Shakhaliev RA, Kubin ND, Nikitina TP, Ionova TI, Shkarupa DD. Comprehensive assessment of the quality of life in patients with pelvic organ prolapse before surgical treatment: A prospective cohort observational study. Gynecology. 2024;26(3):216–222. DOI: 10.26442/20795696.2024.3.202920
Комплексная оценка качества жизни пациенток с пролапсом тазовых органов перед проведением хирургического лечения
Шахалиев Р.А., Кубин Н.Д., Никитина Т.П., Ионова Т.И., Шкарупа Д.Д. Комплексная оценка качества жизни пациенток с пролапсом тазовых органов перед проведением хирургического лечения. Гинекология. 2024;26(3):216–222. DOI: 10.26442/20795696.2024.3.202920
Shakhaliev RA, Kubin ND, Nikitina TP, Ionova TI, Shkarupa DD. Comprehensive assessment of the quality of life in patients with pelvic organ prolapse before surgical treatment: A prospective cohort observational study. Gynecology. 2024;26(3):216–222. DOI: 10.26442/20795696.2024.3.202920
Цель. Провести комплексную оценку качества жизни (КЖ) пациенток с пролапсом тазовых органов (ПТО), имеющих показания к реконструктивным операциям (РО), и определить оптимальные инструменты для оценки КЖ в рамках предоперационного скрининга. Материалы и методы. В исследовании приняли участие 860 больных, госпитализированных для проведения РО в Клинику высоких медицинских технологий им. Н.И. Пирогова ФГБОУ ВО СПбГУ. Для оценки КЖ использовали валидированные опросники: общий опросник КЖ RAND SF-36 и специализированные опросники, в частности опросник КЖ при ПТО P-QoL, опросник дисфункции тазовых органов PFDI-20, опросник оценки степени стрессового недержания мочи ICIQ-SF, опросник оценки сексуальной дисфункции при ПТО PISQ-12, Госпитальную шкалу тревоги и депрессии HADS. Боль внизу живота и в пояснице определяли с помощью Визуальной аналоговой шкалы. Результаты. Значительные нарушения КЖ обнаружены у большинства пациенток, включая физические и психоэмоциональные аспекты. Среди больных не выявлено женщин с высоким уровнем физического и психического компонентов здоровья. В большей степени снижены показатели жизнеспособности, общего здоровья, ролевого физического и эмоционального функционирования. Более 1/3 женщин имели пограничный или повышенный уровень тревоги, 1/4 – высокий уровень депрессии. Важно, что опросник P-QoL применен впервые в отечественной популяции пациенток с ПТО. С помощью него определены общее восприятие состояния здоровья, влияние пролапса на жизнь, ролевые, физические, социальные ограничения, ограничения личных взаимоотношений, эмоции, сон/энергия и тяжесть симптомов. На основе проведенного исследования предложены оптимальные инструменты для предоперационного скрининга и мониторинга состояния больных после хирургического вмешательства. Заключение. Популяция женщин с ПТО, имеющих показания к РО, неоднородна по степени выраженности нарушений физического, психосоциального функционирования и степени влияния симптомов несостоятельности тазового дна. В качестве оптимальных инструментов для оценки КЖ и бремени симптомов у пациенток с ПТО в рамках предоперационного скрининга можно рассматривать следующие опросники: P-QoL – для оценки нарушений разных аспектов КЖ, PFDI-20 – для определения выраженности специфических симптомов дисфункции тазовых органов, HADS – для выявления уровня тревоги и депрессии.
Ключевые слова: пролапс тазовых органов, качество жизни, PQoL, валидированные опросники
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Aim. To evaluate comprehensively the quality of life (QoL) of patients with pelvic organ prolapse (POP) who have indications for reconstructive surgery (RS) and determine the optimal tools for QoL assessment as part of preoperative screening. Materials and methods. The study included 860 patients hospitalized for RS at the Saint-Petersburg State University Hospital. The following validated questionnaires were used to assess QoL: the RAND SF-36 (general QoL questionnaire and specialized questionnaires), in particular the P-QoL (QoL Pelvic Organ Dysfunction Questionnaire in POP), the PFDI-20 (Pelvic Organ Dysfunction Questionnaire), the ICIQ-SF (Stress Incontinence Questionnaire), the PISQ-12 (PTD Sexual Dysfunction Questionnaire), the HADS (Hospital Anxiety and Depression Scale). Lower abdominal and lower back pain was assessed using a Visual Analog Scale. Results. Significant QoL reduction was found in most patients, including in physical and psycho-emotional aspects. Among the patients, there were no women with a high level of physical and mental health components. The indicators of vitality, general health, role-physical, and emotional functioning were more significantly reduced. More than 1/3 of women had borderline or increased levels of anxiety, and 1/4 had high levels of depression. Notably, the P-QoL questionnaire was used for the first time in the russian population of patients with POP. It identifies general health perceptions, the impact of prolapse on life, role, physical, social and personal limitations, emotions, sleep/energy, and symptom severity. Based on the study, optimal tools for preoperative screening and monitoring the state of patients after surgery are proposed. Conclusion. The population of women with POP with indications for RS is heterogeneous in terms of the severity of physical and psychosocial functioning impairment and the degree of impact of pelvic organ prolapse symptoms. The following questionnaires can be considered as optimal tools for assessing QoL and symptom burden in patients with POP as part of preoperative screening: P-QoL to assess the decrease of various QoL aspects, PFDI-20 to determine the severity of specific pelvic organ dysfunction symptoms, HADS to identify the level of anxiety and depression.
Keywords: pelvic organ prolapse, quality of life, PQoL, validated questionnaires
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20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. DOI:10.1111/j.1600-0447.1983.tb09716.x
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2021;27(6):337-43. DOI:10.1097/SPV.0000000000001069
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28. Vrijens D, Berghmans B, Nieman F, et al. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre. Neurourol Urodyn. 2017;36(7):1816-23. DOI:10.1002/nau.23186
________________________________________________
1. Good MM, Solomon ER. Pelvic Floor Disorders. Obstet Gynecol Clin North Am. 2019;46(3):527-40. DOI:10.1016/j.ogc.2019.04.010
2. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141-8. DOI:10.1097/AOG.0000000000000057
3. Gvozdev MIu, Tupikina NV, Kasian GR, Pushkar' DIu. Prolaps tazovykh organov. Metodicheskie rekomendatsii. Moscow: ABV-press, 2016 (in Russian).
4. Ghanbari Z, Ghaemi M, Shafiee A, et al. Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(23):7166.. DOI:10.3390/jcm11237166
5. Kasyan GR, Tupikina NV, Gvozdev MYu, Pushkar DYu. Pelvic organ prolapse and occult stress in continence. Experimental and Clinical Urology. 2014;1:98-102 (in Russian).
6. Peinado Molina RA, Hernández Martínez A, Martínez Vázquez S, Martínez Galiano JM. Influence of pelvic floor disorders on quality of life in women. Front Public Health. 2023;11:1180907. DOI:10.3389/fpubh.2023.1180907
7. Molina-Barea R, Slim M, Calandre EP. Health-Related Quality of Life and Psychosocial Variables in Women with Colorectal Pelvic Floor Dysfunction: A Cross-Sectional Study. Healthcare (Basel). 2024;12(6):668. DOI:10.3390/healthcare12060668
8. Carroll L, O' Sullivan C, Perrotta C, Fullen BM. Biopsychosocial profile of women with pelvic organ prolapse: A systematic review. Womens Health (Lond). 2023;19:17455057231181012. DOI:10.1177/17455057231181012
9. Svihrova V, Svihra J, Luptak J, et al. Disability-adjusted life years (DALYs) in general population with pelvic organ prolapse: a study based on the prolapse quality-of-life questionnaire (P-QOL). Eur J Obstet Gynecol Reprod Biol. 2014;182:22-6. DOI:10.1016/j.ejogrb.2014.08.024
10. Khan K, Rada M, Elfituri A, et al. Outcome reporting in trials on conservative interventions for pelvic organ prolapse: A systematic review for the development of a core outcome set. Eur J Obstet Gynecol Reprod Biol. 2022;268:100-9. DOI:10.1016/j.ejogrb.2021.08.028
11. Novik AA, Ionova TI, Gandek B, et al. Pokazateli kachestva zhizni naseleniia Sankt-Peterburga. Problemy Standartizatsii v Zdravookhranenii. 2001;4:22-31 (in Russian).
