Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar;299(3):773-777.
doi: 10.1007/s00404-019-05046-7. Epub 2019 Jan 17.

Prolapse surgery versus vaginal pessary in women with symptomatic pelvic organ prolapse: which factors influence the choice of treatment?

Barbara Bodner-Adler  1 , Klaus Bodner  2 , Anna Stinglmeier  2 , Oliver Kimberger  3   4 , Ksenia Halpern  2 , Heinz Koelbl  2 , Wolfgang Umek  2   5
Affiliations

Prolapse surgery versus vaginal pessary in women with symptomatic pelvic organ prolapse: which factors influence the choice of treatment?

Barbara Bodner-Adler et al. Arch Gynecol Obstet. 2019 Mar.

Abstract

Objective: To investigate which specific clinical factors influence patients' choice of prolapse treatment.

Methods: This study includes a total of 510 cases with symptomatic pelvic organ prolapse (POP) of stage II or higher requiring prolapse treatment. Patients were divided into surgery and pessary groups according to their own choice and treatment preference. Primary outcome of interest was to define potential clinical parameters, which contribute to surgical treatment decision.

Results: A total of 252/510 (49%) women decided for prolapse surgery and 258/510 (51%) cases were treated conservatively with vaginal pessary. Hypertension, COPD as well as polypharmacy were parameters, which were statistically significantly more common in the pessary group compared to the surgically managed cases (p <0.05). On the contrary, women undergoing prolapse surgery were significantly younger and showed more advanced POP-Q (pelvic organ prolapse quantification) stages (p < 0.05). Clinical factors, such as BMI (body mass index), parity, mode of delivery and postmenopausal status, did not differ between the two groups (p > 0.05). Multiple logistic regression analysis revealed that advanced POP-Q stage (p < 0.001) as well as the absence of smoking (p < 0.001) were independent factors associated with surgical treatment decision.

Conclusion: Women, who favoured prolapse surgery, were younger and in significant better health condition (less hypertension and COPD), but showed a significantly higher POP-Q stage compared to women choosing pessary treatment. Our data indicate that women with higher POP-Q stage and non-smokers tended to decide for prolapse surgery. This information could help in clinical practice to guide patients for the best possible treatment decision and strengthen individual counselling.

Keywords: Clinical parameters; Pelvic organ prolapse; Pessary use; Prolapse surgery.

PubMed Disclaimer

Conflict of interest statement

All the authors declare that they have no conflict of interest.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Rahn DD, Good MM, Roshanravan SM, Shi H, Schaffer JI, Singh RJ, et al. Effects of preoperative local estrogen in postmenopausal women with prolapse: a randomized trial. J Clin Endocrinol Metab. 2014;99(10):3728–3736. doi: 10.1210/jc.2014-1216. - DOI - PMC - PubMed
    1. Dietrich W, Elenskaia K, Obermayr A, Horvat R, Mayerhofer K, Umek W, et al. Relaxin and gonadal steroid receptors in uterosacral ligaments of women with and without pelvic organ prolapse. Int Urogynecol J. 2012;23:495–500. doi: 10.1007/s00192-011-1615-9. - DOI - PubMed
    1. Swift S, Woodman P, O’Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192:795–806. doi: 10.1016/j.ajog.2004.10.602. - DOI - PubMed
    1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ and urinary incontinence. Obstet Gynecol. 1997;89(4):501–506. doi: 10.1016/S0029-7844(97)00058-6. - DOI - PubMed
    1. Heit M, Rosenquist Ch, Culligan P, Graham C, Murphy M, Shott S. Predicting treatment choice for patients with pelvic organ prolapse. Obstet Gynecol. 2003;101:1279–1284. - PubMed

Publication types