87: Predictors of surgical vs. non-surgical management of pelvic organ prolapse

Abstract

To identify and compare predictors of surgical and non-surgical treatment choice for pelvic organ prolapse (POP). We were specifically interested to see if race or prolapse bother predicts treatment choice. Patients were part of a prospective database of women age 18 and older who presented to a tertiary care female pelvic medicine and reconstructive surgery (FPMRS) practice for POP from September 2014 to June 2017. The practice consists of 3 FPMRS-trained specialists. At the intake visit informed consent was obtained, patients completed the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Organ Prolapse Quantification (POP-Q) examination was performed and medical and demographic history obtained. Patients were included if they had an overall POP-Q stage ≥2. After initial assessment, patients were offered a choice in treatment between non-surgical treatment with expectant management, a pessary and/or physical therapy, or surgical correction for POP. Patients were excluded if race/ethnicity was not disclosed or if they were not offered a choice in treatment. This included some patients not considered to be surgical candidates. Treatment selection was defined as the therapeutic modality selected at the time of initial consultation and does not reflect changes after this point. Overall PFDI-20 and Pelvic Organ Prolapse Distress Inventory (POPDI) sub-scales were indicators of prolapse bother, and both the overall score as well as the sub-scores were used in the analysis. Anatomical severity of prolapse was dichotomized as having at least one vaginal compartment (apical, anterior, or posterior) beyond the hymen or no compartments beyond the hymen as determined by POP-Q examination. Race was dichotomized as white or non-white. Chi-square and student’s t-test were used to compare groups as appropriate. Pearson coefficient was to assess the correlation between PFDI-20, POPDI-6, and treatment choice. Of 235 women in the database, 189 met inclusion criteria for this study. At the time of initial consultation, 65.6% of patients chose surgical management. There was no difference in anatomical severity between treatment groups. The majority of women (81.5%) identified as white, 7.9% identified as Black, 7.4% were Hispanic, and 3.2% identified as another race. There was no difference between races in anatomical severity of prolapse. Higher scores on both the overall PFDI-20 (surgical management: 108.3 ± 55.0 vs. non-surgical management: 82.9 ± 48.1; r = 0.22; p = 0.0024) and POPDI-6 sub-scale (surgical management: 42.0 ± 20.9 vs. non-surgical management: 30.1 ± 17.2; r = 0.28; p = 0.0002) were correlated with surgical management. A higher proportion of white women chose surgery compared to non-white women (N = 68.83% vs. 51.43%; p = 0.05). Greater prolapse bother and white race are associated with the selection of surgical management over non-surgical management of POP at initial consultation.