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

Abstract

Introduction and hypothesis This study aimed to evaluate the efficacy and safety of ring pessaries under continuous use for > 2 years. Our starting hypothesis was that their use without periodic removal, cleaning or replacement for between 24 to 48 months after insertion is safe and effective. Methods This was a prospective observational and descriptive study. One hundred one women who successfully completed the 24 first months of continuous use of a ring pessary were included and monitored for another 24 months. The objectives were to establish the percentage of patients maintaining its use 48 months after insertion, the reasons for discontinuation and the adverse events. Another purpose of this study was to determine the timing of replacement of the vaginal pessary in long-term users. Results Of the women, 92.1% (93/101) had successful pessary use, and it was discontinued by three patients (2.9%, 3/101); 76.2% (77/101) of the women continued pessary use after the end of the study, and in 16 (15.8%, 16/101) patients, after pessary removal, the prolapse disappeared and did not recur. Forty-five women (48.4%, 45/93) presented some adverse events that required temporary pessary removal. The most common one was an increase in vaginal discharge (73.3%, 33/45). In four women (8.9%, 4/45), the ring pessary was detected embedded in the vaginal epithelium. Conclusions Continuous use of a ring pessary can be recommended for 2 years in hysterectomized women and for 4 years in non-hysterectomized women if there are no complications.

A randomized controlled study comparing the objective efficacy and safety of a novel self-inserted disposable vaginal prolapse device and existing ring pessaries

“…Urogenital infections are common in women. Vaginal purulent discharge, pruritus, and foul smells are common among pessary users ( 33 , 34 ). In this study, with ProVate, there were no signs, or symptoms of vaginal or UTIs.…”

The impact on complication rates of delayed routine pessary reviews during the COVID-19 pandemic

“…A further prospective study has been published investigating whether rings could be left in situ for 24–48 months without removal, cleaning, or replacement. These data reported that 45 out of 93 (48.4%) had an adverse event requiring a temporary pessary break, demonstrating a further rise in “complications” with an increase in time interval [ 15 ].…”