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Pessary: A Rediscovered Tool

  • Elena CattoniEmail author
  • Paola Sorice
  • Linda Leidi-Bulla
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)

Abstract

Although surgical management of symptomatic pelvic organ prolapse (POP) is often necessary, pessary still remains the most common effective, inexpensive, and safe nonsurgical option to help patients alleviate their symptoms.

Despite the majority of practitioners prescribe pessaries in their clinical practice, a lack of consensus exists whether conservative therapies should always be attempted at first. However thanks to the aging of population worldwide, there has been a renewed interest in the use of conservative treatment for POP.

References

  1. 1.
    Lawrence JM, Luckacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorder in community-dwelling women. Obstet Gynecol. 2008;11(3):678–85.CrossRefGoogle Scholar
  2. 2.
    Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;29:4–20.Google Scholar
  3. 3.
    Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):125–30.CrossRefGoogle Scholar
  4. 4.
    Shah SM, Sultan AH, Thakar R. The history and evolution of pessaries for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):170–5.CrossRefGoogle Scholar
  5. 5.
    Atrip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36:541–63.CrossRefGoogle Scholar
  6. 6.
    Lamers BHC, Broekman BMW, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Int Urogynecol J. 2011;22:637–44.CrossRefGoogle Scholar
  7. 7.
    Sevilla C, Wieslander CK, Alas A, et al. The pessary process: Spanish-speaking Latinas’ experience. Int Urogynecol J. 2013;24(6):939–46.CrossRefGoogle Scholar
  8. 8.
    Kapoor DS, Thakar R, Sultan AH, et al. Conservative versus surgical management of prolapse: what dictates patient choice? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1157–61.CrossRefGoogle Scholar
  9. 9.
    Serati M, Giarenis I, Meschia M, et al. Role of urodynamics before prolapse surgery. Int Urogynecol J. 2015;26(2):165–8.CrossRefGoogle Scholar
  10. 10.
    Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Effort (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14.CrossRefGoogle Scholar
  11. 11.
    Lone F, Thakar R, Sultan AH, et al. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114:56–9.CrossRefGoogle Scholar
  12. 12.
    Rusavy Z, Bombieri L, Freeman RM. Procidentia in pregnancy: a systematic review and recommendations for practice. Int Urogynecol J. 2015;26(8):1103–9.CrossRefGoogle Scholar
  13. 13.
    Lipp A, Shaw C, Glavind K. Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2014;(12):CD001756.  https://doi.org/10.1002/14651858.CD001756.pub6.
  14. 14.
    Bugge C, Hegen S, Thakar R. Vaginal pessaries for pelvic organ prolapse and urinary incontinence: a multidisciplinary survey of practice. Int Urogynecol J. 2013;24:1017–24.CrossRefGoogle Scholar
  15. 15.
    Jeffrey S, Franco A, Fynes M. Vaginal wind: the cube pessary as a solution. Int Urogynecol J. 2008;19:1457.CrossRefGoogle Scholar
  16. 16.
    Thakar R, Stanton S. Management of genital prolapse. BMJ. 2002;324:1258–62.CrossRefGoogle Scholar
  17. 17.
    Pott-Grinstein E, Newcomber JR. Gynecologists’ pattern of prescribing pessaries. J Reprod Med. 2001;46:205–8.PubMedGoogle Scholar
  18. 18.
    ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 85: Pelvic organ prolapse.Google Scholar
  19. 19.
    Fernando RJ, Thakar R, Sultan AH, et al. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.CrossRefGoogle Scholar
  20. 20.
    Bash KL. Review of vaginal prolapse pessaries. Obstet Gynecol Surv. 2000;55(7):455–60.CrossRefGoogle Scholar
  21. 21.
    Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol. 2005;106:615–34.CrossRefGoogle Scholar
  22. 22.
    Nemeth Z, Nagy S, Ott J. The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes. Int Urogynecol J. 2013;24:1695–701.CrