2008
DOI: 10.1007/s00192-008-0574-2
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Complications of neglected vaginal pessaries: case presentation and literature review

Abstract: Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistu… Show more

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Cited by 101 publications
(41 citation statements)
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“…Vesicovaginal fistulas (VVFs), although uncommon, are among the most serious complications of neglected pessaries. 48 The reports identify Gellhorn and shelf designs most often; 12 rectovaginal fistula and VVFs appear more common with rubber or PVC pessaries when compared with polythene pessaries. 35 Fistula formation may also be associated with fecal impaction, hydronephrosis, and urosepsis, 32 however, these complications were generally reported in the setting of neglect.…”
Section: Discussionmentioning
confidence: 99%
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“…Vesicovaginal fistulas (VVFs), although uncommon, are among the most serious complications of neglected pessaries. 48 The reports identify Gellhorn and shelf designs most often; 12 rectovaginal fistula and VVFs appear more common with rubber or PVC pessaries when compared with polythene pessaries. 35 Fistula formation may also be associated with fecal impaction, hydronephrosis, and urosepsis, 32 however, these complications were generally reported in the setting of neglect.…”
Section: Discussionmentioning
confidence: 99%
“…35 Fistula formation may also be associated with fecal impaction, hydronephrosis, and urosepsis, 32 however, these complications were generally reported in the setting of neglect. 22,23 Although serious complications caused by neglected pessaries are rare, 49 in case reports describing VVFs, bowel fistulae, and incarcerated pessaries, 91% were correlated to neglected pessaries, 12 and patients with dementia and nursing home residents could be at higher risk. 39 Several reports implicated pessaries as a causal mechanism for both vaginal and cervical cancer.…”
Section: Discussionmentioning
confidence: 99%
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“…[11] Lone et al [3] performed a large prospective study to identify complications of pessary use and reasons for discontinuation over a period of 5 years. It was noted that most complications become apparent within the first 6 months after pessary insertion, and minor complications such as vaginal discharge, odour and excoriation/bleeding can be managed conservatively with local oestrogen application, a pessary 'holiday' and a change in pessary size at reinsertion.…”
Section: Discussionmentioning
confidence: 99%
“…[11] Lone et al [3] reported an overall minor complication rate of 12.1% (pain/discomfort, excoriation/bleeding, disimpaction/constipation) in symptomatic patients followed up over a 5-year period. Entrapment, also frequently referred to as embedment, is a common complication reported mainly with neglected and forgotten ring pessaries.…”
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confidence: 99%