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

Abstract

Objective: 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.

Design: Prospective longitudinal observational study, over 2 years.

Setting: Tertiary urogynaecology centre.

Population: Women with prolapse or stress incontinence due for surgery.

Methods: 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).

Main outcome measures: 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.

Results: 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.

Conclusions: 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.