Pelvic organ prolapse is defined as descent of the anterior or posterior vaginal wall, the uterus, or the vaginal vault (after hysterectomy). Pelvic floor muscle training (PFMT) and pessaries are commonly used in the conservative treatment of prolapse. Although both treatments could typically be applied in primary care, there have been no high-quality studies on the effectiveness of these treatments in women with prolapse in this setting. The main objective of this thesis was to investigate the effectiveness and cost-effectiveness of conservative treatments for older women with symptomatic prolapse in a primary care population. The thesis comprises two randomized controlled trials: in the first trial, watchful waiting was compared with PFMT in women with a symptomatic mild prolapse (leading edge above the hymen); in the second trial, PFMT was compared with pessary treatment in women with a symptomatic advanced prolapse (leading edge at or beyond the hymen). During the two years of follow-up, PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting in women with mild prolapse, but the difference between groups was too small to be clinically relevant. Nevertheless, PFMT more often led to women’s perceived improvement of symptoms and lower absorbent pads costs. In women with advanced prolapse, there was no significant difference between PFMT and pessary treatment in the reduction of pelvic floor symptoms. However, women with typical prolapse symptoms seemed to benefit more from pessary treatment than from PFMT. Also, pessary treatment was preferable to PFMT in the cost-effectiveness analysis.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2017|