomes after MUS [International Consultation on Incontinence Questionnaire (ICIQ)-Female Lower Urinary Tract Symptoms, SUI item; pad use] and POP repair (ICIQ-Vaginal Symptoms; POPQ stage).

Results: At 1-year evaluation, 78 (88%) women reported satisfaction. Assessment identified combined cure of both POP/SUI in 64 (72%) patients, in contrast to failure of MUS, POP repair, and both repairs in 15 (17%) patients, 9 (10%) patients, and 1 (1%) patient, respectively. Subset analysis revealed dissatisfaction in 5% (3/64) of patients achieving complete cure of both SUI and POP. In contrast, 40% (6/15) were dissatisfied if there was failure to cure SUI, 22% (2/9) if failure to cure POP, and the patient with failure of both was not dissatisfied. The ICIQ-Vaginal Symptoms domain score for vaginal bulge was the only assessed outcome demonstrating a statistical relationship with patient-reported satisfaction.

Conclusions: Among women achieving cure of both SUI and POP via concurrent surgical repair, 95% reported satisfaction. Interestingly, a variety of outcomes measures fail to correlate with satisfaction. Further, in patients with complete cure of concurrent pelvic surgeries, a percentage still report dissatisfaction, highlighting the complicated nature of patient satisfaction.

After concurrent prolapse and incontinence repair, improvements in validated outcome measures are seen. However, determinants of patient satisfaction remain complex.

From the *Division of Urology, Virginia Commonwealth University School of Medicine; and †Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Glen Allen, VA.

Reprints: David E. Rapp, MD, 5829 Ascot Glen Dr, Glen Allen, VA 23059. E-mail: derapp@yahoo.com.

The authors have declared they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins