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Outcomes of cystocele repair surgery in relation to different anesthesia methods
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
2010 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 7, 876-881 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate outcomes of cystocele surgery by different anesthesia and evaluation of patients’ satisfaction.

Design: Population-based, retrospective study.

Setting: All clinics including patients in the Swedish National Register for Gynecological Surgery.

Population: A total of 1364 women who underwent cystocele repair surgery from January 2006 to June 2009.

Methods: The study population was retrieved from the register among subjects who underwent surgery with complete information on concurrently used anesthesia. Clinical variables were compared. Peri- and postoperative complications were investigated. Multivariate logistic regression analysis was applied to identify independent factors for patient satisfaction.

Main outcome measures: Time to recovery, complications and patient satisfaction.

Results: We found a wide variation between hospitals with respect to use of local anesthesia in cystocele surgery. Length of hospital stay, duration of use of postoperative painkilling drugs, and patient-reported time to return to daily activity was shorter in the local anesthesia-group compared to the other two anesthesia forms. Postoperative complications did not differ between groups. Age (≥50 years) and patient-reported complications were independent factors related to patient satisfaction (OR 3.05; 95 %CI 1.36-6.82 and OR 0.21; 95 %CI 0.12-0.36 respectively). Patient satisfaction did not relate to methods of anesthesia.

Conclusion: Cystocele surgery can be performed safely using local anesthesia thus limiting use of more invasive anesthesia methods. Local anesthesia benefits patients and should be increased.

Place, publisher, year, edition, pages
Stockholm: NFOG , 2010. Vol. 89, no 7, 876-881 p.
Keyword [en]
Cystocele, anesthesia, national register, patient satisfaction
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-35174DOI: 10.3109/00016349.2010.487515ISI: 000282892200003OAI: oai:DiVA.org:umu-35174DiVA: diva2:332261
Available from: 2010-08-03 Created: 2010-08-03 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Vaginal prolapse – clinical outcomes and patients’ perspectives: a study using quantitative and qualitative methods
Open this publication in new window or tab >>Vaginal prolapse – clinical outcomes and patients’ perspectives: a study using quantitative and qualitative methods
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Pelvic organ prolapse (POP) is a relatively common condition. In Sweden, the overall estimated prevalence of POP in the female population is 31% and the prevalence of symptomatic prolapse is 8–15%. The prevalence of POP increases with age. The lifetime risk of undergoing pelvic floor surgery is estimated to 11%.

The aim of this thesis was to investigate outcomes of vaginal hysterectomy for treatment of prolapse; to study outcomes of cystocele repair surgery and patient satisfaction related to different anaesthesia methods; to explore women’s experiences of vaginal prolapse; and to investigate what is known regarding POP prior to surgery and healthcare-seeking behaviour.

Methods: In the Swedish National Quality Register for Gynaecological Surgery (Gynop-register), 941 women were identified who underwent vaginal hysterectomy for prolapse from 1997 to 2005 and 1,364 women were identified who underwent cystocele repair surgery from 2006 to 2009. In-depth interviews were performed with 14 women with vaginal prolapse. Interview data were analyzed with a qualitative content analysis. To investigate women’s knowledge about POP and healthcare-seeking behaviour, a questionnaire was developed, validated and distributed to women with planned surgery for POP. Women undergoing hysterectomy or incontinence surgery were used as reference groups.

Results: Severe complications after vaginal hysterectomy occurred in 3% of cases. Sexual activity was improved after vaginal hysterectomy, the number of women reported to have intercourse increased by 20% (p = 0.006). Subjective symptoms of urinary incontinence and overactive bladder were resolved in 50% of the women. De novo stress incontinence was reported by 11% of the women.

Use of local anaesthesia (LA) in reconstruction of cystocele showed advantage over other forms of anaesthesia. Length of hospital stay, duration of use of postoperative pain-killing drugs, and time to return to daily activity were shorter among women who underwent surgery with LA compared to other forms of anaesthesia. Patient satisfaction was not related to methods of anaesthesia.

In an interview study, the process from recognition the symptoms to seeking healthcare was highlighted. Two categories, “obstacles” and “facilitators” to seeking health care, were identified. One of the obstacles was lack of information on POP in the public domain. The main facilitators were feeling sexually unattractive and impaired physical ability due to POP.

Some findings from the interview study were further explored in the questionnaire study. One out of five women with vaginal prolapse did not know that the symptoms were related to prolapse before consulting their physician. Over 30% of the women in the incontinence group were embarrassed to talk about incontinence, and they were unaware that it could be treated. The most frequent description of vaginal prolapse was vaginal bulging. Women in the prolapse group had significantly less access to information through brochures and public media than women in the incontinence group (p < 0.001).

Conclusion: Short-term follow-up after vaginal hysterectomy showed that sexual activity and urinary symptoms had improved. Cystocele surgery using LA showed no disadvantage compared to surgery using other anaesthesia methods. POP surgery can therefore be performed safely with LA. Information on prolapse should be easily accessible to improve the possibility for women of gaining knowledge and thereby overcoming obstacles to seeking medical advice. Healthcare professionals have a significant role to play in informing women about symptoms and available treatment options.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2011. 69 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1405
Keyword
Vaginal prolapse, national register, pelvic organ prolapse surgery, anaesthesia, knowledge about prolapse, experience, qualitative content analysis, questionnaire
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-40613 (URN)978-91-7459-153-8 (ISBN)
Public defence
2011-03-25, Bergasalen, by 27, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-03-04 Created: 2011-03-02 Last updated: 2011-03-04Bibliographically approved

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