[64] The I-QOL is a 22-item scale targeting avoidance and limiting behavior, psychosocial impact scores and social embarrassment scores in women with UI. Physiotherapy given for 30 min weekly for 4 weeks, followed by two additional sessions over the remaining 6 weeks, resulted in significant improvement in both the PISQ-12 and I-QOL scores for both forms of exercise. Physiotherapy has also been shown to enhance the improvement in sexual function associated with surgical

treatment. In a randomized controlled trial, women with POP and UI who underwent preoperative physiotherapy had improved physical outcomes and QOL when compared to those who had surgery alone.[65] Sacrospinous fixation (SSF) is among the Rapamycin chemical structure vaginal procedures used for restoring the vaginal apex support. While few studies have examined the efficacy of SSF for apical support, one randomized controlled trial comparing SSF with abdominal sacrocolpopexy (ASC) reported a similar subjective success rate (women who reported no symptoms of prolapse) for both procedures an average of 2 years postsurgery

(91% vs. 94% respectively).[66] There was no difference in the objective success rate, defined as no evidence of prolapse beyond the halfway point of the vagina during a valsalva maneuver, VX-809 solubility dmso and both procedures significantly improved QOL as assessed by the UDI-6 and IIQ-7. SSF has also been associated with improved sexual function[67, 68] though the rate of de novo dyspareunia has been reported to range between 1% and 7%.[66, 68, 69] While ASC is associated with a lower rate of recurrent prolapse and less dyspareunia,[66, 70] SSF improves QOL while providing good objective and subjective outcomes, at lower cost and with no increase in the rate of intra-operative complications.[71] Anterior colporrhaphy remains one of the most frequent gynecological procedures for the management of cystocele in women with POP; though,

even when combined with other corrective procedures, it is associated with up to a 50% failure rate for cure of UI.[72] In one study that evaluated the impact of anterior colporrhaphy (combined with vaginal hysterectomy, transvaginal bladder neck suspension with/without posterior colporrhaphy) on QOL, triclocarban significant improvement was reported in all items of the QOL questionnaire that assessed vaginal bulging, difficulty urinating and UI and other health-related QOL items.[73] Further, these QOL improvements were sustained for 49 months postsurgery. These findings must be interpreted with some caution, however, as the authors did not use validated questionnaires. Nevertheless, concurrent with improved QOL, 79% of women with preoperative voiding symptoms achieved normal voiding, while 27% of those with preoperative urge incontinence had persistent symptoms postoperatively.