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Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study

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Abstract

Introduction and hypothesis

This study aimed to evaluate the efficacy of the ring pessary compared with surgery as a primary treatment for advanced pelvic organ prolapse (POP) in non-hysterectomized, postmenopausal women. Our starting hypothesis was that the pessary is as effective as and less risky than surgery.

Methods

This study was a prospective observational study, which recruited 171 women with symptomatic advanced POP in a tertiary hospital for 30 months. They were treated according their preference with either surgery [77/171 (45.0%)] or vaginal ring pessary without support [94/171 (55.0%)]. The primary outcomes included the discontinuation of pessary use and the incidence of recurrent prolapse throughout the study. Secondary outcomes included complications categorized according to Clavien-Dindo classification. Descriptive statistics were used for demographic data. The mean and standard deviation were calculated for continuous variables, and continuity correction tests, Mann-Whitney U tests, and Fisher’s exact tests were used for categorical variables.

Results

There was successful use of a pessary in 84.4% (76/90) of cases, and 89.6% (69/77) of patients did not have prolapse recurrence in the surgical group (>POP-Q 2). In the pessary group, the adverse event rate was 31.6%, and all were Clavien-Dindo grade I. Thirty patients [30/77 (39.0%)] had complications in the surgery group: 14.3% were Clavien-Dindo grade I (11/77), 10.4% were grade II (8/77), and 14.3% were grade III (11/77).

Conclusions

The pessary is effective and has mild adverse events in non-hysterectomized, postmenopausal women with advanced POP.

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Acknowledgements

We thank all patients for agreeing to participate in this study.

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Authors and Affiliations

  1. Department of Surgery, Obstetrics & Gynaecology Area, School of Medicine, Seville University, Sevilla, Spain

    Alessio Miceli & José-Luis Dueñas-Diez

  2. Department of Obstetrics and Gynaecology, Hospital Universitario Virgen Macarena, Sevilla, Spain

    José-Luis Dueñas-Diez

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  1. Alessio Miceli
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Miceli, A., Dueñas-Diez, JL. Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study. Int Urogynecol J 30, 2161–2169 (2019). https://doi.org/10.1007/s00192-019-03919-8

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  • DOI: https://doi.org/10.1007/s00192-019-03919-8

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