Robotic Sacrocolpopexy for the Management of Pelvic Organ Prolapse: An Update on Quality of Life Outcomes
Annah J. Vollstedt, MD1; William Meeks, MA2; Veronica Triana, MD3
1Dartmouth Hitchcock Medical Center, Lebanon, NH; 2Department of Data Management & Statistical Analysis, American Urological Association, Linthicum, MD; 3Concord Hospital Center for Urologic Care, Concord, NH
Introduction
Robotic-assisted laparoscopic sacrocolpopexy (RALS) is a widely-used surgical treatment for pelvic organ prolapse (POP). Our aim was to investigate the longer-term surgical and quality of life (QOL) outcomes in our updated cohort.
Methods
A retrospective cohort study of women undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair was performed. Scores from the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient's PFDI-20 and PFIQ-7 post-operative score by at least 70%.
Results
A total of 205 patients from November 2010 to June 2015 were included in our review with a mean follow-up time of 23 months. Complete pre- and post-operative survey data were available in 180 patients. Clinical improvement was seen in 62.6% by the PFIQ-7 and in 64% by the PFDI-20 survey. We analyzed patient demographics, history, and pre-operative physical exam in those that reached clinical improvement. Younger patient age (OR 0.92, p=0.011) and a higher pre-operative AUA Quality of Life score (OR 1.42, p=0.46) were associated with clinical improvement. Within the PFQI-7, 35.6% of patients saw clinical improvement within the bowel category, compared to the bladder category (54.1%, p<0.001) and the prolapse category (45.6%, p=0.053). Similarly, within the PFDI-20, 45.5% of patients saw clinical improvement within the CRADI-8, compared to the UDI-6 (56.7%, p=0.035) and the POPDI-6 (62.6%, p<0.001). Of the patients who had a concomitant rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score and 51% saw clinical improvement in the bowel portion of the PDFI-20.Conclusions
This is the largest series to analyze pre- and post-operative PFIQ-7 and PFDI-20 scores. Most patients undergoing RALS saw clinical improvement based on the PFDI-20 and PFIQ-7 following RALS. However, there were significantly fewer patients reached our clinical improvement definition within the portions of the surveys that focus on bowel symptoms and functions compared to the portions of the surveys that ask about symptoms related to urination and prolapse. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement their bowel symptoms. This information can be helpful when counseling patients pre-operatively regarding expectations of improving pre-existing bowel symptoms after RALS.
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