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Post-Operative Assessment of Persistent/Recurrent Pelvic Organ Prolapse (POP) After Robotic Sacrocolpopexy: Is There a Correlation Between Objective and Subjective Data?
Paholo G. Barboglio Romo, MD, MPH1, Veronica Triaca, MD2.
1Dartmouth-Hitchcock, Lebanon, NH, USA, 2Concord Urology, Concord, NH, USA.
BACKGROUND: It is controversial whether postoperative POP symptoms after Robotic Assisted Laparoscopic Sacrocolpopexy (RALS) correlate with postoperative anatomical outcomes on physical exam. The aim of our study was to investigate if women with recurrent or persistent apical or anterior POP after RALS exhibited bothersome symptoms.
METHODS: An IRB Approved, single site retrospective cohort study of 131 women undergoing robotic assisted laparoscopic sacrocolpopexy (RALS) for symptomatic apical POP from May 2010 to August 2012. Initial history, physical examination, diagnosis and follow up were performed by single surgeon (VT). Symptoms data were obtained from self-reported validated questionnaires and its subcategories: Short version of the Pelvic Floor Inventory (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20). Baden-Walker grading system was used to evaluate objective data. Women with either anterior or apical POP grade II-IV were categorized as anatomical (objective) recurrence/persistence at one year. We established a strict improvement of >70% on questionnaire’s total score to determine “clinical improvement”. Clinical improvement failure was determined in those patient’s who failed to improve >70% in both questionnaires. Continuous data were analyzed using student’s t-test and categorical data via the Pearson Chi Square test, Wilcoxon sum ranks test.
RESULTS: Complete one year follow up data was available for 92 women and although there was no recurrent/persistent apical prolapse at one year, anterior prolapse was present in 7 patients. Clinical failure in both questionnaires was present in 2/7 (29%) women with persistent/recurrent POP and in 13/85 (15%). The two women who had POP anatomical recurrence/persistence and less than 70% improvement in both questionnaires underwent further anterior repair. B-W grading is displayed in Table 1. The correlation coefficient of anatomical status and women with clinical improvement in both questionnaires was r= -0.07 (p=0.482), and in women who failed to improve >70% was 0.07, (p= 0.479).
CONCLUSION: Our data suggests that prolapse anatomical status is a poor indicator of postoperative clinical failure based on a strict criteria of improvement of >70% in both PFDI-20 and PFIQ-7. Moreover the correlation coefficient is very poor between objective and subjective data based on our analysis. The diagnosis of POP recurrence/persistence should not rely on objective (anatomy) or subjective (symptoms) data alone, but rather on both.
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