Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse?

Bugge, Carol; Dembinsky, Melanie; Kearney, Rohna; Hagen, Suzanne

doi:10.1136/bmj.n310

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…It is acknowledged that there is a lack of robust evidence regarding the risks and benefits of pessary selfmanagement due to the small-scale, non-randomised nature of much of the evidence. 10 While there is currently a lack of robust evidence regarding the benefits of selfmanagement, there is qualitative and observational evidence from women using pessaries about the benefits pessary self-management offers to them, including flexibility in how and when they use the pessary. 6 11 This scoping review aims to map available evidence about the subject of pessary self-management for POP to identify knowledge gaps 12 providing the basis for future research.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…There remains a number of uncertainties regarding the benefits and possible risks of pessary self-management. 10 A preliminary search in May 2021 identified a recent review of the published evidence related to pessary self-management, which highlighted current uncertainties within the subject area. 10 These include whether pessary self-management improves a woman’s satisfaction, quality of life and therefore long-term use of a pessary; whether pessary self-management is safe and what follow-up requirements are for women self-managing their pessary.…”

Section: Introductionmentioning

confidence: 99%

“… 10 A preliminary search in May 2021 identified a recent review of the published evidence related to pessary self-management, which highlighted current uncertainties within the subject area. 10 These include whether pessary self-management improves a woman’s satisfaction, quality of life and therefore long-term use of a pessary; whether pessary self-management is safe and what follow-up requirements are for women self-managing their pessary. 10 However, the review was limited to searching PubMed and had a focus of patient safety as indicated by the search terms used.…”

Section: Introductionmentioning

confidence: 99%

“… 10 These include whether pessary self-management improves a woman’s satisfaction, quality of life and therefore long-term use of a pessary; whether pessary self-management is safe and what follow-up requirements are for women self-managing their pessary. 10 However, the review was limited to searching PubMed and had a focus of patient safety as indicated by the search terms used. Therefore, only five eligible studies were identified.…”

Section: Introductionmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol

2022

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IntroductionPelvic organ prolapse (POP) can be managed with a pessary; however, regular follow-up may deter women from pessary management due to the inconvenience of frequent appointments, as well as preventing pessary users from autonomous decision-making. Pessary self-management, whereby the woman removes and inserts her own pessary may be a solution to these issues. However, there remains a number of uncertainties regarding the potential benefits and risks of pessary self-management. This scoping review aims to map available evidence about the subject of pessary self-management for POP to identify knowledge gaps providing the basis for future research.Methods and analysisThe scoping review will be conducted using the Joanna Briggs Institute scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A search of Medline, CINAHL, Embase and PsycInfo will be undertaken to identify relevant articles which meet the eligibility criteria using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’. A hand search of the reference list of non-original research identified during the search but excluded, will be conducted for additional publications which meet the inclusion and exclusion criteria. Data relevant to the topic of pessary self-management will be extracted and critical appraisal of all included publications undertaken.Ethics and disseminationNo ethical or Health Research Authority approval is required to undertake the scoping review. However, it has been registered with The Open Science Framework (DOI 10.17605/OSF.IO/DNGCP). The findings will inform future research exploring pessary self-management and be disseminated via both a presentation at a national conference and publications in peer reviewed journals.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol

2022

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“…The most common therapeutic tool used for POP internationally is a ring pessary, with a Gellhorn pessary being commonly recommended in more severe cases. Space-occupying pessaries, like the cube pessary, are generally considered to be more difficult for patients to manage than ring and sieve pessaries [ 8 ]. Notwithstanding, in a prior study in which we followed patients inserting and removing a cube pessary daily for a year, we found that it was safe and effective for most patients [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

et al. 2022

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Introduction and hypothesis Loss of anatomical support for the pelvic organs results in pelvic organ prolapse (POP). We hypothesized that daily self-management of a cube pessary might be a safe, feasible long-term treatment in women with symptomatic POP. Methods A cohort of 214 symptomatic POP patients (stage 2+) were enrolled prospectively (January to December 2015). Each patient was size-fitted with a space-filling cube pessary and completed a questionnaire online or by phone ≥5 years after her initial fitting. Change in quality of life (QoL) was measured with the Patient Global Impression of Improvement (PGI-I). Results Of 185 women included in our analyses, 174 (94%) were continuing to use their pessary 4 weeks post-insertion. Among those, 143 (82.2%) used the pessary successfully for ≥5 years. A large majority of these patients (88.8% [127 out of 143]) described their condition as much or very much improved compared with their pretreatment status (PGI–I). Adverse secondary effects (ASEs) were infrequent [15.4% (22 out of 143)]; when they did occur, they were mild, including smelly vaginal discharge (15 out of 22) and slight vaginal bleeding caused by the fitting procedure (6 out of 22). Conclusions Daily self-management of cube pessaries was found to be a safe and effective treatment for improving POP-related symptoms and QoL in the long term.

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The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse—A retrospective cohort study

Paulussen,

Börger,

van Eijndhoven

et al. 2024

Int Urogynecol J

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Introduction and Hypothesis This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM). Methods A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation. Results A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01). Conclusions Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.

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Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse?

Cited by 14 publications

References 13 publications

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse—A retrospective cohort study

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