Pessary For Pelvic Organ Prolapse Research Articles

Effectiveness and safety of a novel, collapsible pessary for management of pelvic organ prolapse

Pessaries are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort with removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data is needed. To assess the effectiveness and safety of the investigational vaginal pessary for pelvic organ prolapse at three months. This was a prospective, seven-center, open-label equivalence study with participants serving as their own controls. Subjects were current users of a Gellhorn or ring pessary with ≥ Stage II prolapse. Baseline subjective and objective data were collected for one month using their current pessary, and then data were collected through a three-month treatment phase with use of the study pessary. The primary outcome was change in Pelvic Floor Distress Inventory-20 score. Secondary outcome measures included objective assessment of prolapse support, changes in the Pelvic Floor Impact Questionnaire-7, and pain with insertion and removal measured on a Visual Analog Scale. Subjects fitted with study pessary were analyzed as intention to treat and those who dropped out were assigned scores at the upper limit of the predefined equivalence limits. Secondary per protocol analyses included subjects who completed treatment. The study was powered to 80% with a minimal important change equivalence limit of 18.3 points on the Pelvic Floor Distress Inventory-20 scale. Square root transformations were used for non-parametric data and p-values adjusted for multiple comparisons. Seventy-eight subjects were enrolled, though 16 withdrew prior to study pessary placement. Sixty-two subjects (50 ring and 12 Gellhorn pessary users) were fitted with the study pessary, and 48 (62%) completed the three-month intervention. The change in Pelvic Floor Distress Inventory-20 scores at three months demonstrated equivalence compared to the subjects' baseline scores, (mean difference -3.96 (improvement), 90% confidence interval (CI) [-11.99, 4.08], p=0.002). Per protocol analysis of the Pelvic Floor Distress Inventory-20, equivalence was not demonstrated with scores favoring the study pessary (mean difference -10.45, 90% CI, [-20.35, 0.54] (p=0.095)). Secondary outcomes included: objective measures of support which were similar, mean difference Ba=0.54 cm, Bp=0.04 cm, favoring study pessary; improvement in mean Pelvic Floor Impact Questionnaire-7 scores for those who completed the trial (pre=32.23, post=16.86, p=0.019); and pain with insertion and removal, which was lower with the study pessary compared to subject's own pessary (mean difference Visual Analogue Scale insertion=9.91 mm (p=0.019), removal=11.23 mm (p=0.019)). No serious adverse events related to the pessary were reported. Equivalence was demonstrated in the study pessary primary outcome compared to current non-collapsible pessaries for change in severity and bother of pelvic floor symptoms. In participants who completed the trial, the Pelvic Floor Impact Questionnaire-7 improved with the study pessary and change in Pelvic Floor Distress Inventory-20 scores were non-equivalent, favoring the study pessary. Subjects reported significantly lower pain scores with both pessary insertion and removal with the novel collapsible pessary compared with their standard pessary.

Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis.

There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary. We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis. Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I2-test of 37% (p = 0.21). Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.

ChatGPT in Urogynecology Research: Novel or Not?

ChatGPT (Chat Generative Pre-trained Transformer) is an artificial intelligence (AI) chatbot that provides human-like responses to text prompts. Little is known regarding ChatGPT's ability to identify original research ideas in urogynecology. Our objective was to evaluate the accuracy of ChatGPT in generating novel systematic review (SR) and research ideas in urogynecology. In this cross-sectional study, we asked ChatGPT to generate 10 novel SR ideas that have not yet been published for each of the following 5 topics: (1) urogynecology, (2) tension-free vaginal tape slings, (3) pessaries for pelvic organ prolapse, (4) beta-3 agonist use for overactive bladder, and (5) sexual function with genitourinary syndrome of menopause. Research idea novelty was assessed by cross-referencing PubMed and Scopus to determine if any prior publications existed. ChatGPT proposed 50 total SR ideas, including 10 for each prompt. Overall, ChatGPT showed 54% overall accuracy in developing novel SR ideas. Nonnovel SR ideas had a median of 19 (interquartile range, 8-35) published SRs on the suggested topic. When stratified by prompt type, 50% of general and 40-70% of specific urogynecology proposed SR ideas were found to be novel. There were no publications of any type identified for 7 of the 50 suggested ideas. ChatGPT may be helpful for identifying novel research ideas in urogynecology, but its accuracy is limited. It is essential for those using ChatGPT to review existing literature to ensure originality and credibility. As AI transforms health care, we encourage all urogynecologists to familiarize themselves with popular AI platforms.

Long-term adherence to pessary use in women with pelvic organ prolapse: A retrospective cohort study.

