Hypothesis / aims of study
Although the average lifespan of women has increased, healthy life expectancy has not seen a parallel increase, thus presenting an urgent issue. Frailty significantly affects healthy life expectancy, and pelvic organ prolapse (POP) is commonly observed in elderly women. This study evaluated the associations between frailty, POP, and urinary symptoms.
Study design, materials and methods
Of the 119 patients who visited our outpatient clinic between April 2020 and November 2022 and underwent imaging studies for evaluation of POP, 65 patients with no prior treatment for POP and who underwent POP or urinary incontinence surgery at our institution were included in the study. POP quantification (POP-Q) was used to assess POP, and the impact on the quality of life was assessed using the P-QOL. The Kihon Checklist (KCL), a Japanese questionnaire for comprehensive frailty assessment, was used to assess frailty, and the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) were used to assess urinary symptoms. Postoperative POP-Q assessments were conducted in the outpatient clinic, and questionnaire evaluations were conducted retrospectively via a postal survey in January 2023.
Results
The mean patient age was 74.5 years. Severe POP cases were defined as stage 3 or higher, and severe POP cases were significantly worse than mild cases in almost all domains of the P-QOL. Frailty assessment using KCL revealed that cases with positive domains of motor function decline and pre-frail or frail cases were significantly more common in the severe cases of POP-Q. IPSS showed no association with POP severity, but ICIQ-SF and OABSS scores were worse when POP severity was higher. Postoperatively, P-QOL, IPSS, ICIQ, and OABSS improved, and the number of cases classified as pre-frail and frail by the basic checklist tended to decrease.
Interpretation of results
In this study, POP severity was found to affect QOL and was associated with muscle weakness and frailty. Surgical treatment showed potential improvements in QOL domains and a reduction in frailty. P-QOL was correlated with POP severity, whereas IPSS showed no association. The relationship between P-QOL and POP stage suggests that it may better reflect overall QOL. The correlation of the ICIQ-SF and OABSS with severity indicates that POP is more strongly related to storage symptoms. The reduction in positive frail cases postoperatively implies a positive impact of pelvic floor disorder treatment on conditions such as sarcopenia and frailty.