(Poster 145) Timing on Decision to Surgery for Patients Undergoing POP and SUI

Objectives: To identify demographic and clinical factors associated with the time between surgical recommendation and a patient’s decision to proceed with surgical management for pelvic organ prolapse (POP) and stress urinary incontinence (SUI).

Methods: A retrospective chart review was conducted on 197 patients who underwent surgery for POP and/or SUI. To minimize the potential impact of the COVID-19 pandemic on decision-making, only patients who elected surgery between 2017 and 2019 were included. All procedures were performed by a single urogynecologist. Patients who underwent surgery for overactive bladder were excluded. Variables analyzed included age, race, procedure type, employment status, marital status, type of insurance, body mass index (BMI), and whether patients had attempted pessary use or pelvic floor physical therapy (PFPT) prior to surgery. Bivariate analysis was used to assess associations between these variables and time to surgical decision-making.

Results: The mean age of patients was 64.2 years. On average, the time to decide on surgery was 172.32 days. Patients undergoing combined POP and SUI procedures took the shortest time to decide (127.74 days), compared to those with POP only (163.13 days) and SUI only (272.5 days) (p = 0.003). Patients who had trialed a pessary or pelvic floor physical therapy (PFPT) took significantly longer to decide than those who did not (358.72 vs. 88.72 days, p < 0.001). Patients with public insurance decided more quickly than those with private insurance (154.08 vs. 195.87 days, p = 0.044). No significant associations were found between time to decision and race, ethnicity, employment status, marital status, age, BMI, county of residence, or prolapse stage.

Conclusions: Our study demonstrates that decision time for POP and SUI surgery is influenced by both clinical presentation and systemic factors. Patients undergoing combined POP and SUI procedures opted for surgery sooner, whereas those with isolated SUI took the longest to decide on surgery. Those who were initiated on conservative therapies—such as pessary or PFPT—at or prior to the initial consult understandably took longer to decide to proceed with surgery, reflecting a stepwise management approach. These findings can inform counseling strategies, helping to set realistic expectations for patients who may be considering surgical intervention. Additionally, patients with public insurance opted for surgery significantly earlier than those with private insurance, suggesting potential differences in healthcare navigation, cost sensitivity, or access to care that merit further investigation. By identifying these influencing factors, we can better support patients with more personalized counseling.