REGRET, SATISFACTION AND SYMPTOM IMPROVEMENT:  ANALYSIS OF THE IMPACT OF COLPOCLEISIS FOR THE MANAGEMENT OF SEVERE PELVIC ORGAN PROLAPSE.

T.L. Wheeler II, H.E. Richter, R.E. Varner, K.L. Burgio, DT. Redden, P.S. Goode, C.G. Chen  

Medical-Surgical Oncology, University of Alabama, Birmingham, AL

OBJECTIVE:  The purpose of this study was to assess a cohort of patients having undergone a colpocleisis procedure greater than one year post operation to determine:  1) the proportion of patients who regretted having the procedure 2) patient satisfaction with the procedure and 3) changes in symptom severity following surgery.  
MATERIALS AND METHODS: 54 candidates who underwent colpocleisis between March 1998 and April 2003 were identified from the University of Alabama at Birmingham (UAB) Genitourinary Disorders database.  From August to October of 2004, participants were contacted by an investigator not involved with the surgery and were asked 1) “do you regret having your surgery, and, if so, why?” 2) “how satisfied  are you with your progress (completely, somewhat, or not)?” and 3) to complete the short form Urogenital Distress Inventory (UDI).  The satisfaction question has been previously validated.  Baseline UDI values were obtained preoperatively.  Improvement on the UDI (baseline versus last interview) was tested using the dependent t-test.  Wilcoxon Rank Sum was used to test for the effect of concomitant incontinence procedure on UDI change.  Spearman Rank Correlation Coefficient was used to correlate change in UDI scores with time since procedure and age.
RESULTS:  Nineteen of the 54 candidates were excluded (8 deceased, 6 demented and 5 lost to follow-up).  Three candidates declined any participation.  Thirty-two participants responded to the regret question.  Twenty-eight of these participants answered the satisfaction question and repeated the UDI. Mean age at follow up was 81.4(±5.0) years, and follow-up interval was 26.5 (±12.9) months.  Three participants (9.32%) regretted having colpocleisis performed.  Two participants gave recurrent prolapse (5 and 7 months post operation) as the reason for regret, while one participant, without recurrent prolapse, who had a concomitant modified Pereyra, cited continued urinary leakage as the reason for regret. No participant cited loss of sexual function as a reason for regret.  Fifty seven percent (16/28) were completely satisfied, 29% somewhat and 14% (4/28) not satisfied.  Mean UDI score improved significantly from 63.4 (±23.9) at baseline to 24.2(±26.7) at last interview (p<0.001).  A concomitant incontinence procedure did not significantly effect change in UDI scores (p= 0.4378).  There was a negative correlation between change in UDI scores with time since procedure (r= -0.40, p= 0.0527) and age (r= -0.44, p=.033).

CONCLUSION:  Patients report minimal regret, significant satisfaction and symptom improvement more than a year post surgery.  Smaller improvements were reported with longer time from surgery and increasing age.

Key Words:  colpocleisis, regret, satisfaction, outcomes       

Disclosure – Speakers Bureau: H. Richter, Pfizer, Novartis; R.E. Varner, Pfizer, Gynecare; P.S. Goode,  Lilly, Ortho-McNeil, Pfizer; Consultant: K.L. Burgio, Lilly, Ortho-McNeil, Novartis, Yamanouchi, Merck.