Change search
ReferencesLink to record
Permanent link

Direct link
Vaginal prolapse – clinical outcomes and patients’ perspectives: a study using quantitative and qualitative methods
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Pelvic organ prolapse (POP) is a relatively common condition. In Sweden, the overall estimated prevalence of POP in the female population is 31% and the prevalence of symptomatic prolapse is 8–15%. The prevalence of POP increases with age. The lifetime risk of undergoing pelvic floor surgery is estimated to 11%.

The aim of this thesis was to investigate outcomes of vaginal hysterectomy for treatment of prolapse; to study outcomes of cystocele repair surgery and patient satisfaction related to different anaesthesia methods; to explore women’s experiences of vaginal prolapse; and to investigate what is known regarding POP prior to surgery and healthcare-seeking behaviour.

Methods: In the Swedish National Quality Register for Gynaecological Surgery (Gynop-register), 941 women were identified who underwent vaginal hysterectomy for prolapse from 1997 to 2005 and 1,364 women were identified who underwent cystocele repair surgery from 2006 to 2009. In-depth interviews were performed with 14 women with vaginal prolapse. Interview data were analyzed with a qualitative content analysis. To investigate women’s knowledge about POP and healthcare-seeking behaviour, a questionnaire was developed, validated and distributed to women with planned surgery for POP. Women undergoing hysterectomy or incontinence surgery were used as reference groups.

Results: Severe complications after vaginal hysterectomy occurred in 3% of cases. Sexual activity was improved after vaginal hysterectomy, the number of women reported to have intercourse increased by 20% (p = 0.006). Subjective symptoms of urinary incontinence and overactive bladder were resolved in 50% of the women. De novo stress incontinence was reported by 11% of the women.

Use of local anaesthesia (LA) in reconstruction of cystocele showed advantage over other forms of anaesthesia. Length of hospital stay, duration of use of postoperative pain-killing drugs, and time to return to daily activity were shorter among women who underwent surgery with LA compared to other forms of anaesthesia. Patient satisfaction was not related to methods of anaesthesia.

In an interview study, the process from recognition the symptoms to seeking healthcare was highlighted. Two categories, “obstacles” and “facilitators” to seeking health care, were identified. One of the obstacles was lack of information on POP in the public domain. The main facilitators were feeling sexually unattractive and impaired physical ability due to POP.

Some findings from the interview study were further explored in the questionnaire study. One out of five women with vaginal prolapse did not know that the symptoms were related to prolapse before consulting their physician. Over 30% of the women in the incontinence group were embarrassed to talk about incontinence, and they were unaware that it could be treated. The most frequent description of vaginal prolapse was vaginal bulging. Women in the prolapse group had significantly less access to information through brochures and public media than women in the incontinence group (p < 0.001).

Conclusion: Short-term follow-up after vaginal hysterectomy showed that sexual activity and urinary symptoms had improved. Cystocele surgery using LA showed no disadvantage compared to surgery using other anaesthesia methods. POP surgery can therefore be performed safely with LA. Information on prolapse should be easily accessible to improve the possibility for women of gaining knowledge and thereby overcoming obstacles to seeking medical advice. Healthcare professionals have a significant role to play in informing women about symptoms and available treatment options.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2011. , 69 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1405
Keyword [en]
Vaginal prolapse, national register, pelvic organ prolapse surgery, anaesthesia, knowledge about prolapse, experience, qualitative content analysis, questionnaire
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-40613ISBN: 978-91-7459-153-8OAI: oai:DiVA.org:umu-40613DiVA: diva2:401371
Public defence
2011-03-25, Bergasalen, by 27, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-03-04 Created: 2011-03-02 Last updated: 2011-03-04Bibliographically approved
List of papers
1. Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care
Open this publication in new window or tab >>Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care
2009 (English)In: BMC Women's Health, ISSN 1472-6874, Vol. 9Article in journal (Refereed) Published
Abstract [en]

Background: Vaginal hysterectomy is often used to correct uterovaginal prolapse, however, there is little information regarding outcomes after surgery in routine clinical practice. The objective of this study was to investigate complications, sexual activity, urinary symptoms, and satisfaction with health care after vaginal hysterectomy due to prolapse.

