Patient characteristics that are associated with continued pessary use versus surgery after 1 year - 25/08/11
, Vivian C. Aguilar, MD b, Eric R. Sokol, MD b, Neil D. Jackson, MD b, Deborah L. Myers, MD b
Reprint requests: Jeffrey L. Clemons, MD, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA 98431.Abstract |
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.
Study design |
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 ≥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 ≥65 years (P < .001), stage III-IV posterior vaginal wall prolapse (P=.007), and desire for surgery (P=.04) were independent predictors.
Conclusion |
Age ≥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.
Le texte complet de cet article est disponible en PDF.Key words : Pessary, Pelvic organ prolapse, Surgery
Plan
| Presented at the Twenty-fourth Annual meeting of the American Urogynecologic Society, Hollywood, Fla, September 11-13, 2003. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. |
Vol 191 - N° 1
P. 159-164 - juillet 2004 Retour au numéro
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