Factors affecting patient choice for continued observation versus intervention for pelvic organ prolapse
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ORIGINAL ARTICLE
Factors affecting patient choice for continued observation versus intervention for pelvic organ prolapse Marieme Mbaye 1 & L. Autumn Edenfield 1 & Abbigail Woll 1 & Steven E. Swift 1 Received: 2 July 2020 / Accepted: 23 July 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis To analyze the reasons for eventual choice of a therapeutic intervention in subjects who initially chose observation for bothersome pelvic organ prolapse (POP) over therapeutic intervention at their first urogynecology clinic visit. Methods This is a retrospective cohort study of women with bothersome POP who initially chose observation over therapeutic intervention at one institution from 2002 to 2015. Subjects were followed over time with sequential pelvic organ prolapse quantification examinations (POP-Q) and assessments of symptoms and bother utilizing non-validated standard questions. Subjects were divided into two groups: (1) those who chose continued observation versus (2) those who chose therapeutic intervention with either pessary or surgery. Demographic information, POP-Q examinations, and POP symptoms and bother were collected. We analyzed which clinical variables influenced patient decision to elect for therapeutic intervention. Results A total of 111 subjects were enrolled. The distribution of initial POP-Q stage was: stage 2 = 54%; stage 3 = 45%; stage 4 = 1%. Median follow-up was 24 months (range 6 and 110 months). At their last recorded visit, 73 subjects (66%) continued observation and 38 subjects (34%) chose pessary or surgical intervention. We investigated clinical factors for choosing intervention. Increase in POP symptom bother was the only variable that remained significant in determining patient choice of a therapeutic intervention (p < 0.001) after confounding factors were controlled for using multivariate regression analysis. Conclusion In subjects with bothersome POP who initially choose observation and subsequently elect to pursue a therapeutic intervention, worsening symptom bother is the most important factor. Keywords Clinical observation . Factors affecting choice . Pelvic organ prolapse
Introduction Pelvic organ prolapse (POP) is a relatively common urogynecologic condition. Millions of women are given this diagnosis each year with prevalence estimates ranging anywhere from 3.8% to 49.4% among community-based women based on examination [1]. This number is expected to increase by 46% by the year 2050 because of the aging of the population [2]. POP is a disease that is defined by both anatomy and the presence of symptoms that are bothersome to the patient, which is why it can be difficult to determine the precise
* Steven E. Swift [email protected] 1
Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 634 CSB, Charleston, SC, USA
incidence and prevalence of this disease in the population as diagnostic criteria involve a physical examination [3, 4]. Some of the most commonly experienced sympto
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