Primary treatment of pelvic organ prolapse: pessary use versus prolapse surgery

Anne Lotte W.M. Coolen* (Corresponding Author), Stephanie Troost, Ben Willem J. Mol, Jan Paul W.R. Roovers, Marlies Y. Bongers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Citations (Scopus)
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Introduction and hypothesis: The objective of this study was to compare the functional outcomes after pessary treatment and after prolapse surgery as primary treatments for pelvic organ prolapse (POP). Methods: This was a prospective cohort study performed in a Dutch teaching hospital in women with symptomatic POP of stage II or higher requiring treatment. Patients were treated according to their preference with a pessary or prolapse surgery. The primary endpoint was disease-specific quality of life at 12 months follow-up according to the prolapse domain of the Urogenital Distress Inventory (UDI) questionnaire. Secondary outcomes included adverse events and additional interventions. To show a difference of ten points in the primary outcome, we needed to randomize 80 women (power 80%, α 0.05, taking 10% attrition into account). Results: We included 113 women (74 in the pessary group, 39 in the surgery group). After 12 months, the median prolapse domain score was 0 (10th to 90th percentile 0–33) in the pessary group and 0 (10th to 90th percentile 0–0) in the surgery group (p OpenSPiltSPi 0.01). Differences in other domain scores were not statistically significant. In the pessary group, 28% (21/74) of the women had a surgical intervention versus 3% (1/39) reoperations in the surgery group (p = 0.01). Conclusions: In women with POP of stage II or higher undergoing surgery, prolapse symptoms were less severe than in those who were treated with a pessary, but 72% of women who were treated with a pessary did not opt for surgery. Trial registration number: Dutch trial register NTR2856.

Original languageEnglish
Pages (from-to)99-107
Number of pages9
JournalInternational Urogynecology Journal
Issue number1
Early online date9 Jun 2017
Publication statusPublished - Jan 2018
EventIUGA 41st Annual Meeting - Cape Town, South Africa
Duration: 2 Aug 20166 Aug 2016


  • Pelvic organ prolapse
  • Pessary
  • Prolapse surgery


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