Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse

Clemons, Jeffrey L.; Aguilar, Vivian C.; Tillinghast, Tara A; Jackson, Neil D.; Myers, Deborah L.

doi:10.1016/j.ajog.2003.08.034

Cited by 162 publications

(141 citation statements)

References 7 publications

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“…The current literature indicates that younger patients are more likely to choose surgery over pessary use [12,15]. Thus, older women are more likely to continue to use this device than younger women [16]. The median age of the patients in our study was 70 years, which may have contributed to the high continuation rate.…”

Section: Reasons For the High Success Ratementioning

confidence: 80%

“…Studies have reported conflicting data regarding the clinical predictors of successful and unsuccessful fittings [13,[15][16][17][18], and the reasons for early discontinuation are unclear. 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].…”

Section: Risk Factors For Discontinuationmentioning

confidence: 99%

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

et al. 2015

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Section: Reasons For the High Success Ratementioning

confidence: 80%

Section: Risk Factors For Discontinuationmentioning

confidence: 99%

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

et al. 2015

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“…As data on the exact incidence of vaginal irritation and suboptimal treatment are not available, we cannot conclude how the risks that are perceived to be acceptable relate to the realistic risks [15]. In approximately 73% of women with symptomatic POP, there will be a successful pessary placement [16]. We assume that in daily practice the realistic risk of vaginal irritation and incomplete symptom relief are lower than the reported acceptable risk among the interviewed women and thus we consider the risk of 32% of placing problems as an acceptable risk.…”

Section: Discussionmentioning

confidence: 99%

Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

Thys

Roovers

Geomini

et al. 2012

Gynecol Obstet Invest

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Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our main outcome was the willingness to alter treatment preference (by increasing percentages of defined disadvantages) and determine conditions at which treatment preference changes to alternative treatment. Results: Three groups of 25 patients were interviewed: (1) untreated patients, (2) patients who underwent surgery, and (3) patients treated with a pessary. In the treatment-naive group, 48% preferred surgery, 36% a pessary and 16% had no preferable treatment. Patients switched preference from surgery to a pessary at a median risk of stress urinary incontinence of 22% and of recurrent prolapse of 43%. Patients switched preference from pessary to surgery at a median risk of vaginal irritation of 32%, of placing problems of 32% and of incomplete symptom relief of 17%. Conclusions: Patients tend to prefer surgery for POP. When realistic assumptions for (dis)advantages are made, most women consider the disadvantages following both treatment options to be acceptable as they do not exceed the risks described in the literature.

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“…The patients were staged according to POP-Q [5]. Vaginal introitus width was measured horizontally according to the number of finger-widths accommodated across the posterior fourchette (typically one to four) [6]. In this study, 1, 2, 3 and 4 finger-widths corresponded to approximately 1, 3, 5 and 6 cm, respectively.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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Patients with a history of hysterectomy or with a larger vaginal introitus were more likely to achieve success with the Gellhorn pessary. The GH width and the vaginal introitus width influenced the size of both pessaries chosen. The TVL was predictive of the optimal size of the ring pessary with support but was not predictive of the optimal size of the Gellhorn pessary. Finally, the size of the Gellhorn pessary was associated with POP stage.

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Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse

Cited by 162 publications

References 7 publications

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

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

Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

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

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