The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

Abstract

ImportancePessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility.ObjectiveThe objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI.Study DesignWe searched for the terms “stress urinary incontinence” and “pessar/y/ies/ium” in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsTen studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], −0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = −0.89; 95% CI, −1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268).ConclusionsBased on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer

“…In large systematic reviews, PFMT has been quoted to achieve continence in one in every three women (number needed to treat [NNT]=3, 95% confidence interval [CI] 2-5). 15 Carefully fitted continence pessaries can aid in managing SUI, 16 though use needs to be overseen by an experienced clinician and patients need to understand pessary care and risks (including vaginal erosion/ulceration, and in extreme cases, fistula). Continence pessaries are usually reserved for women who are either too frail to be considered for surgical intervention, or as a temporising measure for younger women wishing to complete childbearing before considering surgical intervention for their SUI.…”

Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity

“…The management of incontinence should be directed by UI type and severity, associated level of bother, and patient goals of care [13,31]. If first-line treatment has failed for patients experiencing SUI, patients may benefit from a pessary fitting [38]. There are several pessary shapes and sizes specific to SUI, so fitting should be performed by a trained provider.…”