Outcomes of observation as therapy for pelvic organ prolapse: A study in the natural history of pelvic organ prolapse12. Issue 4 (20th August 2012)

• Record Type: Journal Article
• Authors: Gilchrist, Alienor S.; Campbell, William; Steele, Hannah; Brazell, Hema; Foote, Jonathon; Swift, Steven
• Is Part Of: Neurourology and urodynamics. Volume 32:Issue 4(2013:Apr.)
• Page Start: 383
• Page End: 386
• Publication Date: 2012-08-20
• Subjects: Urinary organs -- Periodicals; Urodynamics -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1002/nau.22298
• Languages: English
• ISSNs: 0733-2467

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Aims</title> <p>To determine the rate of progression or regression of pelvic organ prolapse (POP) in subjects with symptomatic POP who decline intervention (pessary or surgery) and elect observation.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods</title> <p>Sixty‐four patients choosing observation as primary management of symptomatic POP were followed with sequential pelvic organ prolapse quantification (POP‐Q) exams. A change in the leading edge value of ±≥2 cm was considered significant. POP‐Q exam results, choice of therapy and symptom severity at last visit were recorded.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>The leading vaginal edge POP‐Q exam value at initial exam ranged from −1.5 to 7 cm. Distribution of patients by POP‐Q stages on initial exam was: stage I: 1%, stage II: 31%, stage III: 31%, and stage IV: 1.78% (50/64) of patients demonstrated no change in leading edge value from first to last visit on POP‐Q exams. Nineteen percent (12/64) demonstrated progression (≥2 cm increase in leading edge); 3% (2/64) demonstrated regression (≥2 cm decrease in leading edge). Median follow‐up was 16 months (range 6–91 months). On multivariate analysis, no variable, including length of follow‐up, was associated with change in leading edge value (<italic>P</italic> = 0.09, data not shown). At their last recorded visit, 63% (40/64) of subjects continued observation, 38% (24/64) desired a pessary trial or surgical correction. Those desiring intervention had no greater worsening of prolapse on exam at last follow‐up compared with subjects who continued observation.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusion</title> <p>The natural history of pelvic organ prolapse is most often one of very minimal change in subjects who decline intervention (pessary or surgery) and choose observation. Neurourol. Urodynam. 32: 383–386, 2013. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>