The Impact of the COVID Pandemic on Prolapse Severity in Women Visiting a Urogynecology Clinic

Objectives: This study aims to assess the impact of the COVID pandemic on prolapse stage severity and progression. We hypothesized that women would present to their new patient visit at an older age and with a more advanced stage of prolapse during the pandemic compared to before the pandemic.

Methods: This is a retrospective chart review study including new female patients diagnosed with pelvic organ prolapse by one of our Female Pelvic Medicine and Reconstructive Surgery Fellowship-certified physicians. Women were grouped into three time periods for comparison: Pre-COVID between October 1, 2018 and February 28, 2020, During-COVID between March 1, 2020 and December 31, 2020, and After-COVID between January 1, 2021 and May 31, 2022. The three groups were compared using demographic, clinical, and operative variables. The primary outcome of interest was stage of prolapse at presentation: mild (stage I/II) or severe (stage III/IV). A linear regression controlling for confounders was used to evaluate the effect of time period on prolapse severity. P-value < 0.05 was considered statistically significant.

Results: A total of 1,581 patients were included, with 656 (41.5%) Pre-COVID, 277 (17.5%) During-COVID, and 648 (41.0%) After-COVID. The three groups had a similar median age and parity. The During-COVID cohort saw the highest proportion of patients presenting within 6 months of symptom onset with 74 (35.7%) patients, followed by 196 (34.8%) patients in the After-COVID group, and 178 (29.9%) patients in Pre-COVID (p=0.047). Furthermore, women in the During-COVID cohort had a lower number of healthcare visits in the 12 months prior to their visit (p< 0.001). Treatment choices differed by group, with 224 (34.1%) opting for surgery in the Pre-COVID group, 46 (16.6%) During-COVID, and 172 (26.5%) After-COVID. A higher proportion of patients (58.5%) in the During-COVID cohort opted for other non-surgical interventions, followed by 50.5% in the After-COVID cohort and 33.7% in the Pre-COVID cohort (p=0.0005). The adjusted model of time period effect on prolapse stage yielded an odds ratio of 0.85 (95% CI: 0.75-0.97) [Table.1]. More specifically, a higher proportion of women presented with mild prolapse (stage I/stage II) in the During-COVID (76.5%) cohort as compared to the Pre-COVID (62.5%) and After-COVID (70.4%) cohorts (p=0.0005) [Table.2].

Conclusions: Contrary to our hypothesis, women during COVID presented earlier to the urogynecology clinic and with milder forms of prolapse. However, they elected for more conservative treatment options, possibly to reduce hospital stay and interaction with healthcare systems to mitigate infection risk as compared to the other groups. It is possible that the patients with higher stages of prolapse were truly older and had more comorbidities, thus opting not to present to the clinic during the pandemic. In the future, exploring additional variables such as health comorbidities would be important to further explain the results.