A prospective study of pessary use for severe pelvic organ prolapse: 3-year follow-up outcomes

Li, Bin; Chen, Qiaohua; Zhang, Jing; Yu, Cuige; Zhang, Lu

doi:10.1007/s00404-020-05526-1

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…However, only a few patients in our cohort underwent such surgery, making it impossible to evaluate. Improvement in urinary symptoms in short-term pessary use was identified as another possible predictor of pessary continuation in the present study, similar to previous studies evaluating predictors for 1 year and 3 years of continuation 30,31 . This finding suggested that patients tended to continue pessary use when improvements in subjective symptoms outweighed the inconvenience of pessary care.…”

Section: Discussionsupporting

confidence: 89%

“…Improvement in urinary symptoms in short-term pessary use was identified as another possible predictor of pessary continuation in the present study, similar to previous studies evaluating predictors for 1 year and 3 years of continuation. 30,31 This finding suggested that patients tended to continue pessary use when improvements in subjective symptoms outweighed the inconvenience of pessary care. Other treatment options might be considered if patients achieved less improvement in urinary symptoms with short-term pessary use.…”

Section: Long-term Pessary Use In Women With Popmentioning

confidence: 98%

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Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study

Zhou

Kang

et al. 2021

Menopause

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Objective: To evaluate the 5-year pessary continuation rate and identify clinical risk factors associated with discontinuation in patients with symptomatic pelvic organ prolapse (POP). Methods: In this prospective observational study, 312 women with symptomatic POP received pessary treatment between November 2013 and July 2015 in Peking Union Medical College Hospital, China, a tertiary referral center. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted and continued to use the pessary 2 weeks later. Patients with successful pessary fitting were followed for 5 years. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression. Results: In total, 265 patients (84.9%) had successful pessary fitting. After 5 years, 180 of 239 patients continued pessary use (75.3% continuation rate), with 26 lost to follow-up. The discontinuation rates decreased over time, from 8.7% at 1 year to 2.7% at 5 years. Total vaginal length < 7.5 cm (TVL, OR = 2.7, 95% CI 1.3-5.7, P = 0.007), improvement in Urinary Impact Questionnaire-7 scores < 50% at 3 months (OR = 2.1, 95% CI 1.1-4.2, P = 0.025), and incapability of self-care (OR = 2.6, 95% CI 1.3-5.1, P = 0.008) were potential discontinuation risk factors. Conclusion: Three-quarters of patients with symptomatic POP had successful pessary treatment at 5-year follow-up. TVL < 7.5 cm, poor urinary symptom relief at 3 months, and incapability of self-care were potential discontinuation risk factors.

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Section: Discussionsupporting

confidence: 89%

Section: Long-term Pessary Use In Women With Popmentioning

confidence: 98%

Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study

Zhou

Kang

et al. 2021

Menopause

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“…Li 3-year follow-up results of 60 women (mean age 68.9 ± 9 years) treated with a vaginal pessary due to advanced POP. 9 Overall, there was a significant improvement in urinary, rectal, and pelvic symptoms; however, five women (8%) developed de novo SUI and 12 women (20%) had pessary-associated vaginal erosions. At the end of 3 years of follow-up, only two-thirds of the women were still using the vaginal pessary.…”

Section: Discussionmentioning

confidence: 86%

“…Moreover, at the end of the study, 142 (54.6%) women preferred to undergo pelvic reconstructive surgery. Li et al reported 3‐year follow‐up results of 60 women (mean age 68.9 ± 9 years) treated with a vaginal pessary due to advanced POP 9 . Overall, there was a significant improvement in urinary, rectal, and pelvic symptoms; however, five women (8%) developed de novo SUI and 12 women (20%) had pessary‐associated vaginal erosions.…”

Section: Discussionmentioning

confidence: 99%

A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women

Gold

Baruch

Amir

et al. 2021

J American Geriatrics Society

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Objectives To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). Design A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow‐ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. Setting The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. Participants The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. Main outcome Primary outcomes included time intervals between follow‐up visits, pessary‐associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. Results The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65–100 years). Mean interval between follow‐up examinations was 3.3 ± 1.1 months (range 1–6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2–4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. Conclusions Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.

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Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study

et al. 2022

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A prospective study of pessary use for severe pelvic organ prolapse: 3-year follow-up outcomes

Cited by 4 publications

References 18 publications

Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study

Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study

A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women

Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study

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