Priority 21 from the Pessary use for Prolapse PSP

UNCERTAINTY: Is a pessary as acceptable as surgery for the treatment of prolapse? (JLA PSP Priority 21)
Overall ranking	21
JLA question ID	0054/21
Explanatory note	Treatment for prolapse aims to remove or reduce the symptoms which impact on the quality of life of the woman. For the clinician advising the woman and for the woman trying to decide which treatment would be best for her, knowing how pessary treatment compares with surgery in the short and long term will add to the available knowledge. Examples: Is it better than obliterative surgery for elderly, sexually-inactive women? When would you choose a pessary over surgery in a woman who has completed her family, is fit and strong? The comparison of costs of pessary use over time versus surgery?
Evidence	None identified
Health Research Classification System category	Renal and urogenital

Extra information provided by this PSP
Original uncertainty examples	When woukd you choose a pessary over surgery in a woman who has completed her family, is fit and strong ~ Is it better than obliterative surgery for elderly, sexually-inactive women? ~ I have had a hysterectomy and prolapse operation, which now I am facing another operation less than 2 years on. Is the pessary an alternative or a a delay until further operations are considered for a patient? ~ Are there studies comparing acceptability of pessary vs operative intervention? Many women want the latter and are fit for surgery but see stuck with pessaries and over years- the pain and local irritation are awful- seem fine short term for " holding" but not long term. ~ How often do women change from using a pessary to an operation? ~ How to choose between an operation and a pessary while still fit and healthy when do I do something more permanent ~ Which is better to manage a prolapse - pessary or surgery
Submitted by	4 x healthcare professionals, 4 x women, 4 x literature

Extra information provided by this PSP

Original uncertainty examples

When woukd you choose a pessary over surgery in a woman who has completed her family, is fit and strong ~ Is it better than obliterative surgery for elderly, sexually-inactive women? ~ I have had a hysterectomy and prolapse operation, which now I am facing another operation less than 2 years on. Is the pessary an alternative or a a delay until further operations are considered for a patient? ~ Are there studies comparing acceptability of pessary vs operative intervention? Many women want the latter and are fit for surgery but see stuck with pessaries and over years- the pain and local irritation are awful- seem fine short term for " holding" but not long term. ~ How often do women change from using a pessary to an operation? ~ How to choose between an operation and a pessary while still fit and healthy when do I do something more permanent ~ Which is better to manage a prolapse - pessary or surgery

Submitted by

4 x healthcare professionals, 4 x women, 4 x literature

PSP information
PSP unique ID	0054
PSP name	Pessary use for Prolapse
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8 September 2017