Pessary treatment for pelvic organ prolapse and health-related quality of life: a review

Abstract

Pessaries have been used to treat women with pelvic organ prolapse (POP) since the beginning of recorded history. This review aims to assess the effect of pessary treatment on the disease-specific, health-related quality of life in women with pelvic organ prolapse. After a Medline search using the Mesh term ‘pessary’ and critical appraisal, 41 articles were selected and used in this review. Pessaries are widely used to treat pelvic organ prolapse. It is minimally invasive and appears to be safe. Although there is evidence that the use of pessaries in the treatment of pelvic organ prolapse is effective in alleviating symptoms and that patient satisfaction is high, the follow-up in many published papers is short, and the use of validated urogynaecological questionnaires is limited. Comparison with surgical treatment of pelvic organ prolapse is rare and not assessed in a randomised controlled trial.

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

“…43 Vaginal discharge and infection may affect as many as one-third of users; 45 bleeding, pain, and constipation were also often reported. 16,46 These issues have led to changes in pessary shape design. 4,47 Serious complications include fistulae.…”

“…The side effects of pessary use are not obvious; moreover it is not clear whether the therapeutic impact is high enough to overlook possible risks or which patients benefit the most from pessary treatment. 16 Few studies have tested the relative value of different practice models for pessary use, although pessaries have assumed growing importance in the treatment of POP. 17 A 2004 Cochrane review of pessaries use for POP and updated in 2013 13,18 found only 1 randomized controlled trial examining the efficacy of pessary use.…”

Erratum to: An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)

“…(i) Pessary: A device that is inserted into the vagina to provide structural support to one or more of descending vaginal compartments, i.e., the uterus, anterior vaginal wall (and bladder), posterior vaginal wall (and rectum) and/or vaginal apex (with or without small intestine after a prior hysterectomy) [47].…”

“…31 and 32 [47]. Pelvic physiotherapy: Assessment, prevention and/or treatment of pelvic floor dysfunction, performed by a pelvic physiotherapist.…”

Treatment of pelvic organ prolapse

“…8 Some recent studies have shown that pessaries are effective in alleviating symptoms and patient satisfaction is high. 13 According to the 2004 Cochrane database systematic review, there was no evidence from randomized controlled trials upon which to base treatment of women with pelvic organ prolapse through the use of different types of device, define the indications, nor guide the pattern of replacement and follow-up care. 14 These may be offered to women who have symptomatic prolapse, elderly women who are poor candidates for surgery, those who wish to defer surgery to possibly complete their family, for short-term relief before surgery, or to offer long-term relief for women who do not want to undergo surgery.…”