Patient characteristics that are associated with continued pessary use versus surgery after 1 year

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.