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Introduction and Hypothesis <p>This study compared functional outcomes of pessary and surgery as the primary treatment for symptomatic pelvic organ prolapse (POP) in elderly women.</p> Methods <p>In this prospective cohort study, 148 women aged 80 and above with symptomatic POP were treated at our institute between November 2013 and May 2023 with either surgery (<i>n</i> = 23) or pessary (<i>n</i> = 125). Treatment was based on patient preference. A long-term follow-up of over 1&#xa0;year was conducted. The primary outcome was subjective patient-reported improvement measured with the Patient Global Impression of Improvement scale. Secondary outcomes included symptom remission and adverse events. The ability of self-management of pessary and the discontinuation of pessary use were also analyzed.</p> Results <p>One hundred thirty-two patients completed at least 1&#xa0;year of follow-up (median 696&#xa0;days); 94.7% women (18/19) in the surgery group and 87.6% women (99/113) in the pessary group reported subjective improvement (risk difference −7.1% [2-sided 95% CI, −16.3 to 12.9]; <i>p</i> value, .70), showing no statistical difference. Among pessary users, 68.3% of ring pessary users and 50.0% of Gellhorn pessary users were able to independently manage the pessary (<i>p</i> = .21). Reasons for discontinued pessary use were mainly perceived inconvenience, pain or discomfort, and decreased daily activity or negligible POP symptoms. Four patients switched from pessary to surgery.</p> Conclusions <p>Pessary is an effective and safe primary treatment for symptomatic POP in elderly women and can be managed independently in the majority of elderly users.</p>

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Primary Treatment of Pelvic Organ Prolapse in Women Aged Over 80 Years: Pessary Versus Surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月7日

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  • Qianlan Yu,
  • Ming’e Li,
  • Ying Zhou

摘要

Introduction and Hypothesis

This study compared functional outcomes of pessary and surgery as the primary treatment for symptomatic pelvic organ prolapse (POP) in elderly women.

Methods

In this prospective cohort study, 148 women aged 80 and above with symptomatic POP were treated at our institute between November 2013 and May 2023 with either surgery (n = 23) or pessary (n = 125). Treatment was based on patient preference. A long-term follow-up of over 1 year was conducted. The primary outcome was subjective patient-reported improvement measured with the Patient Global Impression of Improvement scale. Secondary outcomes included symptom remission and adverse events. The ability of self-management of pessary and the discontinuation of pessary use were also analyzed.

Results

One hundred thirty-two patients completed at least 1 year of follow-up (median 696 days); 94.7% women (18/19) in the surgery group and 87.6% women (99/113) in the pessary group reported subjective improvement (risk difference −7.1% [2-sided 95% CI, −16.3 to 12.9]; p value, .70), showing no statistical difference. Among pessary users, 68.3% of ring pessary users and 50.0% of Gellhorn pessary users were able to independently manage the pessary (p = .21). Reasons for discontinued pessary use were mainly perceived inconvenience, pain or discomfort, and decreased daily activity or negligible POP symptoms. Four patients switched from pessary to surgery.

Conclusions

Pessary is an effective and safe primary treatment for symptomatic POP in elderly women and can be managed independently in the majority of elderly users.