Comparison of Colpocleisis and Long-Term Pessary Therapy in the Management of Severe Pelvic Organ Prolapse: A Retrospective Observational Study.

Objective: The aim of the study was to compare the effectiveness, complications, and treatment preference parameters of long-term pessary therapy versus vaginal obliteration (colpocleisis) in elderly, sexually inactive female patients with severe pelvic organ prolapse (POP).

Design: This study was a single-center, retrospective observational study. Participants/Materials: In our study, we included elderly, sexually inactive women treated for advanced POP between January 2015 and November 2023. Long-term pessary therapy was applied in 30 cases, while 46 patients underwent vaginal obliteration. The mean follow-up duration was 41.9 ± 31.9 vs. 61.9 ± 40.1 months, respectively.

Setting: The study was performed at the department of urology of our university (n = 76).

Methods: Data collection was carried out based on clinical patient documentation and telephone interviews. We used a standardized, non-validated questionnaire specifically designed for this study covering four domains: patient characteristics; POP-related symptoms; treatment effectiveness and complications; socioeconomic and health-related parameters, including treatment preferences. Pre- and post-treatment parameters and intergroup differences were statistically analyzed.

Results: The mean age of the patients was 74 ± 5.6 years, and the mean BMI was 25.6 ± 4.4. Following both pessary therapy and surgery, high rates of symptom resolution were observed regarding vaginal foreign body sensation, discomfort, and/or palpable bulge (93.5% vs. 95.5%) and obstructive voiding difficulty (100% vs. 96.4%). The rate of patient satisfaction was high in both groups (90% vs. 97.8%, p = 0.15); however, symptom improvement was significantly greater following vaginal obliteration (VAS: 8.9 ± 1.1 vs. 7.7 ± 1.7, p < 0.001). Pessary therapy was discontinued in 23.3% of cases, and 20% later required surgical POP intervention. No reoperations due to recurrence were required following obliterative surgery. Adverse events occurred in 26.6% of pessary patients, and complications occurred in 17.3% of surgically treated patients. The most frequent reason for choosing pessary therapy was fear of surgery (76.6%), while the most common reason for choosing surgery was refusal of pessary therapy (58.5%).

Limitations: The retrospective design and relatively small sample size limit the generalizability of the findings.

Conclusions: In elderly, sexually inactive women requiring treatment for advanced POP, both vaginal obliteration and long-term pessary therapy provide excellent therapeutic alternatives. The two modalities demonstrate comparable outcomes, high effectiveness, and an acceptable rate of non-severe complications, making both options suitable for appropriately selected patients.