Cervical and vaginal cancer associated with pessary use

Schraub, S; Sun, Xu; Maingon, P.; Horiot, J C; Daly, N; Keiling, R; Pigneux, J; Pourquier, T. H.; Rozan, R; Vrousos, C

doi:10.1002/1097-0142(19920515)69:10<2505::aid-cncr2820691020>3.0.co;2-o

Cited by 45 publications

(24 citation statements)

References 16 publications

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“…25 Chronic inflammation in association with viral infections has been suggested to predispose patients to such cancers as the tumours appeared at the site of pessary placement. 50 It has been proposed that wearing a vaginal ring or cup-and-stem pessary for a long time may cause cancer of the vagina, ulcerative vaginitis, or fistulae. Primary cancer of the vagina was reported in 6 women among a group of 13 with major pelvic complications correlated to long-term pessary use, 38 and in a women who developed vaginal and cervical cancer after 18 years of pessary use.…”

Section: Discussionmentioning

confidence: 99%

“…Primary cancer of the vagina was reported in 6 women among a group of 13 with major pelvic complications correlated to long-term pessary use, 38 and in a women who developed vaginal and cervical cancer after 18 years of pessary use. 50 Other mechanisms proposed included the generation of metaplastic and subsequent dysplastic change of the squamous mucosa, 51 and the potential In the case where multiple instances of a single complication was reported, the complication may appear in more than 1 grade based on how the complication was managed as reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

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

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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“…Partial decline in blood flow by a pessary may form lesions such as an ulcer, and necrosis by continuous pressure may form a bladder-vagina or rectum-vagina fistula. In addition, when a pessary serves as a foreign body, the clustering of bacteria may be a cause of infection or, rarely, cervical or vaginal cancer can occur because chronic inflammation, chemical carcinogenesis, and foreign body carcinogenesis might be the etiologic factors [19]. When a pessary compresses the bladder or ureter, hydronephrosis or hydroureter, or symptoms associated with splanchnic emphraxis may occur.…”

Section: Discussionmentioning

confidence: 99%

Survey of the characteristics and satisfaction degree of the patients using a pessary

et al. 2004

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The objective of this study was to evaluate characteristics, satisfaction degree, and problems of patients using a pessary for pelvic organ prolapse. A total of 104 patients who had been fitted with a pessary and available for follow-up for pelvic organ prolapse management were enrolled. The patients answered questions on general characteristics, indications for pessary use, complications from pessary use, satisfaction degree, and frequency of removal. The results indicated that 76 (73.0%) patients had at least more than one medical illness and 86 (82.7%) patients complained of lower urinary symptoms such as incontinence, urgency, frequency, or nocturia. Eighty-four (80.7%) patients used pessaries as they were not surgical candidates due to poor medical status or old age. After using a pessary, 76 (73.1%) patients had symptoms such as bleeding, erosion, or foul odor; 70.2% of the women answered that they were satisfied or more than satisfied and 19.1% of the patients removed their pessaries, of whom 80.0% were unable to continue use due to repeated expulsion of the pessary and uncomfortable fitting. These data suggest that the pessary tends to be used for high-risk patients due to medical problems or old age. Despite the high frequency of complications from pessary use, it was seen that the frequency of removing the pessary was low and the satisfaction degree was high. Most of the complications were not thought to be serious. To decrease the frequency of complications, the regular follow-up visit and proper management of pessary use were thought to be needed. Further studies are warranted on tailor-fitting the pessary by variable use and relieving the symptoms associated with the lower urinary tract.

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“…The older, acrylic, rigid pessaries are more prone to cause these complications. Cervicovaginal atypia and cancer have been reported in pessary users, 71 although there is little evidence to support any direct relationship between pessaries and cancer.…”

Section: Complications Of Pessary Usementioning

confidence: 99%

Behavioral Therapy for Urinary Incontinence and Nonsurgical Management of Pelvic Organ Prolapse

Vakili¹,

Chesson²

2005

Journal of Pelvic Medicine and Surgery

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Cervical and vaginal cancer associated with pessary use

Cited by 45 publications

References 16 publications

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

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

Survey of the characteristics and satisfaction degree of the patients using a pessary

Behavioral Therapy for Urinary Incontinence and Nonsurgical Management of Pelvic Organ Prolapse

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