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Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice

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International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Symptomatic vaginal prolapse affects 6–28% of women and significantly impacts their quality of life. Pessaries for prolapse are used by three-quarters of clinicians as a first-line treatment; however, current clinical use in the UK is unknown and there is a lack of clinical guidance or training. This study is aimed at informing the upcoming UK Clinical Guidance on best practice for the use of pessaries document.

Methods

A 19-question, anonymised, electronic survey was sent to members of the nine professional bodies delivering pessary care in the UK.

Results

Of 917 respondents, 403 (246 nurses, 134 doctors, 22 physiotherapists and 1 other profession) currently deliver pessary care. PVC/vinyl ring, silicone ring, Gellhorn and shelf pessaries are most popular, and are used frequently by 93% of respondents. Further pessary training was deemed necessary by 62% of those currently providing pessary care, and 70% of those who do not. The most highly rated method for previous and future training is shadowing another clinician. One in three respondents receive no ancillary support and nearly 1 in 7 (predominantly nurses) report the absence of cross-cover arrangements, leaving a gap in care provision.

Conclusions

Service provision, support and pessary training in the UK vary greatly. This calls for the standardisation of care, training and development of a national guideline. We present a clear rationale and need for a UK guideline on pessary management of vaginal prolapse and a standardised pessary training model for multi-professional use.

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References

  1. Eva UF, Gun W, Preben K. Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand. 2003;82(3):280–6. https://doi.org/10.1034/j.1600-0412.2003.00103.x.

    Article  PubMed  Google Scholar 

  2. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403. https://doi.org/10.1097/01.AOG.0000263469.68106.90.

    Article  PubMed  Google Scholar 

  3. Lowder JL, Ghetti C, Nikolajski C, Oliphant SS, Zyczynski HM. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol. 2011;204(5):441.e1–5. https://doi.org/10.1016/j.ajog.2010.12.024.

    Article  PubMed  Google Scholar 

  4. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    Article  Google Scholar 

  5. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. https://doi.org/10.1097/AOG.0000000000000286.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014. https://doi.org/10.1002/14651858.CD004014.pub5.

    Article  Google Scholar 

  7. Bugge C, Hagen S, Thakar R. Vaginal pessaries for pelvic organ prolapse and urinary incontinence: a multiprofessional survey of practice. Int Urogynecol J. 2013;24(6):1017–24. https://doi.org/10.1007/s00192-012-1985-7.

    Article  PubMed  Google Scholar 

  8. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9. https://doi.org/10.1097/01.AOG.0000222903.38684.cc.

    Article  PubMed  Google Scholar 

  9. Bugge C, Adams EJ, Gopinath D, Reid F (2013) Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013(2):CD004010. doi:https://doi.org/10.1002/14651858.CD004010.pub3.

    Article  PubMed Central  Google Scholar 

  10. Gorti M, Hudelist G, Simons A. Evaluation of vaginal pessary management: a UK-based survey. J Obstet Gynaecol. 2009;29(2):129–31. https://doi.org/10.1080/01443610902719813.

    Article  CAS  PubMed  Google Scholar 

  11. Lough K, Hagen S, McClurg D, Pollock A, Group JLAPPS. Shared research priorities for pessary use in women with prolapse: results from a James Lind Alliance priority setting partnership. BMJ Open. 2018;8(4):e021276. https://doi.org/10.1136/bmjopen-2017-021276.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  Google Scholar 

  13. Miller DS (1997) Contemporary use of the pessary. Gynecology and obstetrics. Lippincott-Raven, Philadelphia.

    Google Scholar 

  14. Nemeth Z, Nagy S, Ott J. The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes. Int Urogynecol J. 2013;24(10):1695–701. https://doi.org/10.1007/s00192-013-2093-z.

    Article  PubMed  Google Scholar 

  15. Khaja A, Freeman RM. How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists. Int Urogynecol J. 2014;25(7):941–6. https://doi.org/10.1007/s00192-014-2329-6.

    Article  CAS  PubMed  Google Scholar 

  16. Mao M, Ai F, Zhang Y, Kang J, Liang S, Xu T, et al. Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study. BJOG. 2018;125(11):1434–40. https://doi.org/10.1111/1471-0528.15260.

    Article  CAS  PubMed  Google Scholar 

  17. Atnip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):541–63. https://doi.org/10.1016/j.ogc.2009.08.010.

    Article  Google Scholar 

  18. Wanggren K, Pettersson G, Csemiczky G, Gemzell-Danielsson K. Teaching medical students gynaecological examination using professional patients—evaluation of students’ skills and feelings. Med Teach. 2005;27(2):130–5. https://doi.org/10.1080/01421590500046379.

    Article  PubMed  Google Scholar 

  19. Franken MG, Corro Ramos I, Los J, Al MJ. The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios. BMC Fam Pract. 2018;19(1):31. https://doi.org/10.1186/s12875-018-0714-9.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to acknowledge the multidisciplinary professionals and pessary users within the UK Clinical Guidance Group for the use of pessaries in vaginal prolapse for their time and invaluable experience. We would also like to acknowledge the contribution of survey responders and the funding received from the Chartered Society of Physiotherapy Professional Grant.

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Authors and Affiliations

  1. Addenbrookes Hospital, Cambridge University Hospital Foundation Trust, Cambridge, UK

    Claire A. Brown, Ashish Pradhan & Ivilina Pandeva

  2. Physiotherapy Department, Addenbrookes Hospital, Box 185, Hills Road, Cambridge, CB2 0QQ, UK

    Claire A. Brown

Authors
  1. Claire A. Brown
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  2. Ashish Pradhan
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  3. Ivilina Pandeva
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Contributions

Claire Brown had access to the full data and wrote the manuscript. Ivilina Pandeva is a senior author. Review of the manuscript: Ivilina Pandeva and Ashish Pradhan. The UK Clinical Guidance Group for the use of pessaries in vaginal prolapse was the concept of development.

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Correspondence to Claire A. Brown.

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Appendix 1

Appendix 1

Professional Pessary Guideline Group Questionnaire

1. What is your professional group?

2. Do you provide pessary care for women with prolapse?

3. Is this NHS, private or both?

4. Do you work in a team or are you the only practitioner offering pessary care?

5. What happens to your pessary workload if you are away for a prolonged period of time (e.g. maternity leave, sick leave, annual leave)?

6. Do you have support to run a pessary service?

7. How have you learnt your pessary skills and knowledge?

8. How was the training organized?

9. Did you feel competent to independently provide pessary care for prolapse after this training?

10. How do you keep your pessary care skills and knowledge up to date?

11. Have you trained another professional in pessary skills?

12. In your practice do you need to choose a size of a pessary for a patient, e.g. insert a pessary for the first time or change the size of the pessary?

13. How do you decide which size of pessary to use?

14. Please tick all the pessaries you use in practice. The first column for all the types you have ever used, and the second column for those you most commonly use.

15. In a year, approximately how many pessaries do you insert?

16. Would you like to receive training in pessary care?

17. How would you like to receive this training?

18. What practical skills do you feel that you need, to be able to be competent in pessary care?

19. What theoretical components do you feel you would need to be knowledgeable about delivering pessary care to patients?

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Brown, C.A., Pradhan, A. & Pandeva, I. Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice. Int Urogynecol J 32, 1015–1022 (2021). https://doi.org/10.1007/s00192-020-04537-5

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  • DOI: https://doi.org/10.1007/s00192-020-04537-5

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