Vaginal pessary use is an established, non-surgical treatment option for pelvic organ prolapse. While satisfaction rates are initially high, they seem to decline over time. We aimed to determine the median duration of pessary use among our patients and to evaluate reasons for discontinuation. All patients who were treated with a vaginal pessary for pelvic organ prolapse between 2007 and 2022 at our institution (a maximum observation period of 15years) were included in this retrospective cohort study. Data were collected from the in-house electronic databases and the date of pelvic floor surgery was defined as the primary endpoint. In case of no documented surgery, the date of the last follow-up visit (for patients lost to follow-up or who discontinued pessary use without subsequent surgery) or the date of final data collection (for those with presumed continued pessary use) was used as the primary endpoint. Duration of pessary use is represented by Kaplan-Meier curves. Effects of possible confounders were investigated by Cox regression models. A Cox regression model was evaluated for patients with the three most common types of pessary: ring, cube and shell. A chi-square test was performed to compare therapy adherence according to pessary type. Data of 779 patients could be included in the statistical analysis. The estimated median duration of pessary use was 173weeks (95% CI 104-473) - approximately 3.3years. Overall, 30% of patients opted for surgical therapy and the majority of them did so within 4months of initiation of pessary use (median time: 19weeks, 95% CI 16-26). In 5% of cases a discontinuation of pessary use without subsequent surgery was documented and 18% were lost to follow-up before a planned visit, thus leaving 47% of our patients with presumed continued pessary use. Possible confounding factors for discontinuation of pessary use were tested but were found to be non-significant (body mass index, Pelvic Organ Prolapse - Quantification score, pelvic floor training, age, parity, menopausal status, nicotine consumption, incontinence or size of pessary). Reasons for discontinuation of pessary use were documented in 51% of patients: unspecified patient wish (23%), pessary use tiredness (10%), general dissatisfaction with pessary therapy (7%), unspecified reasons (5%), pessary self-change not possible (1%), erosion, bleeding, pain (2%); none of the pessary types fitted (2%). According to our data, almost half of our patients with pelvic organ prolapse and pessary therapy continued pessary use until a maximum follow-up time of 15years, whereas about one-third of patients finally opted for surgical repair (a majority of these within 4months after pessary therapy initiation). The remaining patients were either lost to follow-up or discontinued pessary use without subsequent surgery. The stated reasons for discontinuation of pessary use were mostly non-specific, but only 1% reported that pessary self-change was not possible. Erosion bleeding or pain was documented in only 2% of cases as reason for discontinuation. This information helps clinicians to inform their patients with pelvic organ prolapse about expected pessary therapy success and strengthens individual counselling. Furthermore, our data indicates vaginal pessary use for pelvic organ prolapse is feasible and safe for all women and that therapy adherence can extend beyond 5years.

Adverse events in women with neglected vaginal pessaries for pelvic organ prolapse: a case report and literature review

Adverse events in women with neglected vaginal pessaries for pelvic organ prolapse: a case report and literature review

Pessaries for pelvic organ prolapse: evaluation of vaginal discharge and pain during pessary cleaning in an outpatient setting.

Pessary treatment for pelvic organ prolapse (POP) is effective and safe, but long-term continuation is low. Pain and vaginal discharge may play a role. This study was aimed at evaluating vaginal discharge and pain during pessary cleaning in an outpatient setting and in continuous pessary use. Women with POP who attended the outpatient clinic for pessary cleaning between January and October 2021 were included. Primary outcome was pain during removal and reinsertion of the pessary, measured by an 11-point numeric rating scale (NRS). Secondary outcome was vaginal discharge, measured by the NRS and Patient Global Impression of Change scale (PGI-C). Multiple linear regression analysis was used to identify associated variables for pain and discharge. A total of 150 women were included. Mean NRS during pessary removal was 4.3 (± 2.7), with 25% of women scoring a 7 or higher. Mean NRS during reinsertion was 1.8 (± 2.0). A smaller genital hiatus and presence of vaginal atrophy or vulvar skin disease were associated with pain during pessary removal. Mean NRS for vaginal discharge was 2.5 (± 2.3). Twenty-five percent of women reported that their vaginal discharge was "(very) much worse" than before they used a pessary. Presence of vaginal erosions was associated with vaginal discharge in this study population. Removing a pessary in an outpatient setting is a painful procedure for many women who use a pessary continuously. Moreover, 25% of these women experience an increase in vaginal discharge while using a pessary. Future research should focus on reducing these disadvantages.

Pessaries for pelvic organ prolapse in women with severe dementia: an ethical challenge.

