Background Pelvic organ prolapse can negatively impact a woman’s overall functioning. When choosing between surgery or pessary, many women have information needs about long-term expectations. While 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 two treatments. Objectives Our primary objective was to compare patient-reported goal attainment and comprehensive physical, social, and emotional functioning outcomes after surgery versus pessary for symptomatic prolapse. Study Design 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 surgery or those anticipating using a pessary long-term to avoid surgery were eligible. Women completed questionnaires at baseline (pre-treatment) and up to 12 months post-treatment including: 2) Pre-treatment goals and actual post-treatment goals achieved; 2) five functioning outcomes encompassing physical, social and emotional function using the Patient-Reported Outcomes Measurement Information System surveys; 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 chi-square. 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 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 = 0.05. We recruited 80 women per group to account for drop out. Results A total of 160 women were enrolled and 72 (90%) surgical (mean follow-up 12 months) and 64 (80%) pessary patients (mean follow up 8 months) had post-treatment data. 14 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 to women who chose pessary (P<0.05). Women who continued pessary use had comparable goal attainment to 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 to 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 (OR 2.70, 95% CI 1.1-6.6, P=0.03). Regarding functioning outcomes, within groups, there were statistically significant improvements between pre- and post-treatment Patient Reported Outcomes Measurement System functioning scores in all 5 domains for the surgery group and 4 of...

Objective-To estimate the association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures.Study Design-We performed a retrospective cohort study of women undergoing outpatient midurethral sling procedures. Exposure was defined as the type of anesthesia, categorized as regional (spinal or combined spinal/epidural) or non-regional (general endotracheal, monitored anesthesia care with sedation, or local). Outcome, acute postoperative urinary retention, was defined as a failed voiding trial prior to discharge.Results-A total of 131 women met our inclusion criteria. Forty-two (32%) women had regional anesthesia and 89 (68%) women had non-regional anesthesia. Overall, 48 (36.6%) women had acute postoperative urinary retention. Women who had regional anesthesia had an increased odds (Adjusted OR=4.4, 95% CI 1.9, 10.2) of acute postoperative urinary retention compared to women receiving non-regional anesthesia.Conclusion-Regional anesthesia is a risk factor for acute postoperative urinary retention following outpatient midurethral slings.

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