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International Urogynecology Journal

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01-10-2009 | Original Article

Conservative versus surgical management of prolapse: what dictates patient choice?

Authors: Dharmesh S. Kapoor, Ranee Thakar, Abdul H. Sultan, Reeba Oliver

Published in: International Urogynecology Journal | Issue 10/2009

Abstract

Introduction and hypothesis

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.

Swift SE (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 183:277–285PubMedCrossRef

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRef

Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646PubMedCrossRef

Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB (1994) Hysterectomy in the United States, 1988–1990. Obstet Gynecol 83:549–555PubMedCrossRef

Pott-Grinstein E, Newcomer JR (2001) Gynecologist’s patterns of prescribing pessaries. J Reprod Med 46:205–208PubMed

Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA (2000) A survey of pessary use by members of the American urogynecologic society. Obstet Gynecol 95:931–935PubMedCrossRef

Heit M, Rosenquist C, Culligan P, Graham C, Murphy M, Shott SS (2003) Predicting treatment choice for patients with pelvic organ prolapse. Obstet Gynecol 101:1279–1284PubMedCrossRef

Weber AM (2001) Anterior colporrhaphy: a randomised trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1306PubMedCrossRef

Hullfish KL, Bovbjerg VE, Gibson J, Steers WD (2002) Patient-centred goals for pelvic floor dysfunction surgery: what is success and is it achieved? Am J Obstet Gynecol 187:88–92PubMedCrossRef

10.

Lowenstein L, Fitzgerald MP, Kenton K, Dooley Y, Templehof M, Mueller ER, Brubaker L (2008) Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 19:81–84PubMed

11.

Elkadry EA, Kenton KS, Fitzgerald MP, Shott S, Brubaker L (2003) Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 189:1551–1557PubMedCrossRef

12.

Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL (2004) Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol 190:345–350PubMedCrossRef

13.

Hullfish KL, Bovbjerg VE, Steers WD (2004) Patient-centred goals for pelvic floor dysfunction surgery: long-term follow-up. Am J Obstet Gynecol 191:201–205PubMedCrossRef

14.

Bradshaw HD, Hiller L, Farkas AG, Radley S, Radley SC (2006) Development and psychometric testing of a symptom index for pelvic organ prolapse. J Obstet Gynaecol 26:241–252PubMedCrossRef

15.

Novi JM, Jeronis S, Morgan MA, Arya LA (2005) Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse. J Urol 173:1669–1672PubMedCrossRef

16.

Brincat C, Kenton K, Fitzgerald MP, Brubaker L (2004) Sexual activity predicts continued pessary use. Am J Obstet Gynecol 191:198–200PubMedCrossRef

17.

Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW (2006) Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol 108:93–99PubMed

18.

Handa VL, Zyczynski HM, Brubaker L et al (2007) Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol 197:629.e1–629.e6CrossRef

19.

Komesu YM, Rogers RG, Kammerer-Doak DN, Barber MD, Olsen AL (2007) Posterior repair and sexual function. Am J Obstet Gynecol 197:101.e1–101.e6CrossRef

20.

Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771PubMedCrossRef

21.

Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC, Continence Program for Women Research Group (2002) Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 99:281–289PubMedCrossRef

22.

Weber AM, Walters MD, Piedmonte MR (2000) Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 182:1610–1615PubMedCrossRef

23.

Pauls RN, Silva WA, Rooney CM et al (2007) Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 197:622.e1–622.e7CrossRef

24.

Kahn MA, Stanton SL (1997) Posterior colporrhaphy: it’s effect on bowel and sexual function. Br J Obstet Gynaecol 104:82–86PubMed

25.

Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185:1332–1338PubMedCrossRef

26.

Fialkow MF, Gardella C, Melville J, Lentz GM, Fenner DE (2002) Posterior vaginal wall defects and their relation to measurements of pelvic floor neuromuscular dysfunction and posterior compartment symptoms. Am J Obstet Gynecol 187:1443–1448PubMedCrossRef

27.

Weber AM, Walters MD, Schover LR (1995) Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol 85:483–487PubMedCrossRef

Title: Conservative versus surgical management of prolapse: what dictates patient choice?
Authors: Dharmesh S. Kapoor
Ranee Thakar
Abdul H. Sultan
Reeba Oliver
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 10/2009
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-009-0930-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conservative versus surgical management of prolapse: what dictates patient choice?

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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