This is the first report of investigate the change of physical performance, muscle strength and skeletal muscle mass in patients undergoing pelvic organ prolapse (POP) surgery. 
In developing countries, especially in Japan, elderly population is increasing, and the rate of aged > 65 years reached 29.1% in 2023. POP is a common pelvic floor disorder, especially in elderly women, which greatly affects a women’s quality of life. Women with pelvic floor dysfunction reportedly restrict their daily activities, which can lead to geriatric syndromes, such as frailty and sarcopenia. Moreover, the common age of patients with POP overlaps with that of geriatric syndrome, and several studies have reported that preoperative frailty and sarcopenia increase the risk of perioperative complications. However, there are no reports on changes in physical function and skeletal muscle mass in patients who underwent POP surgery. Therefore, we investigated the effects of sarcopenia on physical performance, skeletal muscle mass, and muscle strength, which are the diagnostic criteria for sarcopenia, in patients undergoing POP surgery.

After approval was obtained from the Ethics Committee, written informed consent was obtained before the treatment. According to the Asian Working Group for Sarcopenia 2019, physical performance was evaluated by 6m walking speed (cut off point < 1.0 m/sec), muscle strength was evaluated by grip strength (cut off point <18 kg), and appendicular skeletal muscle mass (ASM) using bioelectrical impedance analysis (cut off point < 5.7 kg/m2) were prospectively evaluated before, one month, and 3, 6 and 12 months after POP surgery. Sarcopenia was defined as low ASM and low hand grip strength or low ASM and low physical performance. The Wilcoxon signed-rank test was used for the statistical analyses and p-values of <0.05 were considered statistically significant.

Between March 2021to and March 2023, 62 cases were evaluated. The median age was 74.5 (range 56-83) years, all patients were postmenopausal, 40 patients (64.5%) were diagnosed with POP-Q stage III, and 22 patients (35.5%) were diagnosed with POP-Q Stage IV. Preoperatively, two patients (3.2%) were diagnosed with sarcopenia. Median 6 m walking speed was significantly improved at one month (6.1, range: 4.0-10.2 sec) (p=0.045), three months (5.9, range: 4.1-10.4 sec) (p=0.003), six months (6.0, range: 4.1-10.2 sec) postoperatively compared with the baseline value (6.9, range: 4.2-11.5 sec), however, at 12 months (6.1, range: 4.1-10.0 sec) (p=0.082), no statistically significant improvement was observed compared to baseline value. Medan hand grip strength was also significantly improved at one month (20.0, range: 10.5-34.7 kg) (p=0.008), three months (20.3, range: 10.5-34.7 kg) (p<0.001) six months (20.1, range: 10.5-34.7 kg) postoperatively compared with the baseline value (19.1, range: 10.4-31.7 kg), but no statistically significant difference was observed at 12 months (19.6, range: 10.8-30.4 kg). Conversely, median ASM significantly decreased at one month (6.48, range; 5.18-8.34 kg/m2) (p<0.001) compared with the baseline value (6.61, range; 5.65-9.24 kg/m2), but recovered to baseline value at three months (6.51, range; 5.65-8.73) (p=0.115), six months (6.64, range; 5.23-8.73) (p=0.093), 12 months (6.65, range; 5.65-8.68) (p=0.062). There was no change in the sarcopenia rate at any point.

This study demonstrated that POP surgery improved physical performance and muscle strength despite the short term (one month) and maintained them in the medium term (three and six months) in patients with symptomatic POP. However, in the long term (12 months) these improvements regressed back to preoperative levels. Skeletal muscle mass decreased in the short term (one month) but recovered in the medium to long term (three to 12 months). It seems that the resolution of POP symptoms by POP surgery may contribute to the improvement of patients’ daily activities and lead to better physical performance and muscle strength.

To the best of our knowledge, this is the first study to evaluate the effects of POP repair surgery on the physical performance, muscle strength, and skeletal muscle mass. POP surgery improves physical performance and muscle strength in medium term. It is considered necessary for healthcare providers to implement regular interventions for the preservation of physical function.

Continence 12S (2024) 101621
DOI: 10.1016/j.cont.2024.101621