RELATIONSHIP BETWEEN STAGE OF PELVIC ORGAN PROLAPSE AND SYMPTOMS OF PELVIC FLOOR DYSFUNCTION

M.P. FitzGerald for the Pelvic Floor Disorders Network.

Loyola University Medical Center, Maywood, IL

OBJECTIVE: The link between the severity of pelvic organ prolapse (POP) and pelvic symptoms has not been well described using validated symptom scales. The Colpopexy and prolapse Reduction Efforts (CARE) study is an ongoing randomized study by the Pelvic Floor Disorders Network (PFDN) in which women with POP but without symptoms of stress urinary incontinence (UI) undergoing abdominal sacrocolpopexy (SCP) are randomly assigned to either concomitant Burch or no Burch. At baseline, participants complete the Pelvic Floor Distress Inventory (PFDI), which includes the Urinary Distress Inventory (UDI), Colorectal-Anal Distress Inventory (CRADI), Pelvic Organ Prolapse Distress Inventory (POPDI) subscales, and the Pelvic Floor Impact Questionnaire (PFIQ), which includes Incontinence Impact Questionnaire (IIQ), Colorectal-Anal Impact Questionnaire (CRAIQ) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ) subscales.  Lower scores indicate fewer symptoms (PFDI) and better quality of life (PFIQ).  Our aim was to utilize baseline CARE data to determine whether stage of POP was related to symptoms of pelvic dysfunction.

 MATERIALS AND METHODS: Baseline data from 246 subjects in the CARE study were analyzed. Scores of the three primary subscales of the PFDI and PFIQ were computed for each woman, stratified by prolapse stage (2-4) and previous UI or POP surgery.

RESULTS: Women were mean age 61 (range 31-83); 88% were white.  The table details POPDI and POPIQ scores (median, IQR) by POP stage.

	N	POPDI	POPIQ
POP stage 2	36	123 (85-182)	49 (4-144)
POP stage 3	178	86 (50-146)	19 (2-54)
POP stage 4	52	105 (71-154)	18 (0-54)

There was no consistent relationship between scores and POP stage.  Women with Stage 2 POP had higher summary scores than women with higher stages of POP.  Comparing patients with and without previous surgery, POPDI was higher for Stage 2 (139 vs 110) and Stage 3 (97 vs 84), but lower for Stage 4 (100 vs 118).  The pattern was similar for POPIQ: in patients with previous surgery, POPIQ was higher for Stage 2 (76 vs 18) and Stage 3 (28 vs 15), but lower for Stage 4 (8 vs 34).

CONCLUSION: PFDI and PFIQ scores were higher among patients with Stage 2 POP than those with Stage 3 or 4.  This apparent paradox may be due to the nature of the study population, in that these patients have chosen surgery for their POP. 

Disclosure – Nothing to disclose.