Patient-Reported Outcome Measures used to Assess Surgical Interventions for Pelvic Organ Prolapse, Stress Urinary Incontinence and Mesh Complications: A Scoping Review for the Development of the APPRAISE PROM

Background: This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability.

Objectives: To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools, and the outcomes/experiences assessed.

Search Strategy: Three databases searched from inception to September 2023 were screened by two independent reviewers.

Selection Criteria: Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed.

Data Collection and Analysis: Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed.

Main Results: Of the 2,079 included primary studies, 1,607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1,082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, and body image, and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes.

Conclusions: Currently no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.

Keywords: pelvic organ prolapse; urinary incontinence, stress; pelvic floor; surgical mesh; prolapse; urinary incontinence; pelvic; surgery; prolapse treatment; outcomes; PROMs; PREMs; NIHR