Patient characteristics that are associated with continued pessary use versus surgery after 1 year

• Published in: American journal of obstetrics and gynecology Vol. 191; no. 1; pp. 159 - 164
• Main Authors: Clemons, Jeffrey L., Aguilar, Vivian C., Sokol, Eric R., Jackson, Neil D., Myers, Deborah L.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.07.2004; Elsevier
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Female; Gynecology. Andrology. Obstetrics; Humans; Logistic Models; Medical sciences; Middle Aged; Pelvic organ prolapse; Pessaries; Pessary; Prospective Studies; ROC Curve; Surgery; Uterine Prolapse - surgery; Uterine Prolapse - therapy; Pessary; Surgery; Pelvic organ prolapse; Human; Treatment; Gynecology; Pessary Pelvic organ prolapse Surgery; Obstetrics; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2004.04.048

The purpose of this study was to identify patient characteristics in women with symptomatic pelvic organ prolapse that is associated with continued pessary use versus surgery after 1 year. Fifty-nine women with symptomatic pelvic organ prolapse who were satisfied with their pessary at 2 months were evaluated prospectively at 1 year. Characteristics of women who continued to use a pessary were compared with women who underwent pelvic reconstructive surgery to identify predictors for continued pessary use versus surgery. Forty-three women (73%) continued pessary use, and 16 women (27%) underwent surgery. Characteristics that were associated with continued pessary use were older age (76 vs 61 years; p < .001) and poor surgical risk (26% vs 0%; P = .03). Characteristics that were associated with surgery were sexual activity (81% vs 26%; P < .001), stress incontinence (44% vs 16%; P = .03), stage III-IV posterior vaginal wall prolapse (44% vs 16%; P = .03), and desire for surgery at the first visit (63% vs 12%; P < .001). Age ≥65 years was the best cut-off value for continued pessary use, with sensitivity of 95% (95% CI, 84%, 99%) and a positive predictive value of 87% (95% CI, 74%, 94%). Logistic regression demonstrated that age ≥65 years ( P < .001), stage III-IV posterior vaginal wall prolapse ( P = .007), and desire for surgery ( P = .04) were independent predictors. Age ≥65 years was associated highly with continued pessary use. Desire for surgery and stage III-IV posterior vaginal wall prolapse were associated with discontinued pessary use and pelvic reconstructive surgery.