Pelvic dysfunctions are a common problem in the world, significantly reducing the quality of life of patients.  Vaginal reconstructive surgery is aimed at correcting these disorders. However, there is a proportion of patients who, after undergoing surgical treatment, experience new symptoms. The aim of our prospective cohort study was to identify predictors of de novo pelvic dysfunction after vaginal reconstructive surgery while monitoring patients for 12 months.

We conducted a prospective cohort study with patients who were admitted to the Department of urogynecology with a request for surgery from March to October 2023. Criteria for inclusion in the study: patients with symptomatic pelvic organ prolapse, urinary incontinence with no effect from conservative therapy.  Prior to surgery, the patients completed validated questionnaires – ICIQ-SF (International Conference on Incontinence Questionnaire Short Form), PFDI-20 (Pelvic Floor Distress Inventory), PFIQ-7 Pelvic Floor Impact Questionnaire), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire). After surgical correction, the patients were invited for a follow-up visit after 3, 6, and 12 months to assess their postoperative condition by re-filling out the questionnaire.

The study included 159 people who were admitted to the Department of urogynecology with a request for surgery from March to October 2023. The following groups of factors can be mentioned as possible predictors of postoperative urinary incontinence: higher score of the general ICIQ-SF questionnaire before surgery (p=0.045, OR 1.62 95% CI 1.01-2.59); higher BMI (p=0.042, OR 1.21 95% CI 1.01-1.46). The scores of the preoperative PFDI-20 questionnaire are a predictor of recurrence/occurrence of pelvic organ prolapse. At the same time, the low overall score of this questionnaire is a risk factor.  These data require further investigation as the number of patients and follow-up time increase.

These observations indicate the need for a thorough preoperative examination to identify patients with subtle but potentially significant symptoms of pelvic dysfunction. Although these symptoms may not be the main reason for seeking surgery, their presence may increase the risk of developing clinically significant de novo symptoms in the postoperative period. Addressing these underlying issues through preoperative interventions such as pelvic floor physiotherapy, biofeedback, or dietary changes can potentially reduce the risk of developing new or worsening symptoms of pelvic dysfunction after surgery.

The results of our study have important clinical significance. By identifying patients at higher risk of developing new symptoms of pelvic dysfunction after surgery, doctors can adapt their preoperative counseling and management strategies to reduce these risks. Improving the treatment and monitoring of patients with pelvic dysfunctions creates favorable conditions for reducing the number of postoperative complications and de novo symptoms.