Changes in the symptoms and quality of life of women with symptomatic pelvic organ prolapse fitted with a ring with support pessary

Mao, Meng; Ai, Fangfang; Zhang, Ye; Kang, Jingjing; Liang, Shuo; Xu, Tao; Zhu, Lan

doi:10.1016/j.maturitas.2018.09.003

Cited by 24 publications

(37 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All studies [6][7][8]10,11,12,15,[16][17][18][19]26,[27][28][29][30][31][32][33][34][35] included in this systematic review described the reasons for discontinuation. The discontinuation ratio was 25.2% (9.8% to 52.2%) and among 911/3601 women who stopped using the pessary, we reviewed the main reasons, summarized into Table 3.…”

Section: Reasons For Discontinuationmentioning

confidence: 99%

“…6,[11][12][13] After a successful pessary insertion, its use may cause adverse effects such as vaginal discharge, itching, odor, genital ulcers, and pain. [18][19][20] All of them are actually a common reason for discontinuation 21,22 There are some studies [3][4][5][6][7][8][9][10][11][12][13][14]19 that have addressed the reasons for unsuccessful pessary fitting, but with some inconsistency among studies with regard to the selected variables. The difference between study designs, the fact that these variables are commonly considered secondary outcomes and the need to identify patients at increased risk of unsuccess reinforces the effort to analyze these data systematically, with analysis of the quality of data shown.…”

Section: Introductionmentioning

confidence: 99%

“…Nine studies [6][7][8]11,12,[15][16][17][18][19] included variables that sought reasons for unsuccessful pessary fitting and six 6,7,11,12,15,19 of them were designed exclusively for this reason (primary outcome). The most important associated risk factors were age, 6 body massindex, 6,16,19 parity, 11 total vaginal length, 8,12,15,18 larger genital hiatus, 7,12,15,18 pelvic floor muscle activity, 6 previous surgeries, 15,16 previous hysterectomy 11,16 and advanced POP staging. 7,17 Eleven studies did not describe the use of vaginal estrogen cream during the pessary use, 6,7,10,11,15,19,26,30,32,33,35 and 10 have described its use differently 8,…”

mentioning

confidence: 99%

“…The most important associated risk factors were age, 6 body massindex, 6,16,19 parity, 11 total vaginal length, 8,12,15,18 larger genital hiatus, 7,12,15,18 pelvic floor muscle activity, 6 previous surgeries, 15,16 previous hysterectomy 11,16 and advanced POP staging. 7,17 Eleven studies did not describe the use of vaginal estrogen cream during the pessary use, 6,7,10,11,15,19,26,30,32,33,35 and 10 have described its use differently 8,12,[16][17][18]27,28,29,31,34 of these studies, two of them have only indicated for women with vaginal atrophy identified at the gynecological examination. 28,29 Two studies have counseled patients that if vaginal ulceration or excoriation occurred, women should withdraw the pessary and wait for 2 weeks to maintain vaginal estrogen.…”

mentioning

confidence: 99%

“…8,32 Two studies have counseled its use during 1 week 12,29 and four studies for 2 weeks. [16][17][18]32 Most studies have prioritized pessary support models as first-line treatment 7,11,[17][18][19]31,34,35 ; second-line models (spacefilling) were also mentioned. 11 studies 6,8,[10][11][12]16,[27][28][29][30]33 cited obstructive pessary Gellhorn in treatment conservative of POP.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis

Coêlho

Brito

Araújo

et al. 2020

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims To identify the factors associated with unsuccessful pessary fitting and reasons for discontinuation for women with symptomatic pelvic organ prolapse (POP). Methods This systematic review is registered at the PROSPERO database. We have included all studies, regardless of the study design whose primary outcomes were factors associated with unsuccessful pessary fitting and discontinuation for symptomatic POP women. Exclusion criteria were case series, literature reviews, other forms of conservative treatment. Data selection/extraction was performed by two investigators. For pessary fitting, a meta‐analysis was performed for at least two studies pooled in a forest plot. The risk of bias was classified by the ROBINS‐I and ROB‐2 classification. Results From 409 studies retrieved after data search, only twenty‐one articles remained for final analysis (18 cohort studies, 1 cross‐sectional study, and 2 RCTs). Meta‐analysis was performed in nine studies for pessary fitting and the associated factors were: higher body mass index (BMI) (MD = 0.688 [0.233‐1.143]; P = .03; i2 = 0%), previous reconstructive surgery (OR = 1.705 [1.016‐2.860]; P = .043; i2 = 69%) and advanced POP (OR = 4.2 [2.9‐6.1]; P < .05; i2 = 92%). Older age, larger total vaginal length (TVL), and genital hiatus and previous hysterectomy were not associated factors. Regarding discontinuation, thirteen reasons were quoted, and the most frequent were: the desire for surgical treatment (111/3.601), pessary extrusion (385/3.601), and pain/discomfort (163/3.601). Conclusion Obese, previously reconstructive pelvic surgery, advanced prolapse are at risk for unsuccessful pessary fitting. Pain is the most quoted reason for discontinuation. These pooled data may help clinicians to identify patients that may not succeed in their attempt for pessary treatment.

