All patients will be operated by the same surgeon. Antibiotic prophylaxis will be given
pre-operatively according hospital protocols 30 minute before surgery. Surgery will be
performed under general anesthesia in the lithotomy position with legs in stirrups The
following peri-operative and patient data will be collected and analyzed: preoperative POP-
Q, body mass index (BMI), age, parity, history of vaginal delivery, previous pelvic surgery,
total operating time, estimated bloodloss, serum hemoglobin (Hb) drop (change between
preoperative Hb and postoperative Hb 1 day after surgery), peri-operative complications,
post- operative pain score and POP-Q after 6 and 12 months.
The ICIQ-LUTSqol questionnaire (International Consultation on Incontinence Questionnaire
Lower Urinary Tract Symptoms Quality of Life Module) is a psychometrically robust patient-
completed questionnaire evaluating quality of life (QoL) in urinary incontinent patients with
particular reference to social effects. It has 20 items to response with overall score
between 19- 76 indicating increased impact on quality of life with greater values.
Subjective surgical outcome was measured using the Patient Global Impression of Improvement
(PGI-I), which is a validated tool as a global index of response to prolapse surgery. The
PGI-I is a seven-scale response for women comparing the postoperative condition with the
pre-operative state, 1 being very much better and 7 being very much worse.
The women's prolapse symptoms and their impact will be evaluated before surgical treatment. A
subjective assessment of the prolapse was made using Pelvic Organ Prolapse/Urinary
Incontinence Sexual Questionnaire IUGA revised (PISQ-IR) before and 12 months after
treatment. The PISQ-IR is designed as a condition-specific measure of sexual function in
women with pelvic floor dysfunction, including urinary and anal incontinence and pelvic organ
prolapse. It consists on 18-21 questions depending weather respondent indicates having a
sexual partner or not. The cutoff score of 2.68 for PISQ-IR Summary Score allowed to diagnose
sexual dysfunction in sexually active women with pelvic floor disorders.
Pelvic floor ultrasound will be performed before the operation and at 6 and 12 months after
the operation. The inspection methods are as follows: Before the inspection, patients emptied
the stool and moderately filled the bladder. The following parameters will be measured in
resting state using the maximal Valsalva maneuver: Posterior vesicourethral angle (PVA):This
included the angle between the proximal urethra and posterior wall of the bladder. Urethral
tilt angle: This included the angle between the proximal urethra and vertical axis of the
human body. Value is negative if the urethral axis deviated to the ventral side, and the
value was positive when it is deviated to the dorsal side. Postoperative rotation angle of
the urethra (UR): This refers to the difference in PVA between the Valsalva state and resting
state. Bladder neck descent (BND): This refers to the vertical displacement of the bladder
neck between the Valsalva state and resting state.