INDIAN WELLS, CALIF. – Both surgery and pessary are effective at helping women with pelvic organ prolapse attain pre-treatment goals, improvements in quality of life, and improvements in patient-reported outcome scores, results from a prospective cohort study demonstrated.
“Women seeking care for pelvic organ prolapse have a wide range of severity in symptoms and they often have highly individual goals for treatment,” Dr. Kyle J. Wohlrab said at the annual scientific meeting of the Society of Gynecologic Surgeons. “We know that when we attain those goals, we help their quality of life.”
Dr. Kyle J. Wohlrab
Dr. Wohlrab, of the Division of Female Pelvic Medicine and Reconstructive Surgery at Women and Infants Hospital, Providence, R.I., and his associates set out to compare goal attainment between women who chose surgery versus pessary for treatment of their pelvic organ prolapse. Their secondary aim was to evaluate the association between improvements in symptoms and quality of life scores with goal attainment.
Women were eligible if they had symptomatic bulge symptoms and stage 2 or greater pelvic organ prolapse. They were enrolled when they chose either surgery or pessary for treatment and had a successful pessary fitting. The study participants were asked what their 10 most important goals for treatment were, and the researchers categorized them as functional goals (physical, social, emotional, and sexual) or symptom goals (prolapse, urinary, bowel, and pain/discomfort).
The secondary study outcomes were patient-reported outcomes based on the Pelvic Floor Distress Inventory-20 (PFDI-20), the Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the Body Image Scale (BIS), which were administered at baseline, 6 months, and 12 months.
A total of 160 women were studied, 80 in each treatment group. Compared with those in the pessary group, women in the surgical group were younger at baseline (a mean of 59 years vs. 64 years), and had less severe prolapse (Pelvic Organ Prolapse Quantification System stage 2 vs. 3), but they had worse PFDI-20 scores (a mean of 126 vs. 104) and BIS scores (a mean of 32 vs. 22).
Dr. Wohlrab and his associates found that 75% of patients in the surgery group achieved all of their functional goals, compared with 58% of those in the pessary group, a difference that did not reach statistical significance except in the category of physical function, which favored patients in the surgery group (87% of goals attained, vs. 62% of those in the pessary group; P = .03).
At the same time, 74% of patients in the surgery group achieved all of their symptom goals, compared with 70% of those in the pessary group, a difference that did not reach statistical significance (P = .7).
Both surgery and pessary groups had significant improvements in the PFDI-20, PFIQ-7, and the BIS scores from baseline (P less than .05 for all). Mean scores on the PISQ-12 also improved from baseline in the surgery group (P less than .05), but not in the pessary group.
Dr. Wohlrab reported having no financial disclosures. The meeting was jointly sponsored by the American College of Surgeons.