Predicting treatment choice for patients with pelvic organ prolapse.
OBJECTIVE
To evaluate which clinical factors were predictive of treatment choice for patients with pelvic organ prolapse.


METHODS
One hundred fifty-two patients were enrolled in this cross-sectional study to collect clinical data on potential predictors of treatment choice. Continuous parametric, continuous nonparametric (ordinal), and categoric data were compared with chosen management plan (expectant, pessary, surgery) using analysis of variance, the Kruskal-Wallis test, and the chi(2) test for association, respectively. All significant predictors (P <.05) of treatment choice for pelvic organ prolapse identified during univariate analysis were entered into a backward elimination polytomous logistic regression analysis for predicting surgery versus pessary versus expectant management, with surgery as the reference group.


RESULTS
The probability of choosing expectant management rather than surgery 1). increases as the preoperative pelvic pain score increases (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.07, 2.40; P =.024) and 2). decreases as the prolapse severity increases (OR 0.46; 95% CI 0.29, 0.72; P =.001). The probability of choosing pessary rather than surgery 1). increases as age increases (OR 1.1; 95% CI 1.05, 1.16; P <.001), 2). decreases as the prolapse severity increases (OR 0.77; 95% CI 0.60, 0.99; P =.042), and 3). is less if the participant had prior prolapse surgery (OR 0.23; 95% CI 0.07, 0.76; P =.017).


CONCLUSIONS
Age, prior prolapse surgery, preoperative pelvic pain scores, and pelvic organ prolapse severity were independently associated with treatment choices in a predictable way and provide physicians with medical evidence necessary to support a patient's decision.
Heit
Michael
M
University of Louisville HSC, Louisville, Kentucky 40202, USA. mheit@louisville.edu
Rosenquist
Chris
C
Culligan
Patrick
P
Graham
Carol
C
Murphy
Miles
M
Shott
Susan
S
D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006547:Hernia / Q000628:therapy; D059685:Herniorrhaphy; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D020047:Rectocele / Q000601:surgery / Q000628:therapy; D001745:Urinary Bladder Diseases / Q000601:surgery / Q000628:therapy; D014596:Uterine Prolapse / Q000601:surgery / Q000628:therapy*