Patient Characteristics Associated With a Successful Pessary Fitting

Markle, Danielle; Skoczylas, Laura C.; Goldsmith, Crystal; Noblett, Karen

doi:10.1097/spv.0b013e31822f00ae

Cited by 30 publications

(23 citation statements)

References 13 publications

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“…This result is consistent with results of previous studies . Similar to the study of Markle et al . we found that patients in the POP reconstructive surgery group had a significantly shorter TVL compared with those without prior surgery [median (IQR): 7.0 (6.3–8.0) versus 8.0 (8.0–9.0) cm].…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, 18.5% of the patients developed de novo SUI after pessary fitting in our study; however, most symptoms were mild and only three patients had symptoms severe enough to cause unsuccessful pessary fitting. We compared the success rate of fitting between stage III and stage IV and found no relation between a successful fit and the degree of prolapse, consistent with most studies . This finding indicated that patients with higher POP stages should not be counselled against a pessary fitting trial.…”

Section: Discussionsupporting

confidence: 82%

“…We compared the success rate of fitting between stage III and stage IV and found no relation between a successful fit and the degree of prolapse, consistent with most studies. 10,16,23 This finding indicated that patients with higher POP stages should not be counselled against a pessary fitting trial. The pessary is designed to support the anterior vaginal wall rather than the posterior vaginal wall because the anterior vaginal wall can support the pessary via the pubic bone, whereas a prolapsed posterior vaginal wall lacks the structure to retain the pessary.…”

Section: Discussionmentioning

confidence: 96%

“…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. In our current study, a shorter TVL was an independent predictor of an unsuccessful pessary fitting trial in the multivariable logistic regression analysis.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Mao

Zhang

et al. 2018

BJOG

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Mao

Zhang

et al. 2018

BJOG

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“…17 In multiple studies, widened GH measurements were linked to a decreased chance of pessary retention, a nonsurgical intervention for POP. [18][19][20] Evidently GH measurements have an important predictive value, making its inclusion in the POP-Q quantification system vital to the care of women with pelvic organ prolapse.…”

Section: Introductionmentioning

confidence: 99%

Increasing Anteroposterior Genital Hiatus Widening Does Not Limit Apical Descent for Prolapse Staging During Valsalva's Maneuver: Effect on Symptom Severity and Surgical Decision Making

Guanzon¹,

Heit

Khoder

2018

Female Pelvic Med Reconstr Surg

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Value of pelvic examination in women with pelvic organ prolapse: A systematic review

Pizzoferrato,

Sallée,

Thubert

et al. 2024

Intl J Gynecology & Obste

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BackgroundRecent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.ObjectivesThe aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse‐associated symptoms in terms of diagnosis and predictability of treatment success.Search StrategyThe databases were queried similarly using Medical Subject Headings (MeSH) and non‐MeSH terms broadly related to pelvic examination and POP management.Selection CriteriaWe included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery.Data Collection and AnalysisWe assessed peer‐reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS‐E or RoB2 tools.Main ResultsIn all, 67 studies were retained for the review. Prolapse‐associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements.ConclusionsIn women complaining of prolapse‐associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion—discernible on pelvic examination—are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.

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Patient Characteristics Associated With a Successful Pessary Fitting

Cited by 30 publications

References 13 publications

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

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

Increasing Anteroposterior Genital Hiatus Widening Does Not Limit Apical Descent for Prolapse Staging During Valsalva's Maneuver: Effect on Symptom Severity and Surgical Decision Making

Value of pelvic examination in women with pelvic organ prolapse: A systematic review

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