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

A higher proportion of women in the surgery arm reported successfully achieving symptom and function goals compared to pessary, with 97% of surgery patients reporting 'much better' or 'very much bette

Effect: improvement; 56% surgery vs 39% pessary continuation vs 5% pessary discontinuation achieved 100% goal attainment

Women who had surgery reported significantly greater improvements in PROMIS Physical Function, Social Roles, and Depression domains compared to the pessary group (P<0.05), including when compared only

Effect: improvement; Physical Function mean change 8.7 surgery vs 5.2 pessary continuers; Depression mean change 4.0 surgery vs 0.5 pessary continuers

31 of 80 pessary patients (39%) discontinued pessary use or crossed over to surgery, with reasons including discomfort (47%), persistent bulge symptoms (42%), urinary symptoms (32%), and bowel symptom

Effect: adverse; 31 of 80 pessary patients discontinued or crossed over to surgery; 5% of discontinuers achieved 100% goal attainment vs 56% surgery

Achievement of urinary symptom goals was not different between women who underwent a concomitant anti-incontinence procedure in the surgery group compared to the pessary group (60% surgery versus 64%

Effect: null; 60% surgery vs 64% pessary