Pessaries have been used to treat women with pelvic organ prolapse (POP) since the beginning of recorded history. This review aims to assess the effect of pessary treatment on the disease-specific, health-related quality of life in women with pelvic organ prolapse. After a Medline search using the Mesh term ‘pessary’ and critical appraisal, 41 articles were selected and used in this review. Pessaries are widely used to treat pelvic organ prolapse. It is minimally invasive and appears to be safe. Although there is evidence that the use of pessaries in the treatment of pelvic organ prolapse is effective in alleviating symptoms and that patient satisfaction is high, the follow-up in many published papers is short, and the use of validated urogynaecological questionnaires is limited. Comparison with surgical treatment of pelvic organ prolapse is rare and not assessed in a randomised controlled trial.

The purpose of this paper is to assess the efficacy of physiotherapy and quality of life in women treated for urinary incontinence by specialized physiotherapists in daily community-based practices. Three hundred and fifty-five women were treated in five physiotherapy practices between January 2000 and December 2004. After a minimum follow-up of 12 months, these women received a questionnaire at home. With the questionnaire, we collected demographic data, data on the efficacy of treatment, satisfaction with the result, and the Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Additional information was derived from the medical files. One hundred and eighty-seven women responded. Fifty percent of women were satisfied with the result of physiotherapy. After a mean follow-up of 32 months, 123 out of 130 women (94.6%), who only had physiotherapy, recorded to experience incontinence episodes daily to several times a week. Women who underwent additional incontinence surgery after insufficient physiotherapy recorded significantly less urinary incontinence symptoms and a better quality of life. Pelvic floor muscle training for urinary incontinence is effective in half of the women. If not successful, women seem to benefit significantly from incontinence surgery.

We performed a prospective cohort study to characterize the feasibility of urinary stress incontinence and pelvic organ prolapse surgery in day care. Two hundred and one women were prepared for day surgery by a standardised protocol; 132 women underwent a single Tension-free Vaginal Tape/Tension-free Vaginal Tape-Obturator procedure, and 69 women had additional or only pelvic organ prolapse surgery. The main outcome measures were complications, satisfaction score and recommendation to others, recorded after 3 days and 6-10 weeks. We found that it is feasible and safe to perform pelvic organ prolapse and urinary incontinence surgery in day care. Patients' satisfaction is high in all aspects of care and the majority would recommend it to others. In multivariate logistic regression analysis, only dissatisfaction with the care provided by the staff of the surgical ward was significantly associated with a negative recommendation to others (odds ratio 7.3, 95% confidence interval 1.6-33.5).