Pelvic organ prolapse is commonly treated with intravaginal devices to support the pelvic organs and maintain comfort. Pessaries generally require regular maintenance with removal, cleaning, and replacement. For women with severe dementia, this process can be extremely distressing. We present an illustrative case of a woman in whom the progression of her dementia led to a challenging ethical dilemma about continuing the use of a pessary and call for a conversation about these issues in the urogynaecology community.

Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse

BackgroundPelvic organ prolapse (POP) is a common condition in women, where the downward descent of pelvic organs into the vagina causes symptoms which impacts quality of life. Vaginal pessaries offer an effective alternative to surgery for the management of POP. However, the need for regular follow-up can be burdensome for women and requires significant healthcare resources. The TOPSY study is a randomised controlled trial which aims to determine the clinical and cost-effectiveness of self-management of vaginal pessaries. This paper describes the theoretical and practical development of the self-management intervention.MethodsThe intervention was developed using the MRC complex intervention framework, normalisation process theory (NPT) and self-management theory. The intervention aims to boost perceived self-efficacy in accordance with Bandura’s social cognitive theory and is guided by the tasks and skills Lorig and Hollman describe as necessary to self-manage a health condition.ResultsThe TOPSY intervention was designed to support women to undertake the medical management, role management and emotional management of their pessary. The six self-management skills described by Lorig and Hollman: problem-solving, decision-making, resource utilisation, formation of a patient-provider partnership role, action planning and self-tailoring, are discussed in detail, including how women were supported to achieve each task within the context of pessary self-management. The TOPSY intervention includes a self-management support session with a pessary practitioner trained in intervention delivery, a follow-up phone call 2 weeks later and ongoing telephone or face-to-face support as required by the woman initiated by contacting a member of the research team.ConclusionsThe TOPSY study intervention was developed utilising the findings from a prior service development project, intervention development and self-efficacy theory, relevant literature, clinician experience and feedback from pessary using women and members of the public. In 2022, the findings of the TOPSY study will provide further evidence to inform this important aspect of pessary management.Trial registrationISRCTN Registry ISRCTN62510577. Registered on June 10, 2017

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

ObjectivesPelvic organ prolapse can be managed with a pessary. However, regular follow-up may deter women due to the inconvenience of frequent appointments, as well as preventing autonomous decision making. Pessary...

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol

IntroductionPelvic organ prolapse (POP) can be managed with a pessary; however, regular follow-up may deter women from pessary management due to the inconvenience of frequent appointments, as well as preventing...

Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review.

In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries. Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary. Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries. Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.

Vaginal pessary for pelvic organ prolapse: A survey among french gynecological surgeons

ObjectiveBecause pessaries may offer symptomatic improvement for women with pelvic organ prolapse (POP), the study aimed to assess the opinion and knowledge of participants to a french general surgical gynecological congress, about this device. Material and methodsAn anonymous survey was carried out near 150 surgeons attending a congress by handing them a questionnaire. ResultsThe average age of the 70 respondents was 50 years. 87.7 % were comfortable with fitting and monitoring pessary, 54.3 % think that a pessary can be offered as a first-line treatment in the management of POP. However, main indications of vaginal device are still old women and contraindications to surgery ; 31.4 % do not associate local estrogen therapy with a pessary for postmenopausal women. ConclusionThe majority declares to be comfortable with pessaries, is ready to prescribe it as a first-line treatment and use local estrogen if necessary. Even if change of ideas seems to emerge about pessary, a change in beliefs and habits is still necessary. This progress can be achieved through doctors fully informed.

An audit of vaginal support pessaries for pelvic organ prolapse in western Uganda

An audit of vaginal support pessaries for pelvic organ prolapse in western Uganda

Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study

Introduction and hypothesisThe objective of this study was to determine the efficacy of routine follow-up visits for pessary cleaning, the effect of extended time intervals between visits and the proportion of patients being able to self-manage their pessary for pelvic organ prolapse (POP).MethodsWe conducted a prospective cohort study in patients with a stage ≥II POP without previous POP surgery. All patients received a pessary as primary treatment. Our main outcome measure was a difference ≥2 in median visual analogue scale (VAS) scores (for pain, discharge, irritation) 1 week before and 1 week after cleaning. Measurements were performed after 3- and 9-month cleaning intervals. For the evaluation of the effect of cleaning, 132 patients (3 months’ follow-up) and 87 patients (12 months’ follow-up) were available for analysis. For the evaluation of the effect of the lengthening interval, 123 patients were available.ResultsSelf-management was performed in 45.2% of patients at 1 year. In 93.1% of patients, no differences were observed in pre-and post-cleaning VAS scores (effect of cleaning) on vaginal pain. Nor was there a difference in discharge (72.4%) or irritation 85.1% (p = 0.00). No differences were observed in pre-cleaning VAS scores for vaginal pain, discharge and irritation when the interval was lengthened from 3 to 9 months. No serious adverse events occurred.ConclusionsThere is no proven benefit of regular follow-up visits to clean a pessary. Also, the length of the cleaning interval does not seem to matter.

Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function.

Pelvic organ prolapse (POP) is a common condition among parous women and its prevalence increases with age. Vaginal pessaries are one of the management options for women with prolapse. In the current health climate, where there are controversy surrounding surgical procedures, an increasing number of women are considering a pessary over surgical management. This article aims to provide an overview of POP, its associated symptoms, and the different types of pessaries available. It will go on to describe how sexual activity (SA) and sexual function (SF) needs to be considered as part of the pessary selection discussion, and common concerns expressed by women. A literature review was undertaken to record the current evidence regarding SA and pessary use, and clinical practice and experience are discussed. The main outcome of this study was to consider the preservation or restoration of SF in women using a pessary for prolapse. There are several pessaries available on the market that enable women to maintain SA, and for many of these it will not be noticeable to their partners. If, however, the woman or their partner finds the pessary uncomfortable or obstructing during intercourse, women can be trained to remove and reinsert their pessary as necessary. The evidence suggests that, for those women who are sexually active with their pessaries in situ, they are happy and continue with this form of management in the long term. Health care professionals need to ensure that SF or the desire to be sexually active (in whatever form that may be) is assessed and discussed as part of routine care and is considered in all decision making. Rantell A. Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function. Sex Med Rev 2019;7:597-603.

Moving On: How Many Women Opt for Surgery After Pessary Use for Prolapse?

Our primary objective was to evaluate the proportion of women who underwent surgery after successful pessary fitting for pelvic organ prolapse (POP). Our secondary objectives were to assess when surgery occurs and to evaluate factors associated with choosing surgery as compared to continuing with a pessary. Our study population included women successfully fitted with a pessary for POP 1/1/12 and 12/31/16. We excluded non-English-speaking women and those who used pessary only as a bridge until surgery. We evaluated events occurring after a successful fitting, including whether women (1) continued pessary use, (2) underwent surgery, or (3) discontinued pessary without surgery. Our primary outcome was the proportion of women who opted for surgery after a successful pessary fitting for POP. We also assessed the median time to surgery and compared women who underwent surgery with those who continued with a pessary to assess variables associated with surgery. Of the 444 women with POP who were successfully fitted with a pessary and met inclusion criteria, 137 (31%) ultimately underwent surgery. The median time to surgery was 10 months (interquartile range, 4-18), with 59% having surgery within 1 year, and 89% within 2 years. In a logistic regression analysis controlling for age in decades, advanced POP stage, and Charlson Comorbidity Index, younger age remained significantly associated with surgery (odds ratio, 0.77, 95% confidence interval, 0.62-0.95; P = 0.02). Among women successfully fitted with a pessary for POP, one third ultimately underwent surgery, with approximately 60% of these women undergoing surgery within the first year and 90% within 2 years.

Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

OBJECTIVE:To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP).METHODS:A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries.RESULTS:Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries.CONCLUSIONS:Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.

Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use.

The aim of the study was (1) to evaluate continuation rates of vaginal ring pessary for pelvic organ prolapse (POP), and (2) to identify predictors for continued pessary use. This retrospective chart review study was conducted in a tertiary center. Women who had a ring with support pessary successfully fitted between January 2009 and December 2013 and had completed up to 3 years of follow-up care were included in the analysis. Demographic and obstetric data, body weight, pelvic organ prolapse stage, and associated symptoms were evaluated. All the women were followed until February 28, 2017, unless surgery to correct POP surgery was required, pessary use was discontinued, or the women died. A total of 289 women with symptomatic POP (stages II, III, and IV) were evaluated. The median age was 71 years (range 34-83 y), and the median parity was 3 (range 0-8). Among the women with a successful initial fitting, the failure rate was 5.88% (17/289) at 6 months with most of these women choosing to have surgical intervention. This analysis indicates that the probability of the successful continuation of pessary use after 1, 2, 3, 4, and 5 years was 83.0%, 78.2%, 71.3%, 65.3%, and 61.7%, respectively, reported using a Kaplan-Meier plot. The main cause for discontinuation of pessary use before 3 years was the election for surgical intervention. With regard to predictors for continued pessary use, self-care was the only factor that influenced compliance rates after treatment of 3 years. A ring with support pessary can be used successfully to alleviate symptoms of advanced stage prolapse for 3 years or longer. In addition, proper self-management was found to be a strong predictor for prolonged pessary use.

