Symptomatic pelvic organ prolapse : experience at a tertiary urogynaecology clinic

Abstract

BACKGROUND. Pelvic organ prolapse (POP) is a common reason for gynaecological consultation, especially in the elderly. Associated symptoms have been shown to negatively affect bladder, bowel and sexual function, as well as general quality of life. Treatment options include either surgical repair with mesh or native tissue, or conservative management with vaginal pessaries. There is a lack of data regarding POP in South African (SA) women. OBJECTIVES. To determine the demographic characteristics in patients presenting with symptomatic POP to a tertiary urogynaecology clinic, and to compare patients who opt for surgical treatment with those who request vaginal pessary insertion. METHODS. The study was conducted at the urogynaecology clinic at Steve Biko Academic Hospital, Pretoria, SA. Demographic information was recorded after a detailed history, physical examination and completion of a self-administered symptom questionnaire. RESULTS. A total of 305 patients were included in this study. The mean age was 62 (range 24 - 96) years and the mean vaginal parity was 3.7 (range 0 - 13); 147 patients opted for surgical intervention and 158 for pessary treatment. Cystocele was the most common type of prolapse found on clinical examination. One-quarter of patients were sexually active (25.5%, n=242). Awareness and visualisation or feeling of a lump was the most common symptom reported. Age (p=0.004) and mean vaginal parity (p=0.003) were statistically significant in the pessary group. Finding of a cystocele was significantly greater in patients who opted for pessary insertion (p=0.005). CONCLUSION. Patients who opt for vaginal pessary insertion are older and more vaginally parous than patients who opt for surgical intervention, and cystocele was statistically more significant in women opting for pessary insertion.