Abstract
Introduction
The primary objective of this study was to investigate the percentages of women choosing watchful waiting, pessary use or surgery as first-line treatment of pelvic organ prolapse (POP). Second, the rate and cause of discontinuation of pessary use were investigated.
Methods
A retrospective chart review was conducted on 794 patients referred with POP at a Danish tertiary center for urogynecology at Aalborg University Hospital between 1 January 2014 and 31 December 2015. The following data were registered: age, BMI, previous use of a pessary, total number of births, vaginal births, cesarean sections, previous hysterectomy, prolapse surgery and incontinence surgery, smoking, menopause, sexual status and POP-Q stage in the three vaginal compartments. Pessary treatments were evaluated after 3 months. Additional visits, reason for discontinuation and secondary treatment were noted.
Results
First-line treatment was surgery in 50%, watchful waiting in 33% and pessary use in 17% of patients. Characteristics associated with choosing surgery instead of a pessary were age < 65 years, previous prolapse surgery, prolapse in the anterior or posterior compartment, and POP-Q stage > 2. Characteristics associated with choosing watchful waiting instead of a pessary were age < 65 years and prolapse in the posterior compartment. A total of 33% discontinued pessary treatment within the first 3 months. Discontinuation was associated with age < 65 years, previous hysterectomy and pelvic surgery, and additional visits. Expulsion of the pessary and pain/discomfort were the main causes of discontinuation.
Conclusion
This study showed that 50% of patients referred with POP were treated with conservative treatment (watchful waiting and pessary) and thus more women could probably be treated in primary care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Samuelsson EC, Victor A, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt I):299–305.
Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186:1160–6.
Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–38.
Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853.
Kuncharapu I, Majeroni BA, Johnson DW. Pelvic organ prolapse. Am Fam Physician. 2010;81(9):1111–7.
Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol. 2005;106(3):615–34.
Hampton BS. Pelvic organ prolapse. Med Health Rhode Island. 2009;92(1):5–9.
Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–60.
Heit M, Rosenquist C, Culligan P, Graham C, Murphy M, Shott S. Predicting treatment choice for patients with pelvic organ prolapse. Obstet Gynecol. 2003;101(6):1279–84.
Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev. 2009;30(5):465–93.
Coolen AWM, Troost S, Mol BWJ, Roovers JWR, Bongers MY. Primary treatment of pelvic organ prolapse: pessary use versus prolapse surgery. Int Urogynecol J. 2018;29(1):99–107.
Abdool Z, Swart P. Symptomatic pelvic organ prolapse: experience at a tertiary urogynaecology clinic. S Afr J Obstet Gynaecol. 2016;22(1):18–20.
Nemeth Z, Farkas N, Farkas B. Is hysterectomy or prior reconstructive surgery associated with unsuccessful initial trial of pessary fitting in women with symptomatic pelvic organ prolapse? Int Urogynecol J. 2017;28(5):757–61.
Friedman S, Sandhu KS, Wang C, Mikhail MS, Banks E. Factors influencing long-term pessary use: reply by the authors. Int Urogynecol J. 2010;21(6):673–8.
Mutone MF, Terry C, Hale DS, Benson JT. Factors which influence the short-term success of pessary management of pelvic organ prolapse. Am J Obstet Gynecol. 2005;193(1):89–94.
Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. 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. 2004;190(4):1025–9.
Ding J, Chen C, Song X, Zhang L, Deng M, Zhu L. Changes in prolapse and urinary symptoms after successful fitting of a ring pessary with support in women with advanced pelvic organ prolapse: a prospective study. Urology. 2016;87:70–5.
Gilchrist AS, Campbell W, Steele H, Brazell H, Foote J, Swift S. Outcomes of observation as therapy for pelvic organ prolapse: a study in the natural history of pelvic organ prolapse. Neurourol Urodyn. 2013;32(4):383–6.
Yamada T, Matsubara S. Rectocoele, but not cystocoele, may predict unsuccessful pessary fitting. J Obstet Gynaecol (Lahore). 2011;31(5):441–2.
Wolff B, Williams K, Winkler A, Lind L, Shalom D. Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse. Int Urogynecol J. 2017;28(7):993–7.
Geoffrion R, Zhang T, Lee T. Clinical characteristics associated with unsuccessful pessary fitting outcomes. Obstet Gynecol Surv. 2014;69(2):79–81.
Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–50.
Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynecol Obstet. 2011;114(1):56–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Financial disclaimer
None.
Conflict of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Umachanger, J.K., Marcussen, M.L., Bøggild, H. et al. First-line treatment of pelvic organ prolapse and discontinuation of pessary treatment. Int Urogynecol J 31, 1813–1819 (2020). https://doi.org/10.1007/s00192-020-04338-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-020-04338-w