Title : The longitudinal impact of pelvic floor dysfunction on the quality of life in patients following gynecological tumor surgery: A prospective cohort study

Background: Pelvic floor dysfunction (PFD) is a common complication after gynecological tumor surgery, yet its long-term impact on patients’ quality of life is often underestimated, with a lack of systematic quantitative evidence to guide clinical interventions.

Objective: This study prospectively evaluates the incidence of pelvic floor dysfunction (PFD) in gynecological tumor patients post-hysterectomy, and quantitatively analyzes the longitudinal association between PFD symptoms and health-related quality of life (QLQ-C30) to provide evidence for formulating early intervention strategies.

Methods: A single-center prospective cohort study was conducted on 126 age- and stage-matched hysterectomy patients (45-65 years, tumor stage I-II; 69% endometrial cancer). The Pelvic Floor Distress Inventory-20 (PFDI-20) and EORTC Quality of Life Core Questionnaire (QLQ-C30) were used preoperatively and 3 months postoperatively to assess urinary incontinence (UI), anal incontinence (AI), pelvic organ prolapse (POP), and quality of life. Generalized estimating equations (GEE) were applied to analyze longitudinal associations between pelvic floor distress and quality-of-life scores.

Results: At the 3-month follow-up, the incidence of PFD was 47.6%. Patients with anal incontinence (AI) reported significantly lower overall quality-of-life scores than asymptomatic patients (61.4 ± 17.8 vs. 72.5 ± 18.7, P=0.006), with dual incontinence (DI) patients exhibiting even more severe impairment (P=0.019). Moreover, the generalized estimating equation model revealed a dose-response relationship, showing a 9.3-point decrease in overall quality of life for each additional PFD symptom (P=0.02).

Conclusions: Anal incontinence (AI) and double incontinence (DI) impair quality of life in post-gynecological tumor surgery patients; integrating early PFD screening, targeted rehabilitation, and a multidisciplinary (MDT) follow-up model is essential to improve long-term outcomes.

Attending Physician in Obstetrics and Gynecology (OB/GYN), with long-term dedication to clinical practice, scientific research, and academic teaching in the OB/GYN field. The physician has participated in multiple research projects, as well as the R&D and clinical application of medical patents and innovative technologies, and possesses extensive expertise in the diagnosis and management of gynecological pelvic floor disorders.