Conservative versus surgical management of prolapse: what dictates patient choice?
OBJECTIVE
The aim of this study is to establish whether the presence of severe symptoms influences women's choice of pessaries or surgery for uterovaginal prolapse.


METHODS
This is a prospective study using the validated Sheffield Prolapse Symptoms Questionnaire.


RESULTS
Women choosing surgery (n = 251) were younger (58 versus 66 years), more bothered by dragging lower abdominal pain (33% versus 25%, P = 0.04), need for vaginal digitation (8% versus 3%, P = 0.02), and incomplete bowel emptying (27% versus 19%, P = 0.01) than women choosing pessaries (n = 429). More women opting for surgery were sexually active (51% versus 29%, P < 0.0001), perceived avoidance of sex due to prolapse (28% versus 17%, P = 0.000), and perceived prolapse interfering with sexual satisfaction as a severe problem (26% versus 15%, P = 0.000).


CONCLUSIONS
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.
Kapoor
Dharmesh S
DS
Mayday University Hospital, Surrey, UK.
Thakar
Ranee
R
Sultan
Abdul H
AH
Oliver
Reeba
R
D000368:Aged; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D010570:Pessaries; D011446:Prospective Studies; D011788:Quality of Life; D012725:Sexual Behavior / Q000502:physiology / Q000523:psychology