TY - JOUR
T1 - First-line treatment of pelvic organ prolapse and discontinuation of pessary treatment
AU - Umachanger, Janani Kantharooban
AU - Marcussen, Mette Ladegaard
AU - Bøggild, Henrik
AU - Kjærgaard, Niels
AU - Glavind, Karin
PY - 2020/9
Y1 - 2020/9
N2 - 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.
AB - 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.
KW - Discontinuation
KW - Pelvic organ prolapse
KW - Pessary
KW - Surgery
KW - Treatment
KW - Watchful waiting
UR - http://www.scopus.com/inward/record.url?scp=85084966799&partnerID=8YFLogxK
U2 - 10.1007/s00192-020-04338-w
DO - 10.1007/s00192-020-04338-w
M3 - Journal article
C2 - 32447418
SN - 0937-3462
VL - 31
SP - 1813
EP - 1819
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 9
ER -