Goal attainment after treatment in patients with symptomatic pelvic organ prolapse


      The objectives of this study were to: (1) assess differences in goal attainment of self-described goals after treatment of symptomatic pelvic organ prolapse (POP) for women who chose surgery compared to women who chose pessary; and (2) compare patient global improvement between groups.

      Study Design

      Women who had symptomatic stage ≥II prolapse presenting for care of POP to the urogynecology clinic at the University of New Mexico were recruited. Patients listed up to 3 goals they had for their treatment. In addition, they completed the short forms of the Pelvic Floor Distress Inventory (PFDI-20), the POP/Urinary Incontinence Sexual Questionnaire, and the Body Image Scale. Goals listed by patients were then categorized into 10 categories. Each of the listed goals was categorized based on a consensus of 5 providers. At 3 months' follow-up patients listed if they had met their self-described goals on a scale of 0-10 and also answered the Patient Global Improvement Index (PGI-I).


      There were no significant differences between the 2 groups' baseline characteristics. Surgery patients ranked their goal attainment higher than pessary patients for all the 3 goals listed. Similarly, PGI-I scores were also higher in the surgical (2.4 ± 1.1) than the pessary (1.93 ± 0.8) treatment groups (P < .04). Patients in the surgery group also had better symptom improvement as measured by the PFDI-20 (P < .02).


      Patients who chose surgery had better global improvement and met their goals better compared to patients who chose pessary.

      Key words

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        • Kiresuk T.
        • Sherman R.
        Goal attainment scaling: a general method for evaluating community mental health programs.
        Commun Ment Health J. 1968; 4: 443-453
        • Elkadry E.A.
        • Kenton K.S.
        • FitzGerald M.P.
        • Shott S.
        • Brubaker L.
        Patient-selected goals: a new perspective on surgical outcome.
        Am J Obstet Gynecol. 2003; 189: 1551-1558
        • Hullfish K.L.
        • Bovbjerg V.E.
        • Steers W.D.
        Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up.
        Am J Obstet Gynecol. 2004; 191: 201-205
        • Komesu Y.M.
        • Rogers R.G.
        • Rode M.A.
        • et al.
        Patient-selected goal attainment for pessary wearers: what is the clinical relevance?.
        Am J Obstet Gynecol. 2008; 198: 577.e1-577.e5
        • Bump R.C.
        • Mattiasson A.
        • Bø K.
        • et al.
        The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.
        Am J Obstet Gynecol. 1996; 175: 10-17
        • Barber M.D.
        • Kuchibhatla M.N.
        • Pieper C.F.
        • Bump R.C.
        Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders.
        Am J Obstet Gynecol. 2001; 185: 1388-1395
        • Rogers R.G.
        • Coates K.W.
        • Kammerer-Doak D.
        • Khalsa S.
        • Qualls C.
        A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12).
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 164-168
        • Hopwood P.
        • Fletcher I.
        • Lee A.
        • Al Ghazal S.
        A body image scale for use with cancer patients.
        Eur J Cancer. 2001; 37: 189-197
        • Srikrishna S.
        • Robinson D.
        • Cardozo L.
        Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse.
        Int Urogynecol J. 2010; 21: 523-528
        • Srikrishna S.
        • Robinson D.
        • Cardozo L.
        • Cartwright R.
        Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration.
        BJOG. 2008; 115: 1362-1368
        • Adams S.R.
        • Dramitinos P.
        • Shapiro A.
        • Dodge L.
        • Elkadry E.
        Do patient goals vary with stage of prolapse?.
        Am J Obstet Gynecol. 2011; 205: 502.e1-502.e6
        • Srikrishna S.
        • Robinson D.
        • Cardozo L.
        A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery.
        BJOG. 2010; 117: 1504-1511
        • Hullfish K.L.
        • Bovbjerg V.E.
        • Gurka M.J.
        • Steers W.D.
        Surgical versus nonsurgical treatment of women with pelvic floor dysfunction: patient centered goals at 1 year.
        J Urol. 2008; 179: 2280-2285
        • Lowenstein L.
        • Kenton K.
        • Pierce K.
        • Fitzgerald M.P.
        • Mueller E.R.
        • Brubaker L.
        Patients' pelvic goals change after initial urogynecologic consultation.
        Am J Obstet Gynecol. 2007; 197: 640.e1-640.e3
        • Lowenstein L.
        • FitzGerald M.P.
        • Kenton K.
        • et al.
        Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 81-84
        • Srikrishna S.
        • Robinson D.
        • Cardozo L.
        Role of composite endpoints as an outcome assessment tool in urogenital prolapse.
        J Obstet Gynaecol. 2012; 32: 276-279