GOALS, SYMPTOMS, SIGNS, AND TREATMENTS AMONG WOMEN WITH PELVIC FLOOR DISORDERS

Purpose:    To determine if patient therapeutic goals reflect pelvic floor symptom burden, severity of anatomic prolapse, and treatment choice.

Method:    This study included women seen for a pelvic floor disorder (PFD) by a single surgeon in a specialty clinic from 1/02/2008 to 12/31/2009.  Patients without responses to surveys, detailed physical examination, or recorded self-described therapeutic goals were excluded.  A PFD was defined as any urinary or bowel complaint, pelvic organ prolapse, or sexual dysfunction.  Goals were categorized as seeking information, improving across six possible symptom categories (urinary, bowel, physical activity, sexual function, cosmetic appearance, and discomfort/pain) and ‘other.’  Symptom burden was determined using validated surveys of pelvic floor function (distress: overall (PFDI), urinary (UDI), bowel (CRADI), and prolapse (POPDI); impact: overall (PFIQ), urinary (UIQ), bowel (CRAIQ), and prolapse (POPIQ); and urinary incontinence severity (ISI)).  Health-related quality of life (HRQOL, SF12 MCS and PCS) and prolapse anatomic severity (SEV_POP) based on the POPQ system were assessed.  Correlations of goals with burden, HRQOL, and SEV_POP and surgical vs. non-operative care were evaluated.

Result:    Of 322 patients, 204 had recorded goals and 196 had valid baseline questionnaires.  Ninety patients had completed all prolapse-related surveys.  Comparing the 90 completers with the 106 non-completers revealed no differences at p < .05 for patient age, education level, or BMI.  However, the majority of the burden-related surveys indicated that the completers had greater burden and lower HRQOL.  The table below summarizes the relationship of 5 of the 8 different patient-generated goal categories with burden, HRQOL, treatment choice and prolapse severity.

Goals	Domain	Rate	Significant Correlations
1	Urinary	67%	UDI r=0.31,p<0.003	UIQ r=0.32,p<0.002	ISI r=0.31,p<0.003
2	Sexual	40%	MCS r= -0.33,p<0.002
3	Bowel	39%	CRADI r=0.35, p<0.001	CRAIQ r=0.30,p<0.004
4	Appearance	16%	SEV_POP r=0.38, p<0.001	POPIQ r=0.31,p<0.003	POPDI r=0.29,p<0.006
5	Activity	12%	Surgery r=0.36, p<0.001	PCS r=0.21,p<0.05

Conclusion:    Patient reported goals reflect symptom burden for bowel and bladder complaints while anatomic-based goals appear to reflect measurably altered anatomy.  Goals related to sexual function reflect overall mental HRQOL but not burden or anatomy.  Women seeking return to full activity preferred surgery as a therapeutic choice.  Future research is planned to determine the extent that perceived goal attainment relates to change in symptom burden and treatment choices at follow-up.