Do patients prefer a pessary or surgery as primary treatment for pelvic organ prolapse

To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP).

A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our main outcome was the willingness to alter treatment preference (by increasing percentages of defined disadvantages) and determine conditions at which treatment preference changes to alternative treatment.

Three groups of 25 patients were interviewed: (1) untreated patients, (2) patients who underwent surgery, and (3) patients treated with a pessary. In the treatment-naive group, 48% preferred surgery, 36% a pessary and 16% had no preferable treatment. Patients switched preference from surgery to a pessary at a median risk of stress urinary incontinence of 22% and of recurrent prolapse of 43%. Patients switched preference from pessary to surgery at a median risk of vaginal irritation of 32%, of placing problems of 32% and of incomplete symptom relief of 17%.

Patients tend to prefer surgery for POP. When realistic assumptions for (dis)advantages are made, most women consider the disadvantages following both treatment options to be acceptable as they do not exceed the risks described in the literature.