Conservative versus surgical management of prolapse: what dictates patient choice?

Kapoor, Dharmesh S.; Thakar, Ranee; Sultan, Abdul H.; Oliver, Reeba

doi:10.1007/s00192-009-0930-x

Cited by 82 publications

(54 citation statements)

References 23 publications

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“…In our study, there was a high prevalence of urinary, prolapse, and colorectal-anal symptoms in women presenting with POP, although the prevalence of all three was lower than reported in the literature [13,14]. As expected, SUI was more prevalent in the stage I/II POP group.…”

Section: Discussionsupporting

confidence: 57%

Symptoms, quality of life, and factors affecting women’s treatment decisions regarding pelvic organ prolapse

et al. 2012

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Section: Discussionsupporting

confidence: 57%

Symptoms, quality of life, and factors affecting women’s treatment decisions regarding pelvic organ prolapse

et al. 2012

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“…The 1-year follow-up achieved in our study is better and certainly comparable with most prospective questionnaire follow-up studies [2][3][4][5][6]. This cannot be referred to as "selective loss to follow-up" but represents the real-life situation when women are treated with pessaries or surgery.…”

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confidence: 83%

Response to the Letter to the Editor by Waarsenburg et al.

2015

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a randomised trial but an observational prospective study and therefore was not analysed according to intention to treat. All women with symptomatic pelvic organ prolapse (POP) referred to a specialist urogynaecology clinic were offered a choice of pessary or surgery as their first-line treatment.Women who were excluded because they discontinued pessary use were not necessarily dissatisfied with its use, and the reasons for discontinuation-already in the Results sectionare as follows: difficulty retaining the pessary (7), vaginal discomfort (2) and vaginal discharge (3). Although eight women (6 %) did not experience any untoward symptoms, they changed their decision and opted for surgery and were excluded from the analysis.The 1-year follow-up achieved in our study is better and certainly comparable with most prospective questionnaire follow-up studies [2][3][4][5][6]. This cannot be referred to as "selective loss to follow-up" but represents the real-life situation when women are treated with pessaries or surgery. Moreover, in both groups, almost similar numbers did not complete the 1-year questionnaire (53 and 51, respectively), as shown in Fig. 2 [1].As pelvic floor dysfunction symptoms are best described in accordance with degree of bother, we used the validated ICIQ questionnaire, which assesses bothersomeness of symptoms [7,8]. Our study was not designed to enable interpretation of symptoms on an individual basis; perhaps this is best answered in a qualitative study. Also, the study was designed to assess the cost effectiveness of a primary treatment strategy.To our knowledge, this is the first prospective study to evaluate comparative outcomes of vaginal pessaries and surgery using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires at 1 year. At this time, the study provides the best available evidence base by which to counsel women. This reply refers to the comment available at

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“…Compared to our results, we found a much higher percentage (43%, includes all patients). In the study of Kapoor et al [8], this percentage is even higher (approximately 65%). In contrast to our study, these studies were trying to find predictors for pessary use while we were showing the patients (dis)advantages.…”

Section: Discussionmentioning

confidence: 88%

“…However, previous studies have identified patient characteristics that are associated with successful pessary treatment. There is a strong association between age and continued pessary use [4,5,6,7,8]. Preference for surgery as well as the presence of a posterior compartment prolapse appears to be associated with an increased risk on discontinuation of a pessary [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

Thys

Roovers

Geomini

et al. 2012

Gynecol Obstet Invest

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Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our main outcome was the willingness to alter treatment preference (by increasing percentages of defined disadvantages) and determine conditions at which treatment preference changes to alternative treatment. Results: Three groups of 25 patients were interviewed: (1) untreated patients, (2) patients who underwent surgery, and (3) patients treated with a pessary. In the treatment-naive group, 48% preferred surgery, 36% a pessary and 16% had no preferable treatment. Patients switched preference from surgery to a pessary at a median risk of stress urinary incontinence of 22% and of recurrent prolapse of 43%. Patients switched preference from pessary to surgery at a median risk of vaginal irritation of 32%, of placing problems of 32% and of incomplete symptom relief of 17%. Conclusions: Patients tend to prefer surgery for POP. When realistic assumptions for (dis)advantages are made, most women consider the disadvantages following both treatment options to be acceptable as they do not exceed the risks described in the literature.

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Conservative versus surgical management of prolapse: what dictates patient choice?

Abstract: Nearly two thirds of women with symptomatic prolapse initially opted for conservative management. Women choosing surgery over pessaries for treatment of prolapse describe more severe symptoms related to bowel emptying, sexual function, and quality of life and are bothered by them.

Cited by 82 publications

References 23 publications

Symptoms, quality of life, and factors affecting women’s treatment decisions regarding pelvic organ prolapse

Symptoms, quality of life, and factors affecting women’s treatment decisions regarding pelvic organ prolapse

Response to the Letter to the Editor by Waarsenburg et al.

Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

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