Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study

Abstract

Introduction and hypothesis The objective of this study was to determine the efficacy of routine follow-up visits for pessary cleaning, the effect of extended time intervals between visits and the proportion of patients being able to self-manage their pessary for pelvic organ prolapse (POP). Methods We conducted a prospective cohort study in patients with a stage ≥II POP without previous POP surgery. All patients received a pessary as primary treatment. Our main outcome measure was a difference ≥2 in median visual analogue scale (VAS) scores (for pain, discharge, irritation) 1 week before and 1 week after cleaning. Measurements were performed after 3-and 9month cleaning intervals. For the evaluation of the effect of cleaning, 132 patients (3 months' follow-up) and 87 patients (12 months' follow-up) were available for analysis. For the evaluation of the effect of the lengthening interval, 123 patients were available. Results Self-management was performed in 45.2% of patients at 1 year. In 93.1% of patients, no differences were observed in pre-and post-cleaning VAS scores (effect of cleaning) on vaginal pain. Nor was there a difference in discharge (72.4%) or irritation 85.1% (p = 0.00). No differences were observed in pre-cleaning VAS scores for vaginal pain, discharge and irritation when the interval was lengthened from 3 to 9 months. No serious adverse events occurred. Conclusions There is no proven benefit of regular follow-up visits to clean a pessary. Also, the length of the cleaning interval does not seem to matter.

How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study

“…A prospective cohort study determined the efficacy of routine follow-up visits for pessary cleaning at 3 and 9 months after insertion. They concluded that frequent pessary cleaning in asymptomatic women is not efficient, and there is no difference in the severity of the pessary-related adverse effects between a 3- and a 9-monthly follow-up interval [ 12 ].…”

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

“…A prospective cohort following 163 ring pessaries found no difference in pain, discharge, or irritation when the interval of cleaning was increased to 9 months. They also reported that 45.2% were able to manage self-cleaning for the directed period of time [21].…”

“…Seven studies provided data on risk of adverse events with long-term pessary use (without removal or cleaning) [17][18][19][20][21][22][23]. Nine additional articles were reviewed that provided information of interest during the pandemic [24][25][26][27][28][29][30][31][32].…”

“…Based on review of the literature (16 studies) and expert consensus: [16]. Use of a specific telemedicine encounter is preferred for tracking and reimbursement purposes over a telephone encounter (typically used for sharing of discrete information) & Patients can safely extend the time interval between pessary cleanings to 6 months (and, in some cases, up to 24 months) with minimal risk of adverse events [17][18][19][20][21][22][23]. & Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35].…”

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

“…Evidence on pessary self-management is limited and from small non-randomised studies7891011 (table 1, supplementary file). The studies mainly report on the length of time for which women continue to use a pessary.…”