ORIGINAL ARTICLE Natural history of pelvic organ prolapse in symptomatic patients actively seeking treatment Javier Pizarro-Berdichevsky 1,2,3 & Ali Borazjani 4,5 & Alejandro Pattillo 1,2 & Marco Arellano 1 & Jianbo Li 6 & Howard B Goldman 3 Received: 5 March 2017 /Accepted: 3 August 2017 /Published online: 24 August 2017 # The International Urogynecological Association 2017 Abstract Introduction and hypothesis At our institution many symp- tomatic patients must wait months or years for surgery. Our aim was to determine the rates of clinically significant pelvic organ prolapse (POP) progression and identify risk factors associated with POP progression. Methods Data from a prospectively maintained database of POP patients evaluated between 2008 and 2013 were ana- lyzed. Women with symptomatic POP and two or more POP-Q examinations prior to surgery were included. POP progression was defined as having any of the POP-Q points Aa, Ba, C, D, Ap or Bp above the hymen at the baseline examination and at or below the hymen at the follow-up ex- amination. Multivariable logistic analysis was preformed and the results are presented as odds ratios (OR) with 95% confi- dence intervals (CI). Results Of consecutive patients evaluated between July 2008 and June 2013, 388 met the inclusion criteria and were includ- ed. The median time between the POP-Q examinations was 9.9 months (IQR 7.8 to 13.8 months). The POP progression rate was 29.1% (95% CI 24.6–33.6%). Predictors of progres- sion included age (OR 1.7, 95% CI 1.01–2.87) and the base- line status of points Ba, C, Bp and gH (OR 1.91, 95% CI 1.01– 3.62; OR 0.53, 95% CI 0.3–0.94; OR 0.54, 95% CI 0.32– 0.93; OR 2.15, 95% CI 1.13–4.1; respectively). POP-Q point correlations showed that anterior and posterior compartment points evolve with apical compartment points and gH evolves with both the anterior compartment and the apex. Conclusions Up to 29.1% of symptomatic patients with POP showed clinically significant progression over a median follow-up of 9.9 months. The likelihood of progression was not significantly associated with time. Those ≥60 years of age as well as those with point Ba ≥4 cm or gH ≥5 cm at baseline were at increased risk of POP progression. Keywords Pelvic organ prolapse . Natural history . Observation . Risk factors Introduction Pelvic organ prolapse (POP) is the downward descent of the pelvic organs that results in protrusion of the uterus, vagina and/or rectum [1]. It is estimated that 12.6% of women will undergo surgery for POP by the age of 80 years [2]. Evidence regarding the evolution of POP is scarce and conflicting [3]. Bland et al. [4] and Gilchrist et al. [5] reported that POP progresses over time, while Bradley et al. [6] and Handa et al. [7] found that regression is also possible. Norton et al. [8] found that patients with POP-Q stage II are unlikely to require surgery even after 5–7 years. Similarly, other authors This work was presented at the joint meeting of the American Urogynecologic Society and the International Urogynecological Association, 22–26 July 2014. Washington DC, USA. * Javier Pizarro-Berdichevsky jpizarro@med.puc.cl 1 Urogynecology Unit, H. Dr. Sotero del Rio, Santiago, Chile 2 Division Obstetricia y Ginecologia, Pontificia Universidad Católica de Chile, Lira 85, 5to piso, Santiago, Chile 3 Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA 4 Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA 5 Global Innovations for Reproductive Health & Life, Cleveland, OH, USA 6 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA Int Urogynecol J (2018) 29:873–880 DOI 10.1007/s00192-017-3450-0