Successful long-term use of Gellhorn pessary and the effect on symptoms and quality of life in women with symptomatic pelvic organ prolapse

Abstract

More than half of the patients continued long-term use of the pessary. The Gellhorn pessary can resolve prolapse and voiding difficulty symptoms effectively. In addition, the Gellhorn pessary can significantly improve the QOL of women via long-term use. However, the Gellhorn pessary has a limited effect on defecatory symptoms.

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis

“…5,6 It is well known that vaginal pessaries are efficacious 7 and improve 80% to 90% of symptoms; satisfaction rates are also high regarding its use (70%-92%). [8][9][10] The rates of successful pessary fitting are 41% to 86%. [11][12][13][14] This variation occurs mainly from the different success definitions found in the studies (1 to 3 weeks).…”

“…[11][12][13][14] This variation occurs mainly from the different success definitions found in the studies (1 to 3 weeks). The most commonly described predictors in the literature are shorter vaginal length, wide vaginal hiatus 8,11,15 posterior wall prolapse, 15 previous prolapse repair and/or hysterectomy, increased parity, 12,15,16 advanced prolapse 7,17 and women younger than 65 years. 6 Moreover, it is important to know that, in general, pessary extrusion may occur between the first and second week after placement.…”

“…6,[11][12][13] After a successful pessary insertion, its use may cause adverse effects such as vaginal discharge, itching, odor, genital ulcers, and pain. [18][19][20] All of them are actually a common reason for discontinuation 21,22 There are some studies [3][4][5][6][7][8][9][10][11][12][13][14]19 that have addressed the reasons for unsuccessful pessary fitting, but with some inconsistency among studies with regard to the selected variables. The difference between study designs, the fact that these variables are commonly considered secondary outcomes and the need to identify patients at increased risk of unsuccess reinforces the effort to analyze these data systematically, with analysis of the quality of data shown.…”

“…Nine studies [6][7][8]11,12,[15][16][17][18][19] included variables that sought reasons for unsuccessful pessary fitting and six 6,7,11,12,15,19 of them were designed exclusively for this reason (primary outcome). The most important associated risk factors were age, 6 body massindex, 6,16,19 parity, 11 total vaginal length, 8,12,15,18 larger genital hiatus, 7,12,15,18 pelvic floor muscle activity, 6 previous surgeries, 15,16 previous hysterectomy 11,16 and advanced POP staging. 7,17 Eleven studies did not describe the use of vaginal estrogen cream during the pessary use, 6,7,10,11,15,19,26,30,32,33,35 and 10 have described its use differently 8,…”

“…The most important associated risk factors were age, 6 body massindex, 6,16,19 parity, 11 total vaginal length, 8,12,15,18 larger genital hiatus, 7,12,15,18 pelvic floor muscle activity, 6 previous surgeries, 15,16 previous hysterectomy 11,16 and advanced POP staging. 7,17 Eleven studies did not describe the use of vaginal estrogen cream during the pessary use, 6,7,10,11,15,19,26,30,32,33,35 and 10 have described its use differently 8,12,[16][17][18]27,28,29,31,34 of these studies, two of them have only indicated for women with vaginal atrophy identified at the gynecological examination. 28,29 Two studies have counseled patients that if vaginal ulceration or excoriation occurred, women should withdraw the pessary and wait for 2 weeks to maintain vaginal estrogen.…”