Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study

Abstract

Objective: To evaluate the 5-year pessary continuation rate and identify clinical risk factors associated with discontinuation in patients with symptomatic pelvic organ prolapse (POP). Methods: In this prospective observational study, 312 women with symptomatic POP received pessary treatment between November 2013 and July 2015 in Peking Union Medical College Hospital, China, a tertiary referral center. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted and continued to use the pessary 2 weeks later. Patients with successful pessary fitting were followed for 5 years. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression. Results: In total, 265 patients (84.9%) had successful pessary fitting. After 5 years, 180 of 239 patients continued pessary use (75.3% continuation rate), with 26 lost to follow-up. The discontinuation rates decreased over time, from 8.7% at 1 year to 2.7% at 5 years. Total vaginal length < 7.5 cm (TVL, OR = 2.7, 95% CI 1.3-5.7, P = 0.007), improvement in Urinary Impact Questionnaire-7 scores < 50% at 3 months (OR = 2.1, 95% CI 1.1-4.2, P = 0.025), and incapability of self-care (OR = 2.6, 95% CI 1.3-5.1, P = 0.008) were potential discontinuation risk factors. Conclusion: Three-quarters of patients with symptomatic POP had successful pessary treatment at 5-year follow-up. TVL < 7.5 cm, poor urinary symptom relief at 3 months, and incapability of self-care were potential discontinuation risk factors.

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

“…There is disagreement in the literature regarding whether self-management affects the rate of women who choose to continue with pessary management of their prolapse. Self-management has been associated with pessary management continuation 24 28–30. Conversely, other studies reported pessary self-management did not affect pessary continuation rates when compared with either nurse or doctor clinician-led care at 1 year 19 31 32.…”

“…A number of protocols provided specific advice regarding frequency of pessary removal. Whether removal each time they bathed38 or removal and to leave the pessary out overnight once or twice a week 30 42. Seventy per cent (n=35) of women followed this advice given and removed the pessary at least weekly 42.…”

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

“…In our study, the median age was 61 years and only 6% (11 out of 185) of the participants discontinued pessary use within 4 weeks of their initial fitting. In a study of 265 patients fitted initially with ring pessaries, which were replaced with Gellhorn pessaries if the ring pessaries were failing, Ma et al [ 19 ] observed a 5-year success rate of 75.3%. They identified a lack of self-management ability as an important discontinuation risk factor [ 19 ].…”

“…In a study of 265 patients fitted initially with ring pessaries, which were replaced with Gellhorn pessaries if the ring pessaries were failing, Ma et al [ 19 ] observed a 5-year success rate of 75.3%. They identified a lack of self-management ability as an important discontinuation risk factor [ 19 ]. We agree with this suggestion and believe that pessary therapy success rates may be improved in the future with pessaries amenable to self-management.…”

Pessaries: valuable interventions for symptomatic pelvic organ prolapse

“…Other pessary complications were vaginal discharge, bleeding, and de novo SUI. 12 Several advantages of pessaries include being inexpensive, avoiding surgical intervention, and having the potential for long-term use with minor complications. In general, only a complete gynecologic, urologic, and defecatory history and physical examination is necessary, before a pessary trial.…”