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.

Made available in DSpace on 2015-07-22T20:50:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-11-25. Added 1 bitstream(s) on 2015-08-11T03:25:36Z : No. of bitstreams: 1 Publico-045.pdf: 1293717 bytes, checksum: aa77a18d9ad66fac463c08766304abf5 (MD5) / Objetivo: avaliar os resultados anatômicos, funcionais e complicações do tratamento do prolapso da parede vaginal anterior com tela de submucosa de intestino delgado suíno (SIS) e com colporrafia anterior. Pacientes e Métodos: estudo prospectivo e randomizado para comparação do uso de tela de SIS e de colporrafia tradicional. As mulheres foram avaliadas no pré-operatório e com seis meses após a cirurgia. Os parâmetros utilizados foram: sistema de quantificação do prolapso genital (POP-Q), questionário de qualidade de vida validado (P-QoL) e complicações. Os dados foram analisados pelo teste de Mann-Whitney e Qui-quadrado para avaliação da homogeneidade entre os grupos. A seguir, utilizamos o teste t-Student pareado ou teste t-Student de amostras independentes. O estudo foi aprovado pelo Comitê de Ética Local e registrado no ClinicalTrials com o número NCT00827528. Resultados: os resultados representam a análise de 29 pacientes no grupo com tela de SIS e 27 no grupo com colporrafia tradicional. Os grupos foram semelhantes consoante idade, índice de massa corpórea, paridade, estádio do prolapso, cirurgia prévia para prolapso, presença de incontinência urinária de esforço, pontuação no questionário de qualidade de vida e medidas dos pontos anatômicos no pré-operatório. Com seis meses de seguimento, a taxa de cura anatômica no grupo com tela foi de 86,2% comparada com 59,3% no grupo da colporrafia, pelo critério da Sociedade Internacional de Continência (ICS). Não houve diferença de sucesso anatômico entre as técnicas quando consideramos a subdivisão do estádio II. A média do ponto Ba, pré-operatória, no grupo com tela foi de +2,07 cm e +2,22 cm na colporrafia e, no pós-operatório, de -1,93 cm (p<0,001) e de -1,37 cm (p<0,001), respectivamente. O NNT (Número Necessário a Tratar) foi 4. Ambos os procedimentos melhoraram de forma significativa as medidas de qualidade de vida. Contudo, o grupo com tela não demonstrou diferença quando comparado ao da colporrafia tradicional. Houve 4 pacientes com sangramento excessivo no grupo SIS, embora nenhuma requereu hemotransfusão. Observamos maior número de complicações no grupo SIS (20 vs 9; p=0,01) e maior tempo cirúrgico (48,3 min ±16,1 vs 30,3min ±19,4; p=0,001). O tempo de internação hospitalar foi de 3,3 e 3,2 dias, respectivamente. Não houve casos de infecção ou de erosão da tela. Conclusão: As cirurgias para o prolapso genital resultam em melhora significativa da qualidade de vida. Observamos melhor cura anatômica do ponto Ba com tela, de acordo com o critério da ICS. Consoante os parâmetros de qualidade de vida não houve diferença entre as técnicas. Houve maior número de complicações no grupo com tela. / Objective: the aim of this study was to evaluate anatomical, functional results and complications of small intestine submucosa (SIS) graft compared to traditional anterior repair in surgical treatment of anterior vaginal wall prolapse. Methods: This is a randomized and prospective study to compare the SIS graft with traditional colporrhaphy (TC) in surgical treatment of anterior vaginal prolapse. Subjects were randomized to SIS (n=29) or to TC (n=27) and compared preoperatively and at 6 months postoperatively. We used pelvic organ quantification system (POP-Q), a validated prolapse quality of life questionnaire (P-QoL) and possible complications. Data were compared using the Mann–Whitney test or a chi-squared test to determine that there were no significant intergroup differences. This then enabled us to use the independent samples t-test or the paired Student’s t-test. This study was approved by Local Ethics Committee and register at ClinicalTrials NCT00827528. Results: the outcomes represent the analysis of 29 patients in SIS group and 27 in traditional repair. Both groups were paired by age, parity, body mass index, stage of anterior prolapse, previous surgery for prolapse, presence of incontinence, POP-Q measurements and quality of life preoperatively. At 6-month follow-up, SIS group have 86.2% anatomic cure comparing with 59.3% in traditional repair, using the International Continence Society (ICS) patterns. We did not report differences between the techniques when we divided the stage II. The mean point Ba preoperatively in SIS group was +2.07 cm and +2.22 cm in traditional repair and postoperatively -1.93 cm (p<0.001) and -1.37 cm (p<0.001), respectively. The NNT (Number Need to Treat) was 4. Both operations significantly improved prolapse quality-of-life severity measures. Although SIS group did not showed significant improvement in quality-of-life parameters measured in comparison to traditional repair. Excessive bleeding occurred in 4 patients in SIS group although none required blood transfusion. We reported more complications in SIS group (20 vs 9, p=0.01) and longer surgical time (48.3min ±16.1 vs 30.3min ±19.4; p=0.001). The average hospital length was 3.3 and 3.2 days, respectively. We did not reported infections or erosion of the mesh. Conclusions: Surgery for vaginal prolapse results in marked improvement in prolapse quality of life. We could see that SIS repair improved point Ba measurement significantly using the ICS patterns. Regarding quality-of-life parameters we did not observe significant differences in both techniques. / TEDE / BV UNIFESP: Teses e dissertações