Preoperative staging of prolapse does not correlate with symptoms and quality of life

Abstract

Introduction. Several studies have shown minimal or no correlation with POP-Q stage and symptoms of pelvic organ prolapse (POP). This study evaluated the correlation between POP-Q stage, ordinal measurements, symptoms and quality of life (QOL) in women presenting for surgical management of POP. Methods: Forty-five women completed a preoperative questionnaire (PQOL) evaluating symptoms and QOL. These data were correlated with POP-Q stage and the ordinal measurements undertaken at the same visit. Prolapse was also categorised as mild or severe as determined by the most distal point in relation to the hymenal remnant. The best fit of data correlating QOL and anatomical severity of prolapse was established by reiterating analysis in successive 1cm increments from the hymenal remnant. Results: All women had at least stage 2 anterior prolapse and most women had coexisting apical and posterior prolapse. POP-Q stage did not correlate with symptoms and QOL. Correlations (r 0.28-0.36, p<0.05) were detected in five QOL domains when prolapse was defined as severe and Aa or Ba was 􀀁2 but not 􀀁1. Discussion: Anatomical findings, symptoms and QOL are distinct parameters that are all relevant in the evaluation of women with POP. Ordinal measurement of POP is useful in the evaluation of women presenting for surgery, however POP-Q staging may not be useful and POP-Q stage 2 is not an appropriate threshold for determining surgical outcome.