Abstract
Introduction and hypothesis
To review the outcomes and complications of vaginal prolapse management with pessaries in women aged 75 years or older, to ascertain whether pessaries are providing satisfactory long-term outcomes for older women.
Methods
A retrospective observational study was performed on women aged 75 years or older presenting to a tertiary Urogynaecology service with vaginal prolapse who opted for management with a vaginal pessary. Demographic and clinical data were collected by reviewing clinical files. The primary outcome was the proportion of women who opted for pessary management who later required prolapse surgery. Secondary outcomes included pessary complications and risk factors for failure. Kaplan–Meier survival estimates were performed to analyse pessary failure.
Results
Of the 218 women who presented with prolapse, 78% opted for pessary management, and pessary fitting was successful in 84%. Sixty-nine percent of women who opted for initial pessary management underwent surgery later, with a mean time from pessary insertion to surgery of 21.6 months. Vaginal erosions were reported in 42% of pessary users. Risk factors for pessary failure were younger age and previous history of hysterectomy or prolapse surgery.
Conclusions
Although vaginal pessary use was the preferred first-line management choice for vaginal prolapse in most older women, surgery for prolapse was ultimately required in two-thirds of those conservatively managed. As three-quarters of older women presenting with prolapse had surgery as either a primary or secondary procedure; patients need to be advised of the high chance of requiring surgery at a later stage if they opt for pessary management.
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Data Availability
The datasets generated and analyzed during the current research are not publicly available as individual privacy could be compromised, but are available from the corresponding author on reasonable request.
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Acknowledgements
Hamish Neave (Statistician at Te Whatu Ora Waitemata) provided statistical advice and statistical analysis of data.
Elizabeth Thomas (Mercy Hospital for Women, Melbourne) assisted with data collection.
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N Dykes: Study conception, project development, data collection and analysis, manuscript writing and editing.
Y Lim: Study conception, project development, manuscript writing and editing.
A Zilberlicht: Data collection, manuscript editing.
P Dwyer: Critical review, manuscript editing.
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This study was approved by the local hospital research committee (Mercy Health HREC 2018–036).
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Dykes, N., Lim, Y.N., Zilberlicht, A. et al. Are older patients with prolapse likely to continue pessary use? A retrospective observational study. Int Urogynecol J 34, 2919–2923 (2023). https://doi.org/10.1007/s00192-023-05627-w
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DOI: https://doi.org/10.1007/s00192-023-05627-w