The study aimed to compare the surgical outcomes and quality of life outcomes before and after the surgery for post-hysterectomy vault prolapse by using the World Health Organization -quality of Life -BREF Score.

A prospective study was conducted over 20 women with post abdominal or vaginal hysterectomy vault prolapse following abdominal or vaginal hysterectomy admitted in a Tertiary referral hospital over 4-year periods for surgery. The inclusion criteria were women with post hysterectomy vault prolapse irrespective of indication and type of hysterectomy between 25-85 years of age who were willing to participate in the study. The study was approved by the Institute Ethical Committee. Informed written consent was taken from all the patients. The women with general prolapse, nulliparous prolapse, and who were not willing to participate were excluded from the study. A detailed history of symptoms of prolapse, any urinary complaints (SUI or Urge Incontinence), any bowel problems, fecal incontinence, menstrual or detailed obstetric history (mode of delivery, any obstructed or difficult labor), any chronic cough, constipation, or smoking were asked in all cases. All women underwent general physical examination, measurement of BMI, heart, chest, urological, abdominal, and gynecological examination including local examination, speculum examination, and vaginal examination to look for prolapse, its grading as per POPQ (Pelvic Organ Prolapse Quantification)was done. A pelvic muscle function assessment was done and a rectovaginal examination to assess the basal and contraction tone of the anal sphincter complex. Baseline investigations like hemogram, blood sugar (fasting, postprandial), renal and liver function test, urine examination, and urine culture were done for all cases. A urodynamic study was done only when women had urinary incontinence. Ultrasound for residual urine was done before and after surgery.
All women with vault prolapse were subjected to the World Health Organisation- Quality OF Life BREF (WHOQoL- BREF)  score before surgery and 6 months after surgery to assess their quality and to see the impact of surgery on their quality of life.. The permission to use the WHOQoL-BREF score was taken from the WHO. WHOQoL-BREF contains four domains; WHO-PSYCHO (psychological domain), WHO-ENV (environmental domain), WHO-SOCIAL (social relationship domain), and WHO-PHYS (physical domain). The score consists of 26 questions from the few different domains of well-being and 2 questions related to general health perception. It is a QoL questionnaire developed by WHO in 15 countries including India.
STATISTICAL ANALYSIS
Findings were compared using a sum of squares of means and a Chi-square test. The findings of POPQ classification and WHOQoL-BREF Score in vault prolapse were compared using Pearson’s coefficient after Bivariate regression analysis. Assessment of coherence between the clinical evaluation, POPQ, and WHOQoL-BREF score was done using an appropriate statistical method and Chi-square test with p-value of < 0.05 taken as significant.

The mean age, parity, and body mass index were 54.8 years, 3.5, and 22.71 kg/m2 respectively. Preceding surgery was vaginal hysterectomy in 75% of women and abdominal hysterectomy in 25% of women.  The complaints were bulge or mass feeling at the perineum (100%), pressure in the lower abdomen and perineum (55%), and constipation (60%). The type of prolapse was vault prolapse (100%), cystocele (100%), rectocele (100%) and enterocele (45%). POPQ findings were cystocele (90%), rectocele (90%), vault prolapse (100%), and enterocele (45%). The mean WHOQoL- BREF score preoperatively was WHO-Psycho; 12.20+/-2.39, WHO-ENV; 13.10+/-1.37, WHO-Social; 12.50+/-2.12, WHO-Phys; 11.90+/-2.02. It improved significantly 6 months after surgery in all domains and was 13.50+/2.506, 14.60+/-1.35, 14.30+/-1.25, 12.90+/-1.969 respectively (p range 0.0091 to 0.001).

clinical examination, POPQ classification and WHOQoL-BREF were applied on all women presenting with post hysterectomy vault prolapse. We applied all four domains of WHOQoL-BREF; physical, environmental, psychological and social domains before surgery and 6 months after surgery (vaginal sacrospinous fixation or abdominal sacrocolpopexy). There was significant improvement in QoL with surgery in all four In the present study domains with mean of WHO-PSYCHO rising from 12.20 to 13.50, WHO-ENV from 13.10 to 14.60, WHO-SOCIAL from 12.50 to 14.30 and who-phys from 11.90 to 12.90 (p range 0.009-0.001). 
The type of vault prolapse surgery (vaginal sacrospinous fixation (70%) versus abdominal sacrocolpopexy (30%) didn’t change the QoL-BREF (p 0.18). Surgery for vault prolapse can be done by vaginal route, abdominal, laparoscopy o

World Health Organisation- Quality OF Life BREF Score (WHOQoL- BREF) is a useful index to assess the impact of vault prolapse on quality of life and to see the impact of surgery on it.

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