Correlation of subjective and objective assessment of vaginal prolapse surgery – secondary analysis of randomized controlled study in patients with pelvic floor injury treated with vaginal mesh or with sacrospinous ligament fixation

Česká verzia

Authors: K. Švabík; R. El Haddad; J. Mašata; P. Hubka ; A. Martan
Authors place of work: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha přednosta prof. MUDr. A. Martan, DrSc.
Published in the journal: Ceska Gynekol 2015; 80(5): 351-354

Summary

Objective:
We had provided secondary analysis of our randomized controlled study comparing vaginal mesh with sacrospinous fixation for vaginal prolapse. We correlated data from subjective and objective assessment. Secondly we had provided correlations results of subjective and objective assessment between patient with anatomical failure and those without. The aim of this analysis was to provide correlation between objective and subjective outcome measures.

Design:
Subanalysis of randomized controlled study.

Setting:
Obstetric Gynecology Department, First Faculty of Medicine of Charles University and General University Hospital in Prague.

Methods:
This is secondary analysis of single center randomized controlled study comparing two standard procedures for vaginal prolapse after hysterectomy in patients with levator avulsion injury. We had analyzed pre- and postoperative subjective POPDI score (Pelvic Organ Prolapse Distress Inventory) and correlated this score with most prolapsed portion of vaginal wall. We had compared all vaginal compartments using POPQ (Pelvic Organ Prolapse Quantification): anterior wall with point Ba, apical with point C, and posterior with point Bp. Subsequently we compared subjective POPDI score in group of patients with anatomical failure and those without.

Results:
We had included in randomized study 70 women. Mean preoperative POPDI score was 65.25 (3.57–200). We didn’t found any correlation between subjective score and objective assessment in preoperative data: POPDI vs. Ba (p = 0.75) POPDI vs. C (p = 0.57) a POPDI vs. Bp (p = 0.22) and no correlation in postoperative assessment. Postoperative POPDI score decreased to 26.1, but there was no difference in POPDI score in woman with anatomical failure and no failure – 17.4 vs. 23.3 (p = 0.64)

Conclusion:
Secondary analysis of randomized controlled study had shown that objective and subjective assessment have poor correlation. We didn’t found any correlation between degree of prolapse and intensity of complains. The large inter-individual variability in symptoms and low sensitivity of subjective assessment to detect difference makes subjective assessment as an inappropriate tool as a primary outcome measure of pelvic floor surgery.

Keywords:
subjective assessment, Pelvic Organ Prolapse Distress Inventory, vaginal prolapse, pelvic floor reconstructive surgery

Zdroje

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