Quality of life and vaginal symptoms of postmenopausal women using pessary for pelvic organ prolapse: a prospective study.

The use of pessary is an option for the conservative treatment of pelvic organ prolapse (POP). However, here are few studies assess the quality of life (QoL) after inserting the pessary for POP. We have hypothesized that the use of pessary would modify QoL in women with POP. A prospective, observational study was performed that included 19 women with advanced POP. Pessary was introduced, and the SF-36 (general quality of life) and ICIQ-VS (vaginal symptoms and quality of life subdomain) questionnaires were applied before the introduction and after six months. A single question about the satisfaction regarding the use of the device was presented (subjective impression). The mean age of the women included was 76 years. Most of them were non-caucasian (52.6%), with no prior pelvic surgery (57.5%), with urinary symptoms (78.9%). A third of the patients reported sexual activity. After treatment, 22.2% of them presented vaginal infection, and 27.7% increased vaginal discharge. Urinary symptoms remained unaltered. Women reported 100% satisfaction after using the pessary (77.7% partial improvement; 22.3% total improvement). SF-36 had significant improvement in three specific domains: general state of health (p=0.090), vitality (p=0.0497) and social aspects (p=0.007). ICIQ-VS presented a reduction in the vaginal symptoms (p < 0.0001) and an improvement in QoL (P < 0.0001). The use of pessary for six months improved the QoL and reduced vaginal symptoms for women with advanced POP.

Patient-reported goal attainment and comprehensive functioning outcomes after surgery compared with pessary for pelvic organ prolapse

Pelvic organ prolapse can have a negative impact on a woman's overall functioning. When choosing between surgery or pessary, many women have information needs about long-term expectations. Whereas it has been shown that both surgery and pessary can improve prolapse symptoms, there is less information comparing comprehensive functioning outcomes and goal attainment between the 2 treatments. Our primary objective was to compare patient-reported goal attainment and comprehensive physical, social, and emotional functioning outcomes after surgery vs pessary for symptomatic prolapse. We conducted a prospective, observational, cohort study including women choosing surgery or pessary for symptomatic stage 2 or greater prolapse. Women undergoing any modality of prolapse surgeryor those anticipating using a pessary long-term to avoid surgery were eligible. Women completed questionnaires at baseline (before treatment) and up to 12 months after treatment including the following: (1) pretreatment goals and actual posttreatment goals achieved; (2) 5 functioning outcomes encompassing physical, social, and emotional function using the Patient-Reported Outcomes Measurement Information System surveys; and (3) validated symptom and quality-of-life questionnaires. Treatment goals were categorized into symptom goals (prolapse, urinary, bowel, pain) and function goals (physical, social, emotional, sexual). Goals achieved were compared using a χ2 test. Multiple logistic regression was used to identify variables associated with not achieving all pretreatment goals. Mean improvements in functioning scores were compared within groups and between groups using paired and independent Student t tests. Assuming 80% of women would achieve complete goal attainment in the surgery group, 64 women per group would be needed to detect a 20% difference at an alpha of 0.05. We recruited 80 women per group to account for dropout. A total of 160 women were enrolled and 72 surgical (90%) (mean follow-up 12 months) and 64 pessary patients (80%) (mean follow up 8 months) had posttreatment data. Fourteen discontinued pessary use and 8 ultimately crossed over to surgery. At follow-up, a higher proportion of women in the surgery arm reported successfully achieving symptom goals and function goals compared with women who chose pessary (P<.05). Women who continued pessary use had comparable goal attainment with women in the surgery group for almost all goal categories, whereas women who discontinued the pessary or crossed over to surgery had significantly lower goal attainment compared with both the surgery and pessary continuation groups. On multiple logistic regression, only college education or higher was associated with an increased odds of not achieving all pretreatment goals (odds ratio, 2.70, 95% confidence interval,1.1-6.6, P= .03). Regarding functioning outcomes, within groups, there were statistically significant improvements between pre-and posttreatment Patient-Reported Outcomes Measurement Information System functioning scores in all 5 domains for the surgery group and 4 of 5 domainsin the pessary group (P < .05). When comparing between groups, women who had surgery reported significantly greater improvements in the physical function, social roles, and depression domains compared with the pessary group (P < .05). Women undergoing either surgery or pessary for symptomatic prolapse experience goal attainment and improvements in physical, social, and emotional functioning, although surgery is associated with greater improvements.