Objective: To investigate the factors influencing therapy decision of surgery or pessary in patients with severe pelvic organ prolapse (POP).
Methods: Totally 419 cases of III to IV degree POP patients were studied retrospectively. Patients were divided into surgery and pessary groups according to their own choice. Clinical characters were compared such as age, body mass index (BMI), age of onset and disease duration, POP stage, complications.
Results: 67.5% (283/419) patients were in the surgical group and 32.5% (136/419) patients in the pessary group. Patients in surgical group had higher BMI [(25.1 ± 3.5) versus (23.8 ± 2.6) kg/m²], elder age of onset [(62 ± 12) versus (57 ± 11) years old], longer disease duration [(5 ± 8) versus (11 ± 11) years] and higher POP staging of middle compartment and less cardiac disease [20.1% (57/283) versus 30.9% (42/136)] than those in pessary group, all had significant difference (P < 0.05). Logistic regression analysis on the above factors showed a statistically significant difference between two groups, BMI, disease duration and POP staging of middle compartment were independent factors (OR = 1.141, 0.932, 1.389; all P < 0.01).
Conclusions: Patients with higher BMI, higher POP staging of middle compartment and less cardiac disease tended to choose surgery. Patients with younger age of onset and longer disease duration tended to choose pessary. Factors as age, POP staging of anterior and posterior compartment, history of POP surgery, complicated with hypertension and diabetes, showed no influence on treatment choice.