Pessary Uptake and Outcomes in Women Who Ultimately Had Surgery for Prolapse

The objective was to determine patterns of pessary use in women prior to surgery for pelvic organ prolapse at one institution.

Retrospective cohort study of women undergoing surgery for prolapse. Demographics, medical and surgical history, and treatment were collected from the medical record. Factors associated with pessary uptake and outcomes were explored using univariable and multivariable logistic regression. Kaplan-Meier plots were used to evaluate the relationship between key variables and time to surgery.

Among 1228 patients, the mean age was 60.8 (SD 29.2), most were white (84.6%), on Medicare (48.0%), or privately insured (41.9%), and had Pelvic organ prolapse Quantification stage 2 or more (96.6%). One-third (30.6%), initially elected for conservative management with a pessary. Nine (7.3%) chose the pessary as interim management. On multivariable regression, those with public insurance were more likely to choose a pessary (1.48, 1.07-2.05). Current smokers were less likely to choose a pessary (0.34, 0.16-0.69). Among women who chose a pessary, on multivariable regression, patients who had a prior hysterectomy were 57% less likely to be successfully fit. Median time from pessary fitting to surgery was 283.5 days (range 15-6611). The most common reasons for discontinuing pessary use were discomfort/pain (26.5%) or preference for surgery (25.3%).

Our findings support prior work on factors associated with pessary use and successful fitting. Interestingly, patients with public insurance were more likely to choose a pessary, supporting a role for the influence of sociodemographic factors and social determinants of health on the choice of treatment for pelvic organ prolapse.