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


METHODS
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.


RESULTS
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 >or=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 >or=65 years ( P <.001), stage III-IV posterior vaginal wall prolapse ( P =.007), and desire for surgery ( P =.04) were independent predictors.


CONCLUSIONS
Age >or=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.
Department of Obstetrics and Gynecology, Division of Urogynecology, Madigan Army Medical Center, Tacoma, WA 98431, USA. Jeffrey.Clemons@nw.amedd.army.mil
Jeffrey L
JL
Clemons
Vivian C
VC
Aguilar
Eric R
ER
Sokol
Neil D
ND
Jackson
Deborah L
DL
Myers
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010570:Pessaries; D011446:Prospective Studies; D012372:ROC Curve; D014596:Uterine Prolapse / Q000601:surgery / Q000628:therapy*