12. Shkarupa DD, Kubin ND, Peshkov NO, et al. Russian-language versions of questionnaires for assessing the quality of life of patients with pelvic organ prolapse and stress urinary incontinence. Experimental and Clinical Urology. 2016;1:94-7 (in Russian).
13. Shakhaliev R, Kubin N, Nikitina T, et al. Validation of the Russian Version of the Prolapse Quality-of-life Questionnaire and its Application to Assess the Impact of Pelvic Organ Prolapse on Quality of Life and the Effect of Treatment in Women Undergoing Reconstructive Surgery. Int Urogynecol J. 2024;35(4):863-72. DOI:10.1007/s00192-024-05764-w
14. Andrjushhenko AV, Drobizhev MJu, Dobrovol'skij AV. Comparative assessment scales CES-D, BDI and HADS(d) in the diagnosis of depression in general practice. Journal of Neurology and Psychiatry. 2003;5:11-8 (in Russian).
15. Hays RD, Sherbourne CD, Mazel RM. User’s Manual for the Medical Outcomes Study (MOS) Core measures of health-related quality of life. RAND Corporation, 1995. MR-162-RC. Available at: http://www.rand.org. Accessed: 17.03.2024.
16. Digesu GA, Khullar V, Cardozo L, et al. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):176-81. DOI:10.1007/s00192-004-1225-x
17. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103-13. DOI:10.1016/j.ajog.2004.12.025
18. Gotoh M. Quality of life assessment for patients with urinary incontinence. Nagoya J Med Sci. 2007;69(3-4):123-31.
19. Rogers RG, Coates KW, Kammerer-Doak D, et al. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164-8. DOI:10.1007/s00192-003-1063-2
20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. DOI:10.1111/j.1600-0447.1983.tb09716.x
21. Shakhaliev RA, Kubin ND, Nikitina TP, et al. Mediko-sotsial'nyi profil' patsientok s prolapsom tazovykh organov/stressovym nederzhaniem mochi, imeiushchikh pokazaniia k rekonstruktivnym operatsiiam. Vestnik Urologii. 2024 (in Russian).
22. O'Shea M, Boyles S, Bradley CS, et al. AUGS-PERFORM: A New Patient-Reported Outcome Measure to Assess Quality of Prolapse Care. Female Pelvic Med Reconstr Surg. 2022;28(8):468-78. DOI:10.1097/SPV.0000000000001225
23. Pushkar' DIu, Gvozdev MIu, Tupikina NV. Questionnaires as a tool for assessing the quality of life in urogynecological patients. Russian Bulletin of Obstetrician-Gynecologist. 2013;13(1):23‑9 (in Russian).
24. Bradley CS, Brown HW, Shippey SS, et al. Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg.
2021;27(6):337-43. DOI:10.1097/SPV.0000000000001069
25. Doaee M, Moradi-Lakeh M, Nourmohammadi A, et al. Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J. 2014;25(2):153-63. DOI:10.1007/s00192-013-2141-8
26. Danilina OA, Volkov VG. Mental health of women with pelvic prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2021;21(6):77‑81 (in Russian). DOI:10.17116/rosakush20212106177
27. Verbeek M, Hayward L. Pelvic Floor Dysfunction And Its Effect On Quality Of Sexual Life. Sex Med Rev. 2019;7(4):559-64. DOI:10.1016/j.sxmr.2019.05.007
28. Vrijens D, Berghmans B, Nieman F, et al. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre. Neurourol Urodyn. 2017;36(7):1816-23. DOI:10.1002/nau.23186
Клиника высоких медицинских технологий им. Н.И. Пирогова ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия
*rustam.shahaliev@gmail.com
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Rustam A. Shakhaliev*, Nikita D. Kubin, Tatiana P. Nikitina, Tatyana I. Ionova, Dmitry D. Shkarupa