Methods: We analyzed data from the Swedish National Register for Gynecological Surgery (SNRGS) from January 1997 to August 2005. Women participating in the SNRGS were asked to complete surveys at two and six months postoperatively. Of 941 women who underwent vaginal hysterectomy for uterovaginal prolapse, 791 responded to questionnaires at two months and 682 at six months. Complications during surgery and hospital stay were investigated. The two-month questionnaire investigated complications after discharge, and patients’ satisfaction with their health care. Sexual activity and urinary symptoms were reported and compared in preoperative and six-month postoperative questionnaires.

Results: Almost 60 % of women reported normal activity of daily life (ADL) within one week of surgery, irrespective of their age. Severe complications occurred in 3 % and were mainly intra-abdominal bleeding and vaginal vault hematomas. Six months postoperative, sexual activity had increased for 20 % (p=0.006) of women and urinary urgency was reduced for 50 % (p=0.001); however, 14 % (n=76) of women developed urinary incontinence, 76% (n=58) of whom reported urinary stress incontinence. Patients were satisfied with the postoperative result in 93 % of cases and 94 % recommended the surgery.

Conclusion: Vaginal hysterectomy is a patient-evaluated efficient treatment for uterovaginal prolapse with swift recovery and a low rate of complication. Sexual activity and symptoms of urinary urgency were improved. However, 14 % developed incontinence, mainly urinary stress incontinence (11 %). Therefore efforts to disclose latent stress incontinence should be undertaken preoperatively

Place, publisher, year, edition, pages
London: BioMed Central Ltd, 2009
Keyword
Prolaps
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-34472 (URN)10.1186/1472-6874-9-9 (DOI)19379514 (PubMedID)
Available from: 2010-06-09 Created: 2010-06-03 Last updated: 2011-03-31Bibliographically approved
2. Outcomes of cystocele repair surgery in relation to different anesthesia methods
Open this publication in new window or tab >>Outcomes of cystocele repair surgery in relation to different anesthesia methods
2010 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 7, 876-881 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate outcomes of cystocele surgery by different anesthesia and evaluation of patients’ satisfaction.

Design: Population-based, retrospective study.

Setting: All clinics including patients in the Swedish National Register for Gynecological Surgery.

Population: A total of 1364 women who underwent cystocele repair surgery from January 2006 to June 2009.

Methods: The study population was retrieved from the register among subjects who underwent surgery with complete information on concurrently used anesthesia. Clinical variables were compared. Peri- and postoperative complications were investigated. Multivariate logistic regression analysis was applied to identify independent factors for patient satisfaction.

Main outcome measures: Time to recovery, complications and patient satisfaction.

Results: We found a wide variation between hospitals with respect to use of local anesthesia in cystocele surgery. Length of hospital stay, duration of use of postoperative painkilling drugs, and patient-reported time to return to daily activity was shorter in the local anesthesia-group compared to the other two anesthesia forms. Postoperative complications did not differ between groups. Age (≥50 years) and patient-reported complications were independent factors related to patient satisfaction (OR 3.05; 95 %CI 1.36-6.82 and OR 0.21; 95 %CI 0.12-0.36 respectively). Patient satisfaction did not relate to methods of anesthesia.

Conclusion: Cystocele surgery can be performed safely using local anesthesia thus limiting use of more invasive anesthesia methods. Local anesthesia benefits patients and should be increased.

Place, publisher, year, edition, pages
Stockholm: NFOG, 2010
Keyword
Cystocele, anesthesia, national register, patient satisfaction
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-35174 (URN)10.3109/00016349.2010.487515 (DOI)000282892200003 ()
Available from: 2010-08-03 Created: 2010-08-03 Last updated: 2011-03-31Bibliographically approved
3. 'A hidden disorder until the pieces fall into place': a qualitative study of vaginal prolapse
Open this publication in new window or tab >>'A hidden disorder until the pieces fall into place': a qualitative study of vaginal prolapse
2010 (English)In: BMC Women's Health, ISSN 1472-6874, Vol. 10, no 1, 18- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Vaginal prolapse affects quality of life negatively and is associated with urinary, bowel, and sexual symptoms. Few qualitative studies have explored women's experiences of vaginal prolapse. The objective of the study was to elucidate the experiences of living with prolapse and its impact on daily life, prior to surgical intervention.

