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Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse

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Abstract

Introduction and hypothesis

The aim of this study is to evaluate and compare the effectiveness of pessaries and surgery in women with symptomatic pelvic organ prolapse.

Methods

A total of 554 women with symptomatic pelvic organ prolapse (POP) were recruited and treated with either a vaginal pessary (n = 359) or surgery (n = 195). Using the validated Sheffield POP questionnaire, outcomes were evaluated and then compared at 1 year.

Results

At 1 year, the only significant difference between the two groups was increased frequency of intercourse in the surgery group (54% vs 46%; p = 0.028), which was not significant when controlled for age. There was a statistically significant improvement in prolapse, urinary, bowel, and sexual function in both pessary users and those treated surgically.

Conclusions

One year after treatment, women with POP report similar improvement in urinary, bowel, sexual function, and quality of life parameters when treated with pessary or surgical correction.

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References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506

    Article  CAS  PubMed  Google Scholar 

  2. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V (2005) The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 112:971–976

    Article  PubMed  Google Scholar 

  3. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL (2004) Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol 190:1025–1029

    Article  PubMed  Google Scholar 

  4. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW (2006) Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol 108:93–99

    Article  PubMed  Google Scholar 

  5. Komesu YM, Rogers RG, Rode MA, Craig EC, Gallegos KA, Montoya AR et al (2007) Pelvic floor symptom changes in pessary users. Am J Obstet Gynecol 197:620.e1–620.e6

    Article  Google Scholar 

  6. Kuhn A, Bapst D, Stadlmayr W, Vits C, Mueller M (2009) Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Ferti Steril 5:1914–1918

    Article  Google Scholar 

  7. Adams EJ, Thomson AJM, Maher C, Hagen S (2004) Mechanical devices for pelvic organ prolapse in women. Cochrane Database Syst Rev (2):CD004010

  8. Maher C, Baessler K, Glazener CMA, Adams EJ, Hagen S (2007) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev (3):CD004014. doi:10.1002/14651858.CD004014.pub3

  9. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646–651

    Article  CAS  PubMed  Google Scholar 

  10. Bash KL (2000) Review of vaginal pessaries. Obstet Gynecol Surv 55:455–460

    Article  CAS  PubMed  Google Scholar 

  11. Kapoor DS, Thakar R, Sultan AH, Oliver R (2009) Conservative versus surgical managment of prolapse: What dictates patient choice? Int Urogynecol J Pelvic Floor Dycfunct 20:1157–1161

    Article  Google Scholar 

  12. Bradshaw HD, Hiller L, Farkas AG, Radley S, Radley SC (2006) Development and psychometric testing of a symptom index for pelvic organ prolapse. J Obstet Gynaecol 26:241–252

    Article  CAS  PubMed  Google Scholar 

  13. Baden WF, Walker T (1992) Surgical repair of vaginal wall defects. Lippincott, Philadelphia

    Google Scholar 

  14. Powers K, Lazarou G, Wang A, La Combe J, Besinger G, Greston WM et al (2006) Pessary use in advanced pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 17:160–164

    Article  PubMed  Google Scholar 

  15. Hullfish KL, Bovbjerg VE, Gurka MJ, Steers WD (2008) Surgical versus nonsurgical treatment of women with pelvic floor dysfunction: patient centered goals at 1 year. J Urol 179:2280–2285

    Article  PubMed  Google Scholar 

  16. Hullfish KL, Bovbjerg VE, Steers WD (2007) Colpocleisis for pelvic organ prolapse: patient goals, quality of life, and satisfaction. Obstet Gynecol 110:341–345

    Article  CAS  PubMed  Google Scholar 

  17. Schaffer J, Cundiff GW, Amundsen CL, Bent A, Coates KW, Strohbehn K et al (2006) Do pessaries improve lower urinary tract symptoms? J Pelvic Med Surg 12:72–73

    Article  Google Scholar 

  18. Fourth International Consultation on Incontinence (ICI)—5–8 July 2008, Palais des Congres, Paris, France

  19. Clark AL, Gregory T, Smith VJ, Edwards R (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189:1261–1267

    Article  PubMed  Google Scholar 

  20. Fialkow M, Symons RG, Flum D (2008) Reoperation for urinary incontinence. Am J Obstet Gynecol 199:546.e1–546.e8

    Article  Google Scholar 

  21. Fialkow MF, Newton KM, Weiss NS (2008) Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 19:1483–1487

    Article  PubMed  Google Scholar 

  22. Vakili B, Zheng YT, Loesch H, Echols KT, Franco N, Chesson RR (2005) Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol 192:1592–1598

    Article  PubMed  Google Scholar 

  23. Wiskind AK, Creighton SM, Stanton SL (1992) The incidence of genital prolapse after the Burch colposuspension. Am J Obstet Gynecol 167:399–404

    CAS  PubMed  Google Scholar 

  24. Kjolhede P, Noren B, Ryden G (1996) Prediction of genital prolapse after Burch colposuspension. Acta Obstet Gynecol Scand 75:849–854

    Article  CAS  PubMed  Google Scholar 

  25. Lambrou NC, Buller JL, Thompson JR, Cundiff GW, Chou B, Montz FJ (2000) Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol 183:1355–1358

    Article  CAS  PubMed  Google Scholar 

  26. Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD (2005) Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 192:1630–1636

    Article  PubMed  Google Scholar 

  27. Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL (2006) Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol 194:1411–1417

    Article  PubMed  Google Scholar 

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Acknowledgement

We wish to thank IUGA for granting Dr. Z Abdool (Dept Obstetrics & Gynaecology, University of Pretoria, South Africa) the International Fellowship award—2008

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Correspondence to Ranee Thakar.

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Abdool, Z., Thakar, R., Sultan, A.H. et al. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J 22, 273–278 (2011). https://doi.org/10.1007/s00192-010-1340-9

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  • DOI: https://doi.org/10.1007/s00192-010-1340-9

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