Abstract | OBJECTIVE: DESIGN: Multicentre prospective comparative cohort study. SETTING: Twenty-two Dutch hospitals. POPULATION: Women referred with symptomatic POP of stage ≥2 and moderate-to-severe POP symptoms. METHODS: The primary outcome was subjective improvement at the 24-month follow-up according to the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes included improvement in prolapse-related symptoms measured with the Pelvic Floor Distress Inventory (PFDI-20), improvement in subjective severeness of symptoms according to the Patient Global Impression of Severity (PGI-S) scale and crossover between therapies. The primary safety outcome was the occurrence of adverse events. MAIN OUTCOME MEASURE: PGI-I at 24 months. RESULTS: We included 539 women, with 335 women (62.2%) in the pessary arm and 204 women (37.8%) in the surgery arm. After 24 months, subjective improvement was reported by 134 women (83.8%) in the surgery group compared with 180 women (74.4%) in the pessary group (risk difference 9.4%, 95% CI 1.4-17.3%, P < 0.01). Seventy-nine women (23.6%) switched from pessary to surgery and 22 women (10.8%) in the surgery group underwent additional treatment. Both groups showed a significant reduction in bothersome POP symptoms (P ≤ 0.01) and a reduction in the perceived severity of symptoms (P ≤ 0.001) compared with the baseline. CONCLUSIONS: Significantly more women in the surgery group reported a subjective improvement after 24 months. Both therapies, however, showed a clinically significant improvement of prolapse symptoms. TWEETABLE ABSTRACT:
Pessary treatment and vaginal surgery are both efficacious in reducing the presence and severity of prolapse symptoms, although the chance of significant improvement is higher following surgery.
|
Authors | L R van der Vaart, A Vollebregt, A L Milani, A L Lagro-Janssen, R G Duijnhoven, J-Pwr Roovers, C H Van der Vaart |
Journal | BJOG : an international journal of obstetrics and gynaecology
(BJOG)
Vol. 129
Issue 5
Pg. 820-829
(Apr 2022)
ISSN: 1471-0528 [Electronic] England |
PMID | 34559932
(Publication Type: Journal Article, Multicenter Study)
|
Copyright | © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. |
Topics |
- Cohort Studies
- Female
- Humans
- Pelvic Organ Prolapse
(etiology, surgery)
- Pessaries
- Prospective Studies
- Quality of Life
- Surveys and Questionnaires
- Treatment Outcome
|