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International Urogynaecology Consultation chapter 1 committee 4: patients’ perception of disease burden of pelvic organ prolapse

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Abstract

Introduction and hypothesis

This manuscript from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reports on the patients’ perception of disease burden associated with pelvic organ prolapse.

Materials and methods

An international group containing a team of eight urogynaecologists, a physiotherapist and a statistician performed a search of the literature using pre-specified search terms in PubMed and Embase (January 2000 to August 2020). The division of sections within this report includes: (1) perception of POP and the relationship with body image and poor health; (2) a vaginal bulge as it impacts health and wellbeing in women; (3) the impact of POP on sexual life; (4) body image and pelvic floor disorders; (5) POP and mood; (6) appropriate use of treatment goals to better meet patients’ expected benefits; (7) using health-related quality of life questionnaires to quantify patients’ perception of POP; (8) The financial burden of POP to patients and society. Abstracts were reviewed and publications were eliminated if not relevant or did not include populations with POP or were not relevant to the subject areas as noted by the authors. The manuscripts were next reviewed for suitability using the Specialist Unit for Review Evidence (SURE) checklists for cohort, cross-sectional and case-control epidemiologic studies.

Results

The original individual literature searches yielded 2312 references of which 190 were used in the final manuscript. The following perceptions were identified: (1) women were found to have varying perceptions of POP including shame and embarrassment. Some regard POP as consequence of aging and consider there is no effective therapy. (2) POP is perceived as a vaginal bulge and affects lifestyle and emotional wellbeing. The main driver for treatment is absence of bulge sensation. (3) POP is known to affect frequency of sexual intercourse but has less impact on satisfaction. (4) Prolapse-specific body image and genital self-image are important components of a women’s emotional, physical and sexual wellbeing. (5) POP is commonly associated with depression and anxiety symptoms which impact HRQoL although are not correlated with objective anatomical findings. (6) Patient-centered treatment goals are useful in facilitating communication, shared decision-making and expectations before and after reconstructive surgery. (7) Disease-specific HRQoL questionnaires are important tools to assess bother and outcome following surgery, and there are now several tools with Level 1 evidence and a Grade A recommendation. (8) The cost of POP to the individual and to society is considerable in terms of productivity. In general, conservative measures tend to be more cost-effective than surgical intervention.

Conclusions

Patients’ perception of POP varies in different patients and has a far-reaching impact on their overall state of health and wellbeing. However, recognizing that it is a combination of body image and overall health (which affects mental health) allows clinicians to better tailor expectations for treatment to individual patients. There are HRQoL tools that can be used to quantify these impacts in clinical care and research. The costs to the individual patient (which affects their perception of POP) is an area that is poorly understood and needs more research.

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Authors and Affiliations

  1. Department of Urogynaecology, Kings College Hospital, London, UK

    Dudley Robinson

  2. Division of Urogynaecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynaecology, University of the Philippines – College of Medicine, Philippine General Hospital, Manila, Philippines

    Lisa T. Prodigalidad

  3. Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong

    Symphorosa Chan

  4. University of Insubria, Varese, Italy

    Maurizio Serati

  5. Female Pelvic Medicine and Reconstructive Surgery, Columbia University Medical Centre, New York, NY, USA

    Svjetlana Lozo

  6. Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaecology, Washington University, St Louis, MO, USA

    Jerry Lowder

  7. Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA

    Chiara Ghetti

  8. Departments of Obstetrics/Gynaecology and Urology, Division Female Pelvic Medicine and Reconstructive Surgery, UVA Health System, Charlottesville, VA, USA

    Kathie Hullfish

  9. Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, Scotland

    Suzanne Hagen

  10. Canadian Research Chair in Urogynaecological Health and Aging, University of Montreal, Montreal, Canada

    Chantal Dumoulin

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  1. Dudley Robinson
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  2. Lisa T. Prodigalidad
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  8. Kathie Hullfish
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  9. Suzanne Hagen
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Contributions

DR: Planning, writing and editing.

LP: Planning, writing and editing.

SC: Planning, writing and editing.

MS: Planning, writing and editing.

SL: Planning, writing and editing.

JL: Planning, writing and editing.

CG: Planning, writing and editing.

KH: Planning, writing and editing.

SH: Planning, writing and editing.

CD: Planning, writing and editing.

Corresponding author

Correspondence to Dudley Robinson.

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Conflict of interest

DR: Research and Consultancy – Astellas, Allergan, Ferring, Ixaltis.

LP: None.

SC: None.

MS: None.

SL: None.

JL: Hitachi Chemical.

CG: None.

KH: None.

SH: None.

CD: None.

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Appendices

Appendix 1

Fig. 1
figure 1

Perception of prolapse and the relationship with body image and poor health: PRISMA diagram

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Appendix 2

Fig. 2
figure 2

Vaginal bulge impact on health and wellbeing in women: PRISMA diagram

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Appendix 3

Fig. 3
figure 3

Pelvic organ prolapse and sexual function: PRISMA diagram

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Appendix 4

Fig. 4
figure 4

Body image and pelvic floor disorders: PRISMA diagram

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Appendix 5

Fig. 5
figure 5

Pelvic organ prolapse and mood: PRISMA diagram

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Appendix 6

Fig. 6
figure 6

Pelvic organ prolapse and patient goals: PRISMA diagram

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Appendix 7

Fig. 7
figure 7

Health-related Quality of Life (HRQoL) Assessment: PRISMA diagram

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Appendix 8

Fig. 8
figure 8

Cost to society of treating pelvic organ Prolapse: PRISMA diagram

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Robinson, D., Prodigalidad, L.T., Chan, S. et al. International Urogynaecology Consultation chapter 1 committee 4: patients’ perception of disease burden of pelvic organ prolapse. Int Urogynecol J 33, 189–210 (2022). https://doi.org/10.1007/s00192-021-04997-3

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