This study aimed to identify associations between patient-centered goals and pelvic floor measures and treatment choice.
A retrospective study of women seen for a pelvic floor disorder by a single surgeon in a specialty clinic from January 2008 to December 2009 was done. Goals were categorized as information-seeking, improving across any of 6 pelvic floor symptom categories, and “other.” Pelvic floor symptom burden was determined using validated surveys. Health-related quality of life (HRQoL) and vaginal Pelvic Organ Prolapse Quantification points were assessed. Correlations of goals with symptom burden, HRQoL, and anatomic severity and surgical versus nonoperative care were determined.
Ninety patients met inclusion criteria. The mean (SD) age was 56 (14) years, with 67% younger than 65 years; 23.3% of the patients reported a surgery treatment preference; 30.7% had at least 1 Pelvic Organ Prolapse Quantification point greater than or equal to 1 cm. A single goal was reported by 18% of patients with 28%, 37%, 14%, and 3.3% reporting 2, 3, 4, or 5 goals. Goals reflected symptom burden for bowel and bladder complaints, whereas a cosmetic goal seems to reflect both prolapse symptoms and impact as well as measurably altered anatomy. Goals related to sexual function reflected overall mental HRQoL but not symptoms or anatomy. Women with an activity-based goal preferred surgery but the low number of patients who chose surgery did allow statistical significance.
There are not always correlations between a patient’s therapeutic goals and subjective and objective assessments of the pelvic floor or treatment choice.
Patient therapeutic goals do not always relate to pelvic floor symptom burden and the choice of surgery may not be related to symptom severity.
From the Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH.
Reprints: James L. Whiteside, MD, MA, The Christ Hospital, 2123 Auburn Ave, Suite 307, Cincinnati, OH 45219. E-mail: James.Whiteside@TheChristHospital.com.
Reprints will not be available.
Supported by NICHD Grant No. R03 HD061867-02.
The authors have declared they have no conflicts of interest.