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

Background: Forty percent of women will experience prolapse in their lifetime. Vaginal pessaries are considered the first line of treatment in selected patients. Major complications of vaginal pessaries rarely occur. Methods: PubMed and Embase were searched from 1961 to 2022 for major complications of vaginal pessaries using Medical Subject Headings (MeSH) and free-text terms. The keywords were pessary or pessaries and: vaginal discharge, incontinence, entrapment, urinary infections, fistula, complications, and vaginal infection. The exclusion criteria were other languages than English, pregnancy, complications without a prior history of pessary placement, pessaries unregistered for clinical practice (herbal pessaries), or male patients. The extracted data included symptoms, findings upon examination, infection, type of complication, extragenital symptoms, and treatment. Results: We identified 1874 abstracts and full text articles; 54 were assessed for eligibility and 49 met the inclusion criteria. These 49 studies included data from 66 patients with pessary complications amenable to surgical correction. Clavien–Dindo classification was used to grade the complications. Most patients presented with vaginal symptoms such as bleeding, discharge, or ulceration. The most frequent complications were pessary incarceration and fistulas. Surgical treatment included removal of the pessary under local or general anesthesia, fistula repair, hysterectomy and vaginal repair, and the management of bleeding. Conclusions: Pessaries are a reasonable and durable treatment for pelvic organ prolapse. Complications are rare. Routine follow-ups are necessary. The ideal patient candidate must be able to remove and reintroduce their pessary on a regular basis; if not, this must be performed by a healthcare worker at regular intervals.

show abstract

“…There were a total of 23 instances of RVFs in the 17 studies. The review emphasized the possibility of RVFs associated with pessary use [11].…”

Section: Introductionmentioning

confidence: 99%

Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature

Sastre

Pérez-Cejuela

Pereira

et al. 2023

JPM

View full text Add to dashboard Cite

show abstract

“…Outros efeitos adversos menos comum podem acontecer como infecção vaginal e incômodo da manipulação vaginal na sua troca (27,28). Complicações mais graves como encarceramento do dispositivo, migração para cavidade abdominal e fistulas urogenitais são raras, mas podem acontecer e geralmente estão associados a pessários negligenciados (29,30).…”

Section: Introductionunclassified

Estudo randomizado comparando pessário interno e externo no tratamento do prolapso de órgãos pélvicos

Hosoume¹

View full text Add to dashboard Cite

Ao meu orientador, Professor Doutor Jorge Milhem Haddad, pela oportunidade e por ser um grande exemplo de liderança e dedicação.Ao Professor Edmund Chada Baracat, pela oportunidade À equipe médica e de fisioterapia do grupo da Uroginecologia pelo companheirismo Aos colaboradores da Faculdade de Medicina da USP pelo auxílio e suporte À equipe de enfermagem do ambulatório de ginecologia do HCFMUSP, pela dedicação Ao Dr. Pedro Sergio Magnani, meu mentor na Uroginecologia Às pacientes em especial, pelos ensinamentos que me proporcionaram. Aos amigos, pois são fundamentais Normatização AdotadaEssa dissertação ou tese está de acordo com as seguintes normas em vigor no momento desta publicação.-Referencias: adaptado de International Committe of Medical Journals Editors (Vancouver).

show abstract

Preventing the Next Neglected Pessary: A Quality Improvement Initiative

Popiel,

Maggi,

Dalal

et al. 2024

UROGC

View full text Add to dashboard Cite

Importance Pessaries are commonly used to manage pelvic organ prolapse. Pessary management can be done by a medical professional or the patient themselves. Pessary complications are rare. However, pessaries can be difficult to track, and patients who are lost to follow-up are at an increased risk of complications such as vaginal ulceration, pessary embedment, and fistulization. Objectives To create and implement a quality improvement initiative focusing on preventing neglected pessaries. Study Design Through the electronic medical record, we implemented a quality improvement initiative focused on creating a workflow where a pessary can be designated as an implant when inserted. A year after implementation, data was gathered. Results We identified 37% (55/147) of patients without follow-up in the 3 months after pessary placement. Of those, 24% were no longer using pessaries, 24% were self-maintaining or having surveillance with their primary OB/GYN, 16% had surgery for pelvic organ prolapse since placement of the pessary, 15% were lost to follow-up and were considered to be patients “at risk,” and 12% did not have a pessary placed to begin with. Review showed 53% of patients with proper documentation and designation of pessary as an implant. Conclusions This quality improvement initiative can identify patients lost to follow-up, leading to improved patient care and potential to prevent complications.

show abstract

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

Cited by 3 publications

References 42 publications

Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature

Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature

Estudo randomizado comparando pessário interno e externo no tratamento do prolapso de órgãos pélvicos

Preventing the Next Neglected Pessary: A Quality Improvement Initiative

Contact Info

Product

Resources

About