Incontinence pessaries: size, POPQ measures, and successful fitting

Abstract

Introduction and hypothesisThe aim of the study was to determine whether successful incontinence pessary fitting or pessary size can be predicted by specific POPQ measurements in women without advanced pelvic organ prolapse.MethodsIn a multicenter study, women with stress urinary incontinence (SUI) and POPQ stage ≤2 were randomized to three treatment arms: (1) incontinence pessary, (2) behavioral therapy, or (3) both. This study evaluates incontinence pessary size, POPQ measures, and successful fitting in the 266 women assigned to treatment arms 1 and 3.ResultsTwo hundred thirty-five women (92%) were successfully fitted with an incontinence ring (n = 122) or dish (n = 113). Hysterectomy, genital hiatus (GH), and GH/total vaginal length (TVL) ratios did not predict unsuccessful fitting (p > 0.05). However, mean TVL was greater in women successfully fitted (9.6 vs. 8.8 cm, p < 0.01). Final pessary diameter was not predicted by TVL, point D, or point C (p > 0.05).ConclusionsThe vast majority of women with SUI can be successfully fitted with an incontinence pessary, but specific POPQ measures were not helpful in determining incontinence pessary size.

Which factors should be considered in choosing pessary type and size for pelvic organ prolapse patients in a fitting trial?

“…Nager et al found that women with a longer vagina are more likely to be fitted successfully but that various formulas including the TVL do not predict pessary size [9]. However, our findings showed that the ring pessary with support is round, and if the pessary is retained in the vagina, then the TVL and vaginal introitus width are both factors determining pessary size.…”

“…Fitting a pessary is currently guided by experience [4]. There is no consensus on clinical indications for the various types of pessaries or the patient characteristics for sizing [9]. Many providers fit pessaries.…”

Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study

“…In addition to the overall POP‐Q stage and predominant prolapse compartment, other pelvic examination parameters, including TVL, vaginal introitus and genital hiatus (GH), were also evaluated as risk factors for an unsuccessful pessary fitting trial. Unsuccessfully fitted patients had a shorter vaginal length and wider vaginal introitus . Several studies employed extreme values of the pelvic examination parameters to predict unsuccessful pessary fitting, but the cut‐off values were inconsistent among these studies.…”

“…Unsuccessfully fitted patients had a shorter vaginal length and wider vaginal introitus. 12,25 Several studies employed extreme values of the pelvic examination parameters to predict unsuccessful pessary fitting, but the cut-off values were inconsistent among these studies. A shorter vaginal length (≤ 7, ≤ 6 or < 6 cm), 12,23,26 wider vaginal introitus (> 4 fingerbreadths), 12,26 and greater GH/ TVL ratio (≥ 0.9) 19,23 were reported to be associated with an unsuccessful fitting.…”

Successful use of ring pessary with support for advanced pelvic organ prolapse

“…It has been suggested by other authors that previous prolapse surgery or hysterectomy narrows the upper vaginal diameter, making it difficult to retain a pessary [19,20]. It is likely that .…”