An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abstract

Introduction: Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of shortand long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. Methods: A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. Results: In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. Conclusion: There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.

Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study

“…4,5,7 A systematic review showed that vaginal discharge is the most frequent complication related to the use of pessary, occurring in 56% of the users. 6 The results of this study showed that vaginal discharge is very common in women With regard to the vaginal content of the women included in this study, it can be observed that there was no difference between the types of flora in both groups. A recent study assessing the flora before and after one month of use of pessary also showed that the vaginal flora is not always changed by the use of pessary.…”

“…1,3 It is a minimally invasive device and presents low risk, but it can show some complications. 6,8 For instance, vaginal discharge is the primary adverse effect of women using pessary. 6,8 Currently, there are scant data on the use of this device and the possible symptoms associated with its use.…”

“…6,8 For instance, vaginal discharge is the primary adverse effect of women using pessary. 6,8 Currently, there are scant data on the use of this device and the possible symptoms associated with its use. Recent studies show that the most common complaints are genital discomfort, increase in vaginal discharge and foul-smelling odor.…”

Managing female pelvic floor disorders: a medical device review and appraisal

“…Device removal and the use of topical oestrogen was successful in reversing these types of early cytological changes [201]. Foreign body reaction and chronic inflammation have been associated with several cervical and vaginal cancers occurring at the sites of pessary insertion, but the absolute number of cases remains too low to properly evaluate [207,210].…”

Optimal Pessary Care: A Modified Delphi Consensus Study

“…Overall, pessary use is comfortable, effective, and low risk; however, serious adverse events such as vesicovaginal/rectovaginal fistula and incarcerated pessary can occur when recommended follow-up care is neglected. 5 Ongoing care for women using pessaries involves initial assessment, correct fitting, ongoing patient education, and regular follow-up surveillance to allow modifications in management related to symptom change, early signs of potentially serious adverse effects, and/or management of pessary-related problems. This long-term care can result in significant costs to the patient and the health care system in terms of direct financial costs, time, and productivity.…”