[Genital prolapse; treatment and course in four general practices]

OBJECTIVE: To obtain insight into the treatment and course of genital prolapse in four general practices. DESIGN: Historical cohort study. METHOD: The files of patients in whom a prolapse was first diagnosed in the period 1976-2000 and who belonged to the four general practices associated with the General Practice Department of the UMC St Radboud in Nijmegen, the Netherlands, were studied. Data were collected concerning the management, course and symptoms arising from the use of pessaries and complications after operations. RESULTS: 324 patients were included with a median follow-up of 9 years; 15 of them had been treated by a gynaecologist. The initial treatment prescribed by the general practitioner (n = 309) was a wait-and-see policy in 29% of the cases, a pessary (40%), exercises of the muscles of the pelvic floor (15%) or medication (5%). A total of 192 of the 324 patients (59%) received a pessary in the course of time; 47% of them had no problems during the use of a pessary, 17% had increased vaginal discharge and 17% had a pressure ulcer. In 15% of the cases the pessary was ultimately lost because of insufficient support from the pelvic floor muscles. The pessary remained in situ for an average of 5.4 years (SD: 5.4). In 107 (56%) cases it was removed after a period of time; the most important reasons for this were complaints arising from the use of the pessary (54%) and ineffectiveness (24%). In case of a conservative approach (n = 299), the prolapse became worse in 15% of the cases. A total of 128 patients (40%) were referred to a gynaecologist. Of the 92 patients who were operated, 10% experienced a complication and 24% a recurrence. CONCLUSION: The pessary was a frequent and justified treatment in women with a genital prolapse. It is important that the complications of the pessary be reduced further