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Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study

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Abstract

Introduction and hypothesis

The objective was to investigate the rate of adherence to pessary treatment for pelvic organ prolapse (POP), to identify factors associated with long-term (longer than 1 year) use of vaginal pessaries in Brazilian women with POP and its impact on quality of life (QoL).

Methods

A prospective observational study assessed 247 consecutive women candidates for a pessary to manage symptomatic POP. Patients were fitted with a ring pessary and follow-up visits were performed at 1, 6, and 12 months. Pessary complications and reasons for discontinuation were recorded. Prolapse Quality of Life Questionnaire (P-QoL) was applied at baseline and after 1 year of treatment. We used a logistic regression model for the analyses, with p < 0.05 for significance.

Results

A total of 236 women were included in the study, of whom 110 (46.6%) maintained the pessary treatment for longer than 12 months. The main reason for pessary discontinuation was the patient opting for surgery (50.8%). Vulvovaginitis was the main long-term complication (44.5%), followed by vaginal ulceration (16.4%) and urinary urgency (10%). No prior hysterectomy (OR = 2.26; 95% CI 1.19–4.31), vaginal estrogen use (OR = 1.94; 95% CI 1.06–3.52), and mean age (OR = 1.03; 95% CI 1.01–1.06) were variables associated with long-term use of vaginal pessary (p < 0.05 for all). Total P-QoL score significantly changed with pessary use (519.1 at baseline and 260 after 12-month treatment, p < 0.00).

Conclusions

Our study suggests that no prior hysterectomy, the local estrogen therapy, and age might be factors associated with use of a ring vaginal pessary for longer than 1 year. Long-term pessary users had a significant improvement in their quality of life.

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Abbreviations

BMI:

Body mass index

OD:

Odds ratio

POP:

Pelvic organ prolapse

POP-Q:

Pelvic Organ Prolapse Quantification

P-QoL:

Prolapse Quality of Life Questionnaire

QoL:

Quality of life

SD:

Standard deviation

SPSS:

Statistical Package for Social Sciences

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

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Author information

Authors and Affiliations

  1. Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua Napoleão de Barros, 608—Vila Clementino, São Paulo, SP, CEP: 04024-002, Brazil

    Danielle I. Niigaki, Rebecca S. P. Silva, Maria Augusta Tezelli Bortolini, Fátima F. Fitz & Rodrigo A. Castro

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  1. Danielle I. Niigaki
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  2. Rebecca S. P. Silva
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  3. Maria Augusta Tezelli Bortolini
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  4. Fátima F. Fitz
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  5. Rodrigo A. Castro
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Contributions

D. Niigaki and R.S.P. Silva contributed equally to the manuscript.

Conception and design: M.A.T. Bortolini, R.A. Castro; project development: D. Niigaki, M.A.T. Bortolini, R.A. Castro; data collection: D. Niigaki, R.A. Castro; data analysis and interpretation: D. Niigaki, R.A. Castro; manuscript writing: R.A. Castro, F.F. Fitz, R.S.P. Silva; manuscript editing: F.F. Fitz, M.A.T. Bortolini, R.A. Castro; supervision: R.A. Castro.

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Correspondence to Maria Augusta Tezelli Bortolini.

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Human Research Ethics Committee of the Federal University of Sao Paulo (CAAE 09974412.7.0000.5505).

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Niigaki, D.I., Silva, R.S.P., Bortolini, M.A.T. et al. Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study. Int Urogynecol J 33, 3237–3246 (2022). https://doi.org/10.1007/s00192-022-05133-5

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