Body image improves among women undergoing prolapse repair regardless of whether or not hysterectomy is performed or transvaginal mesh is used

Abstract

NON-ORAL POSTER: 35
Objectives: To compare changes in body image among women with uterovaginal prolapse undergoing vaginal mesh hysteropexy (mesh hysteropexy) or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy).
Materials and Methods: This was a planned secondary analysis of a multi-center, randomized trial of women undergoing prolapse repair with a vaginal mesh hysteropexy versus hysterectomy. Women were masked to whether or not a hysterectomy was performed or whether or not mesh was used in the repair. The modified Body Image Scale (BIS) was completed at baseline and at 1.5, 6, 12, 18, 24, and 36 months after surgery. We estimated the minimally important difference (MID) in BIS scores based on half the standard deviation of baseline scores and compared women who had a change that met this standard. Individual BIS items were dichotomized into no impact versus any impact on body image to determine which aspects of body image changed the most following surgery. Comparison of baseline and follow-up scores were analyzed with linear and logistic repeated measures models adjusted for site, intervention, visit, and intervention × visit interaction.
Results: Eighty-eight women underwent mesh hysteropexy and 87 women underwent hysterectomy; women did not differ in baseline characteristics. Mean age of this cohort was 65.9 +/- 7.3 years, the majority were white (86%) and had advanced stage prolapse (stage 3 or 4) (81%). Mean BIS scores were not different at baseline and improved in both groups by 1.5 months after surgery. The improvement was sustained through 36 months postoperatively with no significant differences between groups (all p > 0.05) (Figure). The estimated MID was 3; by 36 months more women in the mesh hysteropexy group had achieved the MID than women in the hysterectomy group (63 vs 47%, p=0.04). No differences between groups were found on individual item scores (all p > 0.05). Aggregated changes in specific BIS items included improvements in feeling less physically attractive from prolapse (47 vs 6%), improvements in feeling less feminine (48 vs 6%), and improvements in feeling less sexually attractive (53 vs 13%) between baseline and 36 months postoperatively (all p < 0.001).
Conclusion: Body image improves following prolapse surgery regardless of whether or not a hysterectomy is performed or transvaginal mesh is used at the time of repair.