Severe Pelvic Organ Prolapse Managed Without Surgery - Pessary Discontinued After Pelvic Floor Muscle Training With M-Mode Ultrasound

Sep 30, 2026

Severe uterine prolapse case managed without ongoing vaginal pessary use. A 63-year-old woman with urinary dysfunction and residual urine was diagnosed with stage III pelvic organ prolapse and received a vaginal pessary. Pelvic floor muscle training proceeded for 4 months while the pessary stayed in place; M-mode ultrasonography monitored pelvic floor function and showed improved bladder base elevation indices. Pessary removal followed PFMT guidance, and after 2 years the uterine prolapse improved to POP-Q stage II without recurrence, urinary dysfunction, or residual urine.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Pelvic organ prolapse background and treatment options

Case Presentation

Patient presentation and baseline diagnosis

Pelvic floor muscle training and monitoring methods

Outcomes and follow-up

IJU Case Reports CASE REPORT OPEN ACCESS Severe Pelvic Organ Prolapse Managed Without Surgery: Pessary Discontinued After Pelvic Floor Muscle Training With M-Mode Ultrasound Yukimasa Ide1,2 | Nobutaka Shimizu1 | Rio Ninomiya3 | Tomoko Ogawa4 | Tetsuya Fukumoto5 | Shinji Hyodo6 | Rie Yoshimura7 | Yoshitaka Kurano7 | Satoshi Fukata7 | Keiji Inoue1,7 1Pelvic Floor Center, Kochi Medical School, Kochi University, Kochi, Japan | 2Department of Physical Therapy, Yawatahama City General Hospital, Ehime, Japan | 3Department of Occupational Therapy, Yawatahama City General Hospital, Ehime, Japan | 4Department of Urology, Yawatahama City General Hospital, Ehime, Japan | 5Department of Urology, Graduate School of Medicine, Ehime University, Ehime, Japan | 6Department of Obstetrics and Gynecology, Yawatahama City General Hospital, Ehime, Japan | 7Department of Urology, Kochi Medical School, Kochi University, Kochi, Japan Correspondence: Nobutaka Shimizu ([nshimizu@kochi-u.ac.jp](nshimizu@kochi-u.ac.jp)) Received: 8 August 2025 | Revised: 18 December 2025 | Accepted: 2 January 2026 Keywords: M-mode ultrasonography | pelvic floor muscle training | pelvic organ prolapse | severe uterine prolapse | vaginal pessary ABSTRACT Introduction: We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training. Case Presentation: A 63-year-old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician-gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M-mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapsequantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years. Conclusions: In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use. 1 | Introduction Pelvic organ prolapse (POP) affects approximately 40% of women. POP prevalence may increase with an aging population [1]. The most commonly reported risk factors for POP are aging, childbirth, and obesity [2] . Treatment options include pelvic floor muscle training (PFMT), surgery, and vaginal pessaries [1] . PFMT is the first-line treatment for mild POP (pelvic organ prolapse-quantification [POP-Q] stage I/II) [2, 3] . However, it is less frequently implemented in severe cases (POP-Q stages III/ IV) [4] . Reports of successful pessary removal using PFMT remain limited. M-mode ultrasonography measures bladder base elevation (BBE) during PFMT. It provides reproducible indices such as BBE time and speed [5, 6] . The M-mode assessment is a key feature of the proposed approach. We present a case in which a pessary was successfully removed from a patient with severe POP under PFMT guidance. 2 | Case Presentation A 63-year-old woman (height: 151 cm; weight: 57 kg; body mass index: 25 kg/m2) presented with dysuria 18 months before PFMT | Abbreviations: BBE, bladder base elevation; MRI, magnetic resonance imaging; PFM, pelvic floor muscles; PFMT, pelvic floor muscle training; POP, pelvic organ prolapse; POP-Q, pelvic organ prolapse-quantification; PT, physical therapist; UI, urinary incontinence. | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association. | IJU Case Reports, 2026; 9:e70138 1 of 4 [https://doi.org/10.1002/iju5.70

FAQs

What condition was treated in the case report?

The case involved severe uterine prolapse (stage III pelvic organ prolapse) presenting with urinary dysfunction and residual urine.

How was pelvic floor muscle training monitored during the treatment?

Pelvic floor function was assessed using M-mode ultrasonography, measuring bladder base elevation time and speed during PFMT.

What happened after pelvic floor muscle training and pessary removal?

The vaginal pessary was removed after improved M-mode findings, and the uterine prolapse improved to POP-Q stage II with no recurrence of prolapse, urinary dysfunction, or residual urine after 2 years.

Sep 30, 2026

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