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International urogynecological consultation chapter 4.1: definition of outcomes for pelvic organ prolapse surgery

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Abstract

Introduction and hypothesis

This manuscript of Chapter 4 of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature and makes recommendations on the definition of success in the surgical treatment of pelvic organ prolapse.

Methods

An international group containing seven urogynecologists performed an exhaustive search of the literature using two PubMed searches and using PICO methodology. The first search was from 01/01/2012–06/12/2022. A second search from inception to 7/24/2022 was done to access older references. Publications were eliminated if not relevant to the clinical definition of surgical success for the treatment of POP. All abstracts were reviewed for inclusion and any disagreements were adjudicated by majority consensus of the writing group. The resulting list of articles were used to inform a comprehensive review and creation of the definition of success in the surgical treatment of POP.

Outcomes

The original search yielded 12,161 references of which 45 were used by the writing group. Ultimately, 68 references are included in the manuscript. For research purposes, surgical success should be primarily defined by the absence of bothersome patient bulge symptoms or retreatment for POP and a time frame of at least 12 months follow-up should be used. Secondary outcomes, including anatomic measures of POP and related pelvic floor symptoms, should not contribute to a definition of success or failure. For clinical practice, surgical success should primarily be defined as the absence of bothersome patient bulge symptoms. Surgeons may consider using PASS (patient acceptable symptom state) or patient goal attainment assessments, and patients should be followed for a minimum of at least one encounter at 6–12 weeks post-operatively. For surgeries involving mesh longer-term follow-up is recommended.

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Data Availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Joseph T. Kowalski

  2. Department of Ob/Gyn, Duke University Medical Center, Durham, NC, USA

    Matthew D. Barber

  3. St. Antoniusziekenhuis Utrecht, Nieuwegein, the Netherlands

    Wenche M. Klerkx

  4. Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland

    Magdalena E. Grzybowska

  5. Birmingham Womens & Children’s Hospital, Birmingham, UK

    Philip Toozs-Hobson

  6. Albany Medical Center, Albany, NY, USA

    Rebecca G. Rogers

  7. Department of Obstetrics & Gynecology, Reinier de Graaf Hospital, 2625 AD, Delft, the Netherlands

    Alfredo L. Milani

Authors
  1. Joseph T. Kowalski
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  2. Matthew D. Barber
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  3. Wenche M. Klerkx
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  4. Magdalena E. Grzybowska
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  5. Philip Toozs-Hobson
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  6. Rebecca G. Rogers
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  7. Alfredo L. Milani
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Correspondence to Joseph T. Kowalski.

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Appendices

Appendix 1

Population

("Pelvic Organ Prolapse"[majr] OR "Cystocele"[ti] OR "rectocele"[ti] OR "enterocele"[ti] OR (("Pelvic Organ*"[ti] OR "uterine"[ti] OR "urogenital"[ti] OR "urinary bladder"[ti] OR "vaginal"[ti]) AND ("Prolapse*"[ti] OR "descent"[ti])))

Intervention

AND

("Gynecologic Surgical Procedures"[Mesh:NoExp] OR "Hysterectomy, Vaginal"[Mesh] OR "vaginal hysterectom*"[tiab] OR "surger*"[tiab] OR "surgical"[tiab] OR (("anterior"[tiab] OR "posterior"[tiab]) AND "colporrhaph*"[tiab]) OR (("apical"[tiab] OR "vault"[tiab]) AND ("suspension*"[tiab] OR "fixation*"[tiab])) OR "uterosacral ligament suspension*"[tiab] OR "Manchester fothergill"[tiab] OR "colpocleisis"[tiab] OR "labhart"[tiab] OR "lefort"[tiab] OR "perineoplast*"[tiab] OR "levatorplast*"[tiab])

Outcome

AND

("Treatment Outcome"[Mesh] OR "outcome*"[tiab] OR "bulge*"[tiab] OR "bulging"[tiab] OR "goal attainment"[tiab] OR "patient-reported goal*"[tiab] OR "Goals"[Mesh] OR "Surveys and Questionnaires"[Mesh] OR "questionnaire*"[tiab] OR "survey*"[tiab] OR "PFDI-20"[tiab] OR "pelvic floor disability index"[tiab] OR "pelvic floor distress inventory"[tiab] OR "HRQoL"[tiab] OR "health-related quality of life"[tiab] OR "PGII"[tiab] OR "patient global impression of improvement"[tiab] OR "UDI-6"[tiab] OR "urogenital distress inventory"[tiab] OR "urinary distress inventory"[tiab] OR "iciq SF"[tiab] OR "ICIQ-UI SF"[tiab] OR "Urinary Incontinence Short Form"[tiab] OR "international consultation of incontinence questionnaire"[tiab] OR "IIQ7"[tiab] OR "IIQ-7"[tiab] OR "incontinence impact questionnaire"[tiab] OR "KHQ"[tiab] OR "King's health questionnaire"[tiab] OR "PISQ12"[tiab] OR "PISQ-12"[tiab] OR PISQ-IR[tiab] OR "VAS"[tiab] OR "visual analogue scale"[tiab] OR "POPIQ-7"[tiab] OR "PFIQ"[tiab] OR "pelvic organ prolapse impact questionnaire"[tiab] OR "pelvic floor impact questionnaire"[tiab] OR "Retreatment"[Mesh:NoExp] OR "retreatment"[tiab] OR "Pessaries"[Mesh] OR "Pessar*"[tiab] OR (("new"[tiab] OR "persistent"[tiab]) AND (("Urinary Bladder"[Mesh] OR "bladder"[tiab] OR "bowel"[tiab])) AND "symptom*"[tiab]) OR "Sexual Health"[Mesh] OR "sexual"[tiab] OR "Pain"[Mesh:NoExp] OR "pain"[tiab])

AND ("2012/01/01"[Date—Publication]: "2030/12/31"[Date—Publication]) NOT ("animals"[mesh] NOT "humans"[mesh])

Appendix 2

(surgery) AND ((anterior prolapse) OR (apical prolapse) OR (cystocele) OR (descending uterus) OR (descensus) OR (enterocele) OR (genital hiatus) OR (normal pelvic organ support) OR (paravaginal defect) OR (pelvic organ prolapse) OR (POP-Q) OR (posterior prolapse) OR (posthysterectomy prolapse) OR (prolapse) OR (prolapse symptoms) OR (rectocele) OR (uterine prolapse) OR (vaginal prolapse) OR (vaginal vault prolapse)) NOT ((hernia) OR (valve) OR (vitreous) OR (eyelid) OR (casereports[Filter])) AND ((fft[Filter]) AND (english[Filter]))

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Kowalski, J.T., Barber, M.D., Klerkx, W.M. et al. International urogynecological consultation chapter 4.1: definition of outcomes for pelvic organ prolapse surgery. Int Urogynecol J 34, 2689–2699 (2023). https://doi.org/10.1007/s00192-023-05660-9

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