Outcomes of observation as therapy for pelvic organ prolapse: a study in the natural history of pelvic organ prolapse.

AIMS: To determine the rate of progression or regression of pelvic organ prolapse (POP) in subjects with symptomatic POP who decline intervention (pessary or surgery) and elect observation.
METHODS: Sixty-four patients choosing observation as primary management of symptomatic POP were followed with sequential pelvic organ prolapse quantification (POP-Q) exams. A change in the leading edge value of ±≥2 cm was considered significant. POP-Q exam results, choice of therapy and symptom severity at last visit were recorded.
RESULTS: The leading vaginal edge POP-Q exam value at initial exam ranged from -1.5 to 7 cm. Distribution of patients by POP-Q stages on initial exam was: stage I: 1%, stage II: 31%, stage III: 31%, and stage IV: 1.78% (50/64) of patients demonstrated no change in leading edge value from first to last visit on POP-Q exams. Nineteen percent (12/64) demonstrated progression (≥2 cm increase in leading edge); 3% (2/64) demonstrated regression (≥2 cm decrease in leading edge). Median follow-up was 16 months (range 6-91 months). On multivariate analysis, no variable, including length of follow-up, was associated with change in leading edge value (P = 0.09, data not shown). At their last recorded visit, 63% (40/64) of subjects continued observation, 38% (24/64) desired a pessary trial or surgical correction. Those desiring intervention had no greater worsening of prolapse on exam at last follow-up compared with subjects who continued observation.
CONCLUSION: The natural history of pelvic organ prolapse is most often one of very minimal change in subjects who decline intervention (pessary or surgery) and choose observation.