# PROGRESS (Patient-Reported Outcomes in Genital Reconstructive Surgeries): A Validated Patient-Reported Outcome Measure Questionnaire to Assess Post-Operative Functional Improvement Following Feminising Genital Reconstructive Surgery

## TL;DR

This study validates a questionnaire to measure outcomes after feminising genital reconstructive surgery, showing significant post-operative improvement in most domains.

## Contribution

The PROGRESS questionnaire is a new validated tool for assessing post-operative outcomes in feminising genital reconstructive surgery.

## Key findings

- The PROGRESS questionnaire showed a statistically significant 35.8% improvement in overall scores at 52 weeks post-surgery.
- High Cronbach’s alpha scores confirmed reliability in four out of five domains, except for bowel function.
- The questionnaire is suitable for clinical use to assess functional outcomes following feminising genital reconstructive surgery.

## Abstract

Background/Objectives: Our aim was to validate a self-reported patient-reported outcome measure (PROM) questionnaire for use by patients undergoing feminising genital reconstructive surgery (fGRS). Methods: We used the Patient Reported Outcomes in Genital REconstructive SurgerieS (PROGRESS) questionnaire to examine key domains: urinary function, sexual function, cosmetic appearance, bowel function, and general health and wellbeing, which were identified as key components by our experienced surgeons. A reduction in score post-operatively represented an improvement in symptoms. Internal consistency was performed to determine the reliability of the questionnaire. Results: Between 2014 and 2024, 117 patients had completed pre- and post-operative questionnaires by week 52. The overall median score for all domains was 0.37 (interquartile range [IQR] 0.32–0.44) at baseline. At week 52 post-surgery, it was 0.24 (IQR 0.16–0.32), with a median difference (% change in overall score) of −0.12 (−35.8%) (p < 0.001). In all domains apart from bowel function, there was a reduction in scores that achieved statistical significance. There were high Cronbach’s alpha scores at baseline and at week 52 for four out of the five domains: general health and wellbeing a = 0.71 at week 0 and a = 0.79 at week 52; sexual function a = 0.83 at week 0 and a = 0.88 at week 52; cosmetic function a = 0.64 at week 0 and a = 0.84 at week 52; urinary function a = 0.74 at week 0 and a = 0.83 at week 52. Bowel function scored poorly, with a = 0.44 at week 0 and a = 0.49 at week 52. Conclusions: The questionnaire is suitable for use in clinical practice as a standardised way to assess functional outcomes following fGRS.