Pessary versus prolapse surgery as primary treatment for symptomatic pelvic organ prolapse

A pelvic organ prolapse is a prevalent condition, and even though it is not a life-threatening condition, it negatively affects women’s lives. The management of POP remains a challenging task demanding specialized skills. Among the effective treatment options are pessary therapy and prolapse surgery, but recommendations on the best approach remain speculative. In this thesis, the effect of pessary versus prolapse surgery is analyzed. The first part of the thesis addresses overall effectiveness and effectiveness on prolapse-related complaints (part I), while the second part focuses on a cost-effective analysis (part II). This approach provides a better understanding of the effectiveness and outcomes of pessary therapy versus surgery for symptomatic POP. The results suggest that after surgery, statistically significant more women report subjective improvement compared to pessary therapy after a 24-months follow-up. However, it is essential to take prolapse specific complaints and cost effectiveness in account when counseling patients. When looking at prolapse specific complaints, the findings of this thesis suggest that both treatment options do not differ in effect with respect to vaginal and bowel symptoms. However, when looking at urinary symptoms and sexual functioning there is a trend towards surgery being more effective, with an increased odds of becoming sexually active again after surgery. From a cost-effectiveness perspective, an initial strategy with pessary therapy appears to be cost-effective compared to initial surgery, considering both healthcare and societal perspectives.