show abstract

Section: Reasons For Discontinuationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis

Coêlho

Brito

Araújo

et al. 2020

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

The effect of pessary treatment on puborectalis muscle function

et al. 2021

View full text Add to dashboard Cite

Introduction and hypothesis The objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment. Methods This was a prospective cohort study of women with symptomatic POP choosing pessary treatment. An interview, clinical examination and 3D/4D transperineal ultrasound were performed at baseline and at 3-month follow-up. POP was assessed using the Pelvic Organ Prolapse Quantification system (POPQ). Parameters compared between baseline and follow-up were: hiatal area at rest (HArest), maximal contraction (HActx), and maximal Valsalva maneuver (HAVal), displacement in contraction (DISPL-ctx, i.e., relative difference between HArest and HActx), and displacement in Valsalva (DISPL-Val, i.e., relative difference between and HAVal and HArest). Parameters were compared in women with and those without complete avulsion. Results A total of 162 women were assessed and 34 were included. Mean age was 64 years (SD 11.4), and mean BMI 24 kg/m2 (SD 3.1). Thirty-one women had a cystocele, 8 a uterine prolapse, and 12 had a posterior compartment prolapse. Twenty-one women (61.8%) had a POP stage II, and 13 (38.2%) a POP stage III. Ring pessaries were most frequently used (97%). In the entire group a statistically significant increase in DISPL-ctx was observed (mean difference 2.1%, p = 0.017). In the no avulsion group HArest and DISPL-ctx increased significantly (mean difference 4.1%, p = 0.016 and 2.7%, p = 0.016 respectively) and the increase in DISPL-ctx was higher than in the avulsion group (mean difference 2.7% vs 0.2%, p = 0.056). Conclusion Our results show that PRM function changes in women with POP undergoing pessary treatment and suggest that such change occurs mainly in the absence of complete avulsion.

show abstract

Transperineal ultrasound to estimate the appropriate ring pessary size for women with pelvic organ prolapse

et al. 2021

View full text Add to dashboard Cite

Introduction and hypothesis The objective was to predict the successful ring pessary size based on the levator hiatal area (HA). Methods This is a prospective case–control study. Women with symptomatic pelvic organ prolapse (POP) choosing pessary treatment were included. All women underwent an interview, clinical examination, and 3D/4D transperineal ultrasound (TPUS). The ring pessary size used in each trial and the reason for unsuccessful trials were recorded. In addition, levator hiatal area divided by ring pessary size (HARP ratio) was measured at rest, maximum contraction, and maximum Valsalva. The HARP ratios of successful and unsuccessful trials were compared, receiver operating characteristic curves in the prediction of successful trials were constructed, and the cut-off optimizing sensitivity and specificity was identified. Results A total of 162 women were assessed and 106 were included with 77 successful trials, 49 unsuccessful trials owing to dislodgment or failure to relieve POP symptoms, and 20 unsuccessful trials owing to pain/discomfort. Rest HARP ratio and Valsalva HARP ratio were significantly smaller in the successful trials versus dislodgment/failure to relieve POP symptoms trials (mean rest HARP ratio [SD]: 2.93 [0.59] vs 3.24 [0.67], p = 0.021; median Valsalva HARP ratio (IQR): 4.65 (1.56) vs 5.32 (2.08), p = 0.004). No significant difference was observed between pain/discomfort trials and successful trials. The best cut-off for the prediction of successful trials was Valsalva HARP ratio ≤ 5.00. Conclusions Unsuccessful fitting trials due to dislodgment/failure to relieve POP symptoms are associated with a small ring pessary with respect to the levator HA. A ring pessary that produces a Valsalva HARP ratio > 5.00 has a higher risk of dislodgment/failure to relieve POP symptoms.

show abstract

Changes in the symptoms and quality of life of women with symptomatic pelvic organ prolapse fitted with a ring with support pessary

Cited by 24 publications

References 28 publications

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis

The effect of pessary treatment on puborectalis muscle function

Transperineal ultrasound to estimate the appropriate ring pessary size for women with pelvic organ prolapse

Contact Info

Product

Resources

About