Abstract
Introduction and hypothesis
Pessaries offer effective conservative management for symptoms of pelvic organ prolapse and are frequently used in the UK. Previous publications have highlighted a lack of evidence-based pessary guidelines. There is also a dearth of evidence regarding who UK pessary practitioners are and the training received.
Methods
A Freedom of Information request was sent to 167 healthcare organisations in the UK. Requested information included the number of pessaries inserted or changed, the grade and profession of pessary practitioners and training requirements at the organisation.
Results
Responses were received from 128 organisations. One hundred and ten had provided information for practitioners managing pessaries. At 66% (72) of organisations, pessary care was provided by both doctors and nurses of varying grades. At 23% of organisations either solely doctors or solely nurses provided pessary care. At the remaining 9% there was a multidisciplinary approach to pessary care. At 3 hospitals, unregistered healthcare professionals provided pessary care.
At the majority of organisations, respondents undertook supervised practise to gain skills in pessary management. Additional methods of training cited were learning through observation or achieving set competencies. Twenty-six percent received didactic training. At 21% of organisations there were no training requirements.
Conclusions
At most organisations, there was a multidisciplinary approach to pessary care. It is questionable whether unregistered healthcare professionals should be delegated responsibility for pessary care. A standardised approach to pessary practitioner training is advocated to ensure that women receive safe, evidence-based pessary care. The UK Clinical Guidance Group for the Use of Pessaries in Vaginal Prolapse is currently developing national evidence-based guidelines to support pessary practitioners in their practice, including training requirements.
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References
Haylen BT, Maher CF, Barber MD, et al. An international urogynaecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(2):165–94.
Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S. Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open. 2011;1(2):e000206.
Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.
Gorti M, Hudelist G, Simons A. Evaluation of vaginal pessary management: a UK-based survey. J Obstet Gynaecol. 2009;29(2):129–31.
Abdool Z, Thakar R, Sultan AH, Oliver R. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22:273–8.
NICE, 2019. Urinary incontinence and pelvic organ prolapse in women: management. Accessed online at https://www.nice.org.uk/guidance/ng123 on 27/04/2020.
International Centre for Allied Health Evidence (2012) Guidelines for use of support pessaries for women with pelvic organ prolapse www.unisa.edu.au/Global/Health/Sansom/Documents/iCAHE/THEPESSARYGUIDELINE_1872012.pdf
Atnip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):541–63.
Mutone MF, Terry C, Hale DS, Benson JT. Factors which influence the short-term success of pessary management of pelvic organ prolapse. Am J Obstet Gynecol. 2005;193(1):89‐94.
Lough K, Hagen S, McClurg D, Pollock A, the JLA Pessary PSP Steering Group. Shared research priorities for pessary use in women with prolapse: results from a James Lind Alliance priority setting partnership. BMJ Open. 2018. https://doi.org/10.1136/bmjopen-2017-021276.
Bugge C, Hagen S, Thakar R. Vaginal pessaries for pelvic organ prolapse and urinary incontinence: a multi-professional survey of practice. Int Urogynecol J 2013. 2013;24:1017–24.
Information Commissioners Office: https://ico.org.uk/for-organisations/guide-to-freedom-of-information/receiving-a-request/. Accessed online on 1 October 2019.
Storey S, Aston M, Price S, Irving L, Hemmens E. Women’s experiences with vaginal pessary use. J Adv Nurs. 2009;65:2350–7.
Royal College of Nursing (2020) Genital examination in women. https://www.rcn.org.uk/professional-development/publications/pub007961. Accessed online on 09/06/2020.
Gordon G, Dolnicek T, Malviya V. A problematic peril of pessaries: the rare case of rectovaginal fistulas resulting from pessary use. J Clin Gynecol Obstet. 2015;4(1):193–6.
Esin S, Harmanli O. Large vesicovaginal fistula in women with pelvic organ prolapse: the role of colpocleisis revisited. Int Urogynecol J. 2008;19:1711–171. https://doi.org/10.1007/s00192-008-0636-5.
Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J. 2008;19:1173–8.
Fernando RJ, Sultan AH, Thakar R, Jeyanthan K. Management of the neglected vaginal ring pessary. Int Urogynecol J. 2007;18:117–9 https://doi.org/10.1007/s00192-006-0089-7.
Grody M, Nyirjesy P, Chatwani A. Intravesical foreign body and vesicovaginal fistula: a rare complication of a neglected pessary. Int Urogynecol J. 1999;10:407–8. https://doi.org/10.1007/s001920050070.
Russell JK. The dangerous vaginal pessary. BMJ. 1961;2(5267):1595–7. https://doi.org/10.1136/bmj.2.5267.1595.
Alperin M, Khan A, Dubina E, Tarnay C, Wu N, Pashos CL, et al. Patterns of pessary care and outcomes for Medicare beneficiaries with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2013;19(3):142–7.
Dwyer L, Kearney R, Lavender T. A review of pessary for prolapse practitioner training. Br J Nurs. 2019;28(9):S18-S24.
Freedom of Information guidance, Information Commissioners Office: https://ico.org.uk/media/for-organisations/documents/1165/time-for-compliance-foia-guidance.pdf. Accessed online on 03/09/19
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This study was funded by The UK Continence Society (UKCS) small grant scheme. None of the authors has any other conflicts of interest to declare.
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Dwyer, L., Stewart, E. & Rajai, A. A service evaluation to determine where and who delivers pessary care in the UK. Int Urogynecol J 32, 1001–1006 (2021). https://doi.org/10.1007/s00192-020-04532-w
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DOI: https://doi.org/10.1007/s00192-020-04532-w