The forgotten pessary: A medical oddity

Summers, Jack L.; Ford, Manley L.

doi:10.1016/0002-9378(71)90911-2

Cited by 9 publications

(5 citation statements)

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“…32 Some authors described pessaries as "outdated" and "risky;" 33,34 there was even reference to the "dangerous pessary." 7 We felt it was not appropriate to state the overall frequency of complications related to pessaries from the reviewed literature.…”

Section: Discussionmentioning

confidence: 99%

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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Introduction: Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of shortand long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. Methods: A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. Results: In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. Conclusion: There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.

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Section: Discussionmentioning

confidence: 99%

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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“…If pessaries are left in situ for prolonged periods serious complications can arise 9,26,27 . Poorly fitted devices have resulted in reports of the cervix, uterus or bowel herniating and strangulating through, an impacted or embedded pessary, cervical incarceration and infection 28,29 .…”

Section: Complications Of Pessariesmentioning

confidence: 99%

Pessary management for pelvic organ prolapse: a review of clinical practice and Australian medical device regulations

Franks,

Krause

2023

ANZCJ

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Pelvic organ prolapse affects up to 50% of women throughout life. Management can be conservative or surgical. Pessaries have become an integral component to management of pelvic organ prolapse, providing symptom improvement and enhancing quality of life. After careful clinical assessment, women choosing pessary management are offered either self-care or clinician-based pessary care. Pessary care can be offered by a range of clinicians, including doctors, nurses and physiotherapists. In this article we review the literature on the historical use of pessaries and how they have changed to be the device manufactured today. We then outline the Australian regulation of vaginal pessaries as per the Therapeutic Goods Administration (TGA). We discuss device classification in relation to clinical practice and guidelines.The TGA classifies pessary devices as either Class 1: device which is intended for transient use, Class 2A: to be used continuously for at least 60 minutes but not more than 30 days, and Class 2B: continuous use for more than 30 days. The majority of pessaries available in Australia are classified as 2A devices.

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“…Sixteen cases underwent office removal and conservative management. The other 23 cases required operative management (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. All but two of these complications were related to a neglected pessary (21/23, 91.3%).…”

Section: Commentmentioning

confidence: 99%

Complications of neglected vaginal pessaries: case presentation and literature review

2008

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Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.

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The forgotten pessary: A medical oddity

Cited by 9 publications

References 0 publications

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Pessary management for pelvic organ prolapse: a review of clinical practice and Australian medical device regulations

Complications of neglected vaginal pessaries: case presentation and literature review

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