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

Coêlho, Suelene Costa de Albuquerque; Brito, Luiz Gustavo Oliveira; Araújo, Camila Carvalho de; Juliato, Cássia Raquel Teatin

doi:10.1002/nau.24458

Cited by 15 publications

(7 citation statements)

References 35 publications

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“…The severity of POP does not influence the likelihood of a successful pessary fitting trial. 23,64,65 In the Delphi survey, 87.5% (7 participants) strongly agreed and 12.5% (1 participant) weakly agreed with this statement. The writing group agreed that it is reasonable to try the smallest possible pessary that holds in the prolapse, is comfortable, and is retained in the vagina with Valsalva.…”

Section: Resultsmentioning

confidence: 88%

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Vaginal Pessary Use and Management for Pelvic Organ Prolapse

2023

UROGC

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At present, guidance for pessary management has fallen to pessary manufacturers and the opinion of expert clinicians, leading to significant variation in recommendations for care.• The purpose of this clinical consensus statement is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited.• The recommendations, developed by the writing group, may support these efforts by providing consistent care guidelines and statements on pessary fitting and management, while highlighting areas for further research for current practitioners or those new to the use of pessaries.

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Section: Resultsmentioning

confidence: 88%

“…Space-filling pessaries (Gellhorn, donut, or cube) are often successful in women who were unsuccessfully fitted with a support pessary (ring). The severity of POP does not influence the likelihood of a successful pessary fitting trial 23,64,65 …”

Section: Resultsmentioning

confidence: 99%

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

2023

UROGC

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“…48 A recent meta-analysis showed 13 reasons for pessary discontinuation with the main ones described as follows: the desire for surgical treatment, pessary extrusion, and pain/discomfort. 49 With respect to surgical options, colostomy and Le Fort colpocleisis were the most common surgical options to treat the described cases in the present study. Although the great majority of the studies have proposed surgery for the treatment of RVF and, subsequently, POP management, 2 cases reported the conservative treatment with estradiol for 1 month and one of them opted to insert another pessary.…”

Section: Discussionmentioning

confidence: 84%

“…The independent predictors for an unsuccessful pessary fitting were higher body mass index and shorter total vaginal length (<7.3 cm may not be appropriate for vaginal pessary) 48 . A recent meta-analysis showed 13 reasons for pessary discontinuation with the main ones described as follows: the desire for surgical treatment, pessary extrusion, and pain/discomfort 49 …”

Section: Discussionmentioning

confidence: 99%

Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review

Pereira

Brito

Slongo

et al. 2021

J Low Genit Tract Dis

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In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries.Methods: Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary.Results: Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries.Conclusions: Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.

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“…In a Danish series of 794 women with POP, only 137 (17%) patients were treated with a pessary as a first‐line treatment, of whom in 33% the treatment was discontinued within 3 months, mainly due to the expulsion of the pessary, pain, or discomfort 13 . Similarly, a recent metanalysis of 21 studies reported 9.8%–52.2% discontinuation rates, the most common reasons for discontinuation were pessary expulsion, pain or discomfort, and patient's decision to undergo surgery 14 …”

Section: Discussionmentioning

confidence: 99%

A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women

Gold

Baruch

Amir

et al. 2021

J American Geriatrics Society

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Objectives To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). Design A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow‐ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. Setting The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. Participants The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. Main outcome Primary outcomes included time intervals between follow‐up visits, pessary‐associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. Results The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65–100 years). Mean interval between follow‐up examinations was 3.3 ± 1.1 months (range 1–6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2–4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. Conclusions Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.

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

Cited by 15 publications

References 35 publications

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review

A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women

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