Role of Pessaries in the Treatment of Pelvic Organ Prolapse

Sansone, Stephanie; Sze, Christina; Eidelberg, Andrew; Stoddard, Michelina; Cho, Ahra; Asdjodi, Saman; Mao, Jialin; Zorn, Kevin C.; Chughtai, Bilal

doi:10.1097/aog.0000000000004931

Cited by 9 publications

(3 citation statements)

References 34 publications

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“…Although the pessary is an effective treatment option for POP, it is often seen as a temporary solution whilst waiting for surgery, or as a therapeutic technique only when surgery is contraindicated. Few studies have assessed their effectiveness and satisfaction using validated questionnaires, and none have been carried out in a French population [ 4 ]. The main purpose of our study was to assess the satisfaction of patients 6 months after having been fitted with a pessary by means of a validated indicator (Patient Global Impression of Improvement, PGI-I) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

Nebel

Créveuil

Briex³

et al. 2022

JCM

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Background: The non-surgical solution for Pelvic Organ Prolapse (POP) typically consists of a pessary fitting. We aimed to assess patient satisfaction and symptom improvement 6 months after a pessary fitting and to identify risk factors associated with pessary failure. Methods: Six months after a pessary fitting, patient satisfaction was assessed by the PGII score; symptoms and quality of life were assessed using validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12, USP, and PFIQ-7). Results: Of the 190 patients included in the study (mean age of 66.7 years), 141 (74%) and 113 (59%) completed the follow-up questionnaires at 1 and 6 months, respectively. Nearly all the women were menopausal (94.6%) and 45.2% declared being sexually active at inclusion. The satisfaction rate was 84.3% and 87.4% at 1 and 6 months, respectively. The global symptom score PFDI-20 had significantly improved at 6 months. A high body mass index (RR = 1.06, CI95%: [1.02–1.09]), as well as high PFDI-20 (1.05 [1.01–1.09]), PFIQ7 (1.04 [1.01, 1.08]), and PISQ12 scores at inclusion (0.75 [0.60, 0.93]), as well as higher GH and GH/TVL measurements (1.49 [1.25–1.78] and 1.39 [1.23–1.57], respectively) were associated with pessary failure. Conclusions: Pessary seems to be an effective treatment for POP with high patient satisfaction. Higher BMI, higher symptom scores, and greater genital hiatus measurements before insertion are risk factors for failure at 6 months.

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Section: Introductionmentioning

confidence: 99%

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

Nebel

Créveuil

Briex³

et al. 2022

JCM

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“…First-line treatment of pelvic organ prolapse (POP) involves the use of a vaginal pessary combined with pelvic floor exercises, whatever the patient’s age and type of prolapse [ 1 , 2 , 3 ]. A recent Cochrane meta-analysis showed that pessaries, in addition to pelvic floor muscle training, improved women’s POP symptoms and prolapse-specific quality of life [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of Key Factors Influencing the Choice of the Type of Vaginal Pessary for Women Presenting with Pelvic Organ Prolapse: Semi-Directive Interviews and Development of an Algorithm

Quoy

Cotelle

Tayrac

et al. 2023

JCM

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(1) Background: Pelvic organ prolapse (POP) can be managed using a vaginal pessary. However, the decision-making process whereby health professionals choose the right pessary is unclear. The objective of this study was to focus on the experience of experts in pessary use and to propose an algorithm. (2) Methods: A prospective study, based on face-to-face semi-directive interviews and group discussions, was conducted on a multidisciplinary panel of professional experts specialized in pessary prescriptions. A consensual algorithm was established, and its accuracy was assessed by expert and non-expert panels. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used. (3) Results: 17 semi-directive interviews were conducted. The parameters involved in the decision-making process regarding the choice of vaginal pessaries were: desire for self-management (65%), associated urinary stress incontinence (47%), POP type (41%), and POP stage (29%). The algorithm was developed step by step (4 iterations) using the Delphi technique. Most of the expert panel (76%) rated the relevance of the algorithm as 7 or more out of 10 on a visual analog scale according to their own experience (reference activity). Finally, most (81%) of the non-expert panel (n = 230) rated the usefulness of this algorithm as 7 or more out of 10 on a visual analog scale. (4) Conclusions: This study provides an expert panel-based algorithm that may help in the prescription of pessaries for POP.

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“…Vaginal pessaries are an effective and safe nonsurgical treatment option for patients with symptomatic pelvic organ prolapse (POP), 1 a common and stigmatized medical condition that greatly impairs quality of life for millions of patients worldwide 2–4 . Contemporary pessaries are manufactured according to a limited set of shapes and sizes using mass production methods, 5 which may compromise their efficacy rate.…”

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confidence: 99%

Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study

Hong

Zhang²,

Eltahawi³

et al. 2023

UROGC

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Importance Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse (POP) when properly fitted. However, pessary fitting and use are often unsuccessful or imperfect. Objective The objective of this study was to assess the feasibility of using patient-specific pessaries fabricated from three-dimensional (3D)-printed molds to improve POP symptoms and increase overall satisfaction of pessary treatment in patients using standard vaginal pessaries. Study Design Patients undergoing POP treatment with standard vaginal pessaries were enrolled in this pilot prospective study. Patient-specific pessaries were designed and fabricated for each patient using patient input, physician input, and anatomic measurements from clinical assessment. Pessary fabrication involved injection of biocompatible liquid silicone rubber into 3D-printed molds followed by a biocompatible silicone coating. Pelvic organ prolapse symptomatic distress and pessary treatment satisfaction were evaluated before and after a 3-week patient-specific pessary home trial using the validated Pelvic Organ Prolapse Distress Inventory-6 form and a visual analog scale, respectively. Results Eight women were included in this study. Changing from standard pessary to patient-specific pessary treatment was associated with an improvement in prolapse symptoms on the Pelvic Organ Prolapse Distress Inventory-6 (median change, −3.5; interquartile range, −5 to −2.5; P = 0.02) and an increase in overall pessary satisfaction on a visual analog scale (median change, +2.0; interquartile range, +1.0 to +3.0; P = 0.02). All patients reported either an improvement or no change in pessary ease of use, comfort, and the feeling of support provided by the pessary. Conclusion Patient-specific vaginal pessaries are a promising alternative to standard pessaries for alleviating POP symptoms and improving patient satisfaction with pessary use.

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Role of Pessaries in the Treatment of Pelvic Organ Prolapse

Abstract: Pessaries are highly effective at improving the quality of life in women with pelvic organ prolapse.

Cited by 9 publications

References 34 publications

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

Identification of Key Factors Influencing the Choice of the Type of Vaginal Pessary for Women Presenting with Pelvic Organ Prolapse: Semi-Directive Interviews and Development of an Algorithm

Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study

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