Treat (the whole of) me: a systematic review and qualitative meta-ethnographic synthesis of the experiences of women with POP, SUI or mesh complications in the context of surgical treatment

Background

Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) are common pelvic floor disorders that may significantly impact women’s quality of life. Surgical interventions are available to treat these conditions, some using synthetic mesh. Whilst most women experience good surgical outcomes, others experience complications; in some cases, this has led to further corrective surgery. As part of the NIHR-funded APPRAISE project which aims to develop surgery-specific PROM and PREM measures for women undergoing treatment for POP, SUI, or mesh complications, we conducted a systematic review of qualitative evidence. The review synthesised findings from existing studies to ensure these measures accurately reflect surgical outcomes and experiences of care.

Methods

We conducted a systematic review of qualitative research with women eligible for surgery for POP, SUI and mesh complications, using meta-ethnography to synthesise study results. Key concepts were synthesised into third-order constructs and a line of argument to reveal insights beyond individual studies.

Results

A total of 2,613 titles and abstracts and 254 full-text articles were screened, with 18 publications included in the final synthesis. We developed 14 third-order constructs, which were abstracted into six higher order themes, reflecting the trajectory of women’s experiences from living with the conditions through to life after surgery. These themes formed the basis of our line of argument synthesis, which demonstrated that that surgical outcomes cannot be understood solely through clinical symptom assessment, and that women’s perceptions of their condition are closely tied to their experiences of care and their social roles. To illustrate the implications for clinical practice, we also developed a visual representation of the synthesis.

Conclusions

The findings speak to the importance of determining what matters to women in defining good outcomes following surgery for POP, SUI or mesh complications and of creating the conditions within which women are able to communicate their needs. This highlights the value of a validated PROM and PREM to capture key functional and quality of life outcomes for women pre- and post-surgery, and to support them in having meaningful conversations with their healthcare providers.

Trial registration

PROSPERO CRD42023412750.