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Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis

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Abstract

Introduction

There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary.

Methods

We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis.

Results

Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66–85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1–23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96–1.27; p = 0.15), with a related I2-test of 37% (p = 0.21).

Conclusion

Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.

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References

  1. Haylen BT, Maher CF, Barber MD et al (2016) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn 35(2):137–168

    Article  PubMed  Google Scholar 

  2. Cardozo L, Rovner E, Wagg A, Wein A, Abrams P (eds) (2023) Incontinence, 7th edn. ICI-ICS. International Continence Society, Bristol UK

    Google Scholar 

  3. Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S (2011) Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open 1(2):e000206

    Article  PubMed  PubMed Central  Google Scholar 

  4. DeLancey JOL (2016) What’s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol 28(5):420–429

    Article  PubMed  PubMed Central  Google Scholar 

  5. ACOG/AUGS Guidance Update: diagnosis and management of pelvic organ prolapse including role of mesh. Available at: https://www.obgproject.com/2019/10/28/acog-augs-guidance-update-diagnosis-and-management-of-pelvic-organ-prolapse-including-role-of-mesh/.

  6. Harvey MA, Lemieux MC, Robert M, Schulz JA. Guideline No. 411: Vaginal Pessary Use. J Obstet Gynaecol Can. 2021;43(2):255–266.e1. https://doi.org/10.1016/j.jogc.2020.11.013

  7. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW (2006) Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol 108:93–99

    Article  PubMed  Google Scholar 

  8. Barber MD (2016) Pelvic organ prolapse. BMJ 354:i3853

    Article  PubMed  Google Scholar 

  9. Zwerink M, Brusse-Keizer M, Van Der Valk PDLPM et al (2014) Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 3:CD002990. https://doi.org/10.1002/14651858.CD002990.pub3

  10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919. (PMID:27733354;PMCID:PMC5062054)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898. (PMID: 31462531)

    Article  PubMed  Google Scholar 

  13. DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 45(pt A):139–145

    Article  PubMed  PubMed Central  Google Scholar 

  14. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  16. Higgins JPT, Thomas J, Chandler J et al (2019) Cochrane handbook for systematic reviews of interventions, 2nd edn. John Wiley and Sons.

  17. Nemeth Z, Nagy S, Ott J (2013) The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes. Int Urogynecol J. 24(10):1695–1701. https://doi.org/10.1007/s00192-013-2093-z. (Epub 2013 Apr 12 PMID: 23579291)

    Article  PubMed  Google Scholar 

  18. Kearney R, Brown C (2014) Self-management of vaginal pessaries for pelvic organ prolapse. BMJ Qual Improv Rep. 3(1):u206180.w2533. https://doi.org/10.1136/bmjquality.u206180.w2533. (PMID:27493737;PMCID:PMC4949618)

    Article  PubMed  PubMed Central  Google Scholar 

  19. Manonai J, Sarit-Apirak S, Udomsubpayakul U (2018) Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use. Menopause 26(6):665–669. https://doi.org/10.1097/GME.0000000000001277. (PMID: 30562318)

    Article  PubMed  Google Scholar 

  20. Chien CW, Lo TS, Tseng LH, Lin YH, Hsieh WC, Lee SJ (2020) Long-term outcomes of self-management Gellhorn pessary for symptomatic pelvic organ prolapse. Female Pelvic Med Reconstr Surg 26(11):e47–e53. https://doi.org/10.1097/SPV.0000000000000770. (PMID: 31393340)

    Article  PubMed  Google Scholar 

  21. Ma C, Zhou Y, Kang J, Zhang Y, Ma Y, Wang Y, Tian W, Xu T, Liang S, Fan G, Cui Y, Zhu L (2021) Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study. Menopause 28(5):538–545. https://doi.org/10.1097/GME.0000000000001751. (PMID: 33625108)

    Article  PubMed  Google Scholar 

  22. Hagen S, Kearney R, Goodman K, Best C, Elders A, Melone L, Dwyer L, Dembinsky M, Graham M, Agur W, Breeman S, Culverhouse J, Forrest A, Forrest M, Guerrero K, Hemming C, Khunda A, Manoukian S, Mason H, McClurg D, Norrie J, Thakar R, Bugge C (2023) Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial. EClinicalMedicine 66:102326. https://doi.org/10.1016/j.eclinm.2023.102326. (PMID:38078194;PMCID:PMC10701109)

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nemeth Z, Kolumban S, Schmidt R, Gubas P, Kovacs K, Farkas B (2023) Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study. Int Urogynecol J 34(4):921–927. https://doi.org/10.1007/s00192-022-05287-2 (Epub 2022 Jul 16. PMID: 35841400; PMCID: PMC9287815)

  24. de Albuquerque Coelho SC, Brito LGO, de Araujo CC, Juliato CRT (2020) Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: systematic review and metanalysis. Neurourol Urodyn 39(7):1912–1921. https://doi.org/10.1002/nau.24458. (Epub 2020 Jul 10 PMID: 32649024)

    Article  PubMed  Google Scholar 

  25. Dabic S, Sze C, Sansone S, Chughtai B (2022) Rare complications of pessary use: a systematic review of case reports. BJUI Compass 3(6):415–423. https://doi.org/10.1002/bco2.174. (PMID:36267197;PMCID:PMC9579882)

    Article  PubMed  PubMed Central  Google Scholar 

  26. Miceli A, Fernández-Sánchez M, Dueñas-Díez JL (2021) How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study. Int Urogynecol J 32(6):1471–1478. https://doi.org/10.1007/s00192-021-04706-0 (Epub 2021 Feb 23. PMID: 33620536; PMCID: PMC7900800)

  27. Arias B, Ridgeway B, Barber M (2008) Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol 19:1173–1178. https://doi.org/10.1007/s00192-008-0574-2

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France

    Alessandro Ferdinando Ruffolo, Marine Lallemant, Deseure Aurore, Yohan Kerbage, Chrystèle Rubod & Michel Cosson

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  1. Alessandro Ferdinando Ruffolo
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  2. Marine Lallemant
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  3. Deseure Aurore
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  4. Yohan Kerbage
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  5. Chrystèle Rubod
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  6. Michel Cosson
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Contributions

AFR: protocol development, data collection, management and analysis, manuscript writing. ML: protocol development, data management. AD: data collection and management. YK: manuscript editing, data management. CR: manuscript editing, supervision. MC: protocol development, supervision, manuscript editing.

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Correspondence to Alessandro Ferdinando Ruffolo.

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Ruffolo, A.F., Lallemant, M., Aurore, D. et al. Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07506-1

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