Pelvic organ prolapse is a prevalent, non-life-threatening, and distressing condition affecting millions of women worldwide. Post-management outcomes are importantly influenced by patients' personal expectations, performance status, and overall health status. At a preoperative visit, it is important to establish the patient's goals and preferences and to determine the type of surgery that ideally matches these goals and preferences. Such an assessment should include an evaluation of medical comorbidities, functional status, sexual activity, beyond clinical examination with POP-Q classification, standardized cough test, and when needed a full urodynamic investigation. 
The aim of this study was to present the preoperative assessment of POP female patients with validated questionnaires in order to assess their quality-of-life.

This is a cross-sectional study performed in an Urogynecology unit of a Tertiary Academic Hospital. Women with POP were consecutively recruited during their preoperative evaluation; all patients filled in the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), Pelvic Organ Prolapse Symptom Score (POP-SS), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol- 5-dimensional questionnaire (EQ-5D). Women with previous incontinence and/or pelvic organ prolspase surgery were excluded. All participants were had undergone clinical examination with POP-Q classification, standardized cough test, and full urodynamics investigation when indicated. Informed oral consent was obtained as appropriately by all the participants, and the Hospital's Ethics Committee approved the study. All data were stored and analysed in Microsoft EXCEL. Paired t-tests and χ2 were used to compare the results among the groups. Statistical significance was defined as p<0.05.

A total of 114 participants were included. The mean±SD age, years in menopause, parity, BMI, height, weight, birth weight were 64.06±8.6 years, 15.29±8.57 years, 2.56±0.97 children, 28.30±4.31 kg/m2, 1.62±0.06 m,73.17±11.64 kg, and 3788.61±545.17 grams. The mean±SD of ICIQ-UI-SF was 6.31±6.09, and 38 subjects had no urinary incontinence. The mean±SD POP-SS and PISQ-12 scores were 11.11±6.05 and 16.30±13.40 respectively. Of these women, 68 (59.6%) were sexually active and 46 (40.4%) were not sexually active. Of the participants, 32% (33/101) had reported a good quality of health status regarding the EQ-5D. Younger patients (<60-years-old) had higher PISQ-12 scores (p=0.0219), mainly because they had higher score in the partner-related domain of this questionnaire (p=0.0007). There were 73 patients presenting only with POP symptoms (65.18%), 10 patients only with stress urinary incontinence (8.92%), and 18 patients with POP & SUI (16.07%). Regarding the ICIQ-SF, women with only POP had significantly lower score compared to women with SUI (p=0.002) and women with POP & SUI (p=0.013), whereas women with SUI did not score differently compared to women with POP & SUI (p=0.529). Regarding the POP-SS, women with only POP, only SUI, and both POP & SUI, had similar scores. Regarding the PISQ-12, women with only POP, only SUI, and both POP & SUI, had similar scores for all the PISQ-12 sub-categories and the total PISQ-12 score.

Quality of life is deteriorated in women with POP and SUI presenting for surgery. The partner factor plays a pivotal role in sexual life, therefore elder patients exhibit lower PISQ-12 scores than younger women mainly due to sexual issues related to their partner. However, the sexual life does not seem to be affected by the type of lower urinary tract symptoms. Patients with POP and/or SUI do not appear to score differently in any of the PISQ-12 domain, and in the total PISQ-12 score. It appears that LUTS and POP symptoms are more trivial parameters affecting sexual life compared to patients’ age and issues related to the partner.

The quality of sexual life in women with POP and SUI presenting for surgery is mainly related with the age of the patients and not the type of pelvic floor disorder. Similarly, the severity of symptoms in the POP-SS is universally affected and does not depend on the type of pelvic floor disorder. ICIQ-SF reflects the incontinence status clearly among women with incontinence and continent women with pelvic organ prolapse.

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