Assessment of the pelvic floor muscle functions before and after pelvic organ prolapse (POP) surgery and association with POP stage and symptoms

Abstract

Pelvic organ prolapse (POP) presents high prevalence in female population, causing a great socially and economically negative impact. At 80 years old, 11.1% of the women had indication for surgery repair of genital prolapse or urinary incontinence. Although some studies indicate that women with POP are more likely to have a decrease in pelvic floor muscles (PFM) strength, there is virtually no study in the literature evaluating as a primary goal PFM ability to contract and strength before and after the surgery for POP correction and its association with objective and subjective variables. The primary objective of the present study is to evaluate the PFM function before and after surgical treatment of POP, whereas the secondary aims are to verify whether there is any association between PFM function with POP stage and symptoms, with the perception of improvement, sexual satisfaction, and history of PFM training before and after surgery. This observational and prospective study will include women attending the Urogynecologic Unit of the Mercy Hospital for Women, Heidelberg, Melbourne, Australia. The inclusion criteria are to have medical indication for surgery repair of POP at stages II, III and IV, to have no previous pelvic surgery, no vaginal or urinary infection, reporting active sexual life in the previous four weeks, stable relationship with the partner, being literate, presenting no endocrinal disease interfering with sexual function, taking no anti-hypertensive drugs. The primary outcome measurements will be done using the modified Oxford scale and the Peritron manometer (Cardiodesign, Melbourne, Australia), whereas the POP-Q, Pelvic Floor Distress Inventory (PFDI-20) Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Patient Global Impression of Improvement (PGI-I) will be used for the secondary outcomes. All evaluations will be performed by only one examiner. Data will be analyzed by using the mixed-effect linear model. The model will be adjusted by using the SAS software, version 9.0. For associations and correlations of the muscle function with objective and subjective variables will be used logistic regression, Kendal correlation, Spearman correlation, Mann-Whitney test and Ch-square test at a significant level of 0.05. (AU)