Abstract
The aim of this study is to assess the accuracy of pre-operative evaluation of pelvic organ prolapse. The design is a prospective observational audit set at the gynaecology department, Teaching Hospital, UK. The population is composed of patients undergoing surgery for prolapse. One hundred and four patients admitted for prolapse surgeries were enrolled in the audit. Patients’ notes were initially reviewed for adequacy of prolapse assessment in the clinic. Patients were then interviewed by the researchers and assessed using a validated Prolapse Quality of Life (P-QOL) questionnaire. The presence of unrecorded symptoms was noted. Prolapse examination in theatre under anaesthesia was compared to the findings in the clinic and the operation performed compared to the proposed operation. The outcome measures were as follows: (1) number of patients who had accurate prolapse symptom assessment before surgery when comparing clinical records with entries on P-QOL questionnaires; (2) number of patients having symptoms related to their pelvic organ prolapse that were not accurately assessed pre-operatively; and (3) the differences, if any, between pre-operative and intra-operative examination of prolapse. Sixteen patients in our cohort (15%) had adequate assessment of their prolapse pre-operatively. Symptoms that were not adequately assessed in descending order were the impact of prolapse on quality of life (76%), sexual function (75%), bowel function (27%) and lower urinary tract symptoms (12.5%). Thirty one patients (30%) had sexual dysfunction, 24 (23%) had bowel symptoms and 23 patients (22%) had urinary symptoms that were not recorded before surgery. Prolapse physical examination was adequate in 59% of the cases. Examinations in theatre were different from clinic findings in 38 cases (37%); 16 cases (42%) had a greater or lesser degree of prolapse than that described in the notes; and 11 cases (29%) had prolapse in a different compartment in the vagina. A combination of both (i.e. different degree of prolapse and prolapse in a different vaginal compartment) was found in another 11 cases (29%). The operation performed was different from the one proposed in the clinic in 21% of the cases (n = 22). Clinical evaluation and examination of patients with vaginal prolapse is often inadequate. Prolapse physical examination in a clinic setting could be different from findings under anaesthesia. This can affect the operation to repair the prolapse. Patients should be counselled about this when listed for surgery.
Similar content being viewed by others
References
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501
Beck RP, McCormick S, Nordstrom L (1991) A 25-year experience with 519 anterior colporrhaphy procedures. Obstet Gynecol 78:1011–1018
Simeone C (2004) Clinical evaluation of urinary incontinence and pelvic prolapse: ICI flow-chart. Arch Ital Urol Androl 76:43–45
Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S (2005) P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 16:176–181
Price N, Jackson SR, Avery K, Brookes ST, Abrams P (2006) Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS. BJOG 113:700–712
Bland DR, Earle BB, Vitolins MZ, Burke G (1999) Use of the pelvic organ prolapse staging system of the International Continence Society, American Urogynecologic Society and Society of Gynecologic Surgeons in perimenopausal women. Am J Obstet Gynecol 181:1324–1328
Vineyard DD, Kuehl TJ, Coates KW, Shull BL (2002) A comparison of preoperative and intraoperative evaluations for patients who undergo site-specific operation for the correction of pelvic organ prolapse. Am J Obstet Gynecol 186:1155–1159
Vierhout ME, Stoutjesdijk J, Spruijt J (2005) A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the pelvic organ prolapse quantification system. Int Urogynecol J 17:46–49
Baden WF, Walker TA (1972) Genesis of the vaginal profile. A correlated classification of vaginal relaxation. Clin Obstet Gynecol 15:1048–1054
Burrows LJ, Meyn LA, Walters MD, Weber AM (2004) Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 104:982–988
Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185:1332–1338
Mouritsen L, Larsen JP (2003) Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 14:122–127
Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol Female Lower Urinary Tract Symptoms Questionnaire: development and psychometric testing. Br J Urol 77:805–812
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379
Handa VL, Garett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 190:27–32
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fayyad, A., Hill, S., Gurung, V. et al. How accurate is symptomatic and clinical evaluation of prolapse prior to surgical repair?. Int Urogynecol J 18, 1179–1183 (2007). https://doi.org/10.1007/s00192-007-0306-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-007-0306-z