METHODS: In-depth interviews were conducted with 14 women with vaginal prolapse, prior to surgical treatment. Recruitment of the informants was according to 'purposive sampling'. An interview guide was developed, including open-ended questions addressing different themes, which was processed and revised during the data collection and constituted part of a study-emergent design. Data were collected until 'saturation' was achieved, that is, when no significant new information was obtained by conducting further interviews. Interviews were audiotaped, transcribed verbatim, and analyzed according to manifest and latent content analysis.

RESULTS: The theme defining the process of living with prolapse and women's experiences was labelled 'process of comprehension and action'. The findings constitute two categories: obstacles and facilitators to seeking health care. The category obstacles comprises six subcategories that define the factors restraining women from seeking health care: absence of information, blaming oneself, feeling ignored by the doctor, having a covert condition, adapting to successive impairment, and trivializing the symptoms and de-prioritizing own health. The category facilitators include five subcategories that define the factors promoting the seeking of health care: confirmation and support by others, difficulty in accepting an ageing body, feeling sexually unattractive, having an unnatural body, and reaching the point of action.

CONCLUSION: The main theme identified was the 'process of comprehension and action'. This process consisted of factors functioning as either obstacles or facilitators to seeking health care. The main obstacles described by the participants were lack of information and confirmation. The main facilitators constituted feeling sexually unattractive and impaired physical ability due to prolapse. Information on prolapse should be easily accessible, to improve the possibility for women to gain knowledge about the condition and overcome obstacles to seeking health care. Health care professionals have a significant role in facilitating the process by confirming and informing women about available treatment.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-34598 (URN)10.1186/1472-6874-10-18 (DOI)000208607500018 ()20497526 (PubMedID)
Note
Epub ahead of printAvailable from: 2010-06-09 Created: 2010-06-09 Last updated: 2011-03-31Bibliographically approved
4. Vaginal prolapse: perceptions and healthcare-seeking behaviour among women prior to gynecological surgery
Open this publication in new window or tab >>Vaginal prolapse: perceptions and healthcare-seeking behaviour among women prior to gynecological surgery
2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 10, 1115-1120 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To investigate perceptions of vaginal prolapse and healthcare-seeking behavior in women prior to gynecological surgery. Design. Prospective, cross-sectional study using a web-based questionnaire. Setting. Clinics including patients in the Swedish National Register for Gynecological Surgery (Gynop-register). Population. 214 women with vaginal prolapse and 347 women without prolapse as reference patients. Methods. A questionnaire was developed for assessment of women's perception of prolapse and their healthcare-seeking behavior. Data were collected through the Gynop-register. For comparisons between the study groups, Student's t-test and the chi-squared test were used. Main outcome measures. Perceptions of prolapse, healthcare-seeking behavior, and source of information. Results. The most common definition of prolapse reported by the women was presence of a vaginal bulge. Reasons for seeking healthcare were interference with physical activity and increasing symptoms. One in five women with prolapse could not relate the symptoms to prolapse. Participants in the prolapse group gained less information on their own condition from brochures and public media compared to participants in the reference group ( p<0.001). Conclusion. There appeared to be a lack of information on pelvic organ prolapse in the public domain. Healthcare professionals have a significant role to play in informing women about symptoms related to the condition and the available treatment options. [ABSTRACT FROM AUTHOR]

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-40547 (URN)10.1111/j.1600-0412.2011.01225.x (DOI)
Available from: 2011-02-28 Created: 2011-02-28 Last updated: 2014-05-15Bibliographically approved

Open Access in DiVA

fulltext(803 kB)3125 downloads
File information
File name FULLTEXT01.pdfFile size 803 kBChecksum SHA-512
57ca5971c7cbf6dae6842e8ad0483a7848aeaf2a603bc4eeb86d1ed550c740aac35236bfdcfef400bd74bd3f41ed41d716fbe53f57a042c7265b9ec42a5393cb
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Pakbaz, Mojgan
By organisation
Obstetrics and Gynaecology
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 3125 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1488 hits
ReferencesLink to record
Permanent link

Direct link