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

Ding, Jing; Chen, Chun; Song, Xiaoxu; Zhang, Lei; Deng, Mou; Zhu, Lan

doi:10.1007/s00192-015-2738-1

Cited by 22 publications

(24 citation statements)

References 21 publications

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“…Also, we have found in some studies that women with important urinary symptoms did not show an interest only for POP improvement; younger women seemed to prefer resolving POP by surgery. 17,[29][30][31][32]35 We have calculated the mean difference between TVL values in cases of success and failure for pessary fitting and we did not find this variable associated with failure. The difference between the TVL in the two groups was only 0.14 cm.…”

Section: Discussionmentioning

confidence: 79%

“…All studies [6][7][8]10,11,12,15,[16][17][18][19]26,[27][28][29][30][31][32][33][34][35] included in this systematic review described the reasons for discontinuation. The discontinuation ratio was 25.2% (9.8% to 52.2%) and among 911/3601 women who stopped using the pessary, we reviewed the main reasons, summarized into Table 3.…”

Section: Reasons For Discontinuationmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“…8,32 Two studies have counseled its use during 1 week 12,29 and four studies for 2 weeks. [16][17][18]32 Most studies have prioritized pessary support models as first-line treatment 7,11,[17][18][19]31,34,35 ; second-line models (spacefilling) were also mentioned. 11 studies 6,8,[10][11][12]16,[27][28][29][30]33 cited obstructive pessary Gellhorn in treatment conservative of POP.…”

mentioning

confidence: 99%

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

Coêlho

Brito

Araújo

et al. 2020

Neurourology and Urodynamics

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Aims To identify the factors associated with unsuccessful pessary fitting and reasons for discontinuation for women with symptomatic pelvic organ prolapse (POP). Methods This systematic review is registered at the PROSPERO database. We have included all studies, regardless of the study design whose primary outcomes were factors associated with unsuccessful pessary fitting and discontinuation for symptomatic POP women. Exclusion criteria were case series, literature reviews, other forms of conservative treatment. Data selection/extraction was performed by two investigators. For pessary fitting, a meta‐analysis was performed for at least two studies pooled in a forest plot. The risk of bias was classified by the ROBINS‐I and ROB‐2 classification. Results From 409 studies retrieved after data search, only twenty‐one articles remained for final analysis (18 cohort studies, 1 cross‐sectional study, and 2 RCTs). Meta‐analysis was performed in nine studies for pessary fitting and the associated factors were: higher body mass index (BMI) (MD = 0.688 [0.233‐1.143]; P = .03; i2 = 0%), previous reconstructive surgery (OR = 1.705 [1.016‐2.860]; P = .043; i2 = 69%) and advanced POP (OR = 4.2 [2.9‐6.1]; P < .05; i2 = 92%). Older age, larger total vaginal length (TVL), and genital hiatus and previous hysterectomy were not associated factors. Regarding discontinuation, thirteen reasons were quoted, and the most frequent were: the desire for surgical treatment (111/3.601), pessary extrusion (385/3.601), and pain/discomfort (163/3.601). Conclusion Obese, previously reconstructive pelvic surgery, advanced prolapse are at risk for unsuccessful pessary fitting. Pain is the most quoted reason for discontinuation. These pooled data may help clinicians to identify patients that may not succeed in their attempt for pessary treatment.

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Section: Discussionmentioning

confidence: 79%

Section: Reasons For Discontinuationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Coêlho

Brito

Araújo

et al. 2020

Neurourology and Urodynamics

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“…[1,2] The primary nonsurgical management for prolapse is a pessary as it is reusable, low-risk, and effective in improving symptoms [3][4][5][6][7]. Many women choose conservative management of prolapse when given the option, and there is mounting evidence that pessaries can be used to manage a wide variety of prolapse types while maintaining a low complication rate [4,6,[8][9][10][11]. While treatment choice is generally tailored to the patient's individual preferences and needs, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Urogynecologic Society (AUGS) recommend a pessary be offered to all patients with prolapse as an alternative to surgery [12].…”

mentioning

confidence: 99%

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

et al. 2018

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Value of pelvic examination in women with pelvic organ prolapse: A systematic review

Pizzoferrato,

Sallée,

Thubert

et al. 2024

Intl J Gynecology & Obste

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BackgroundRecent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.ObjectivesThe aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse‐associated symptoms in terms of diagnosis and predictability of treatment success.Search StrategyThe databases were queried similarly using Medical Subject Headings (MeSH) and non‐MeSH terms broadly related to pelvic examination and POP management.Selection CriteriaWe included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery.Data Collection and AnalysisWe assessed peer‐reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS‐E or RoB2 tools.Main ResultsIn all, 67 studies were retained for the review. Prolapse‐associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements.ConclusionsIn women complaining of prolapse‐associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion—discernible on pelvic examination—are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.

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

Abstract: The ring pessary with support was successfully fitted in patients with advanced POP with a high success rate and few complications. Older patients were more likely to prefer the ring pessary with support due to its convenient use.

Cited by 22 publications

References 21 publications

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

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

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

Value of pelvic examination in women with pelvic organ prolapse: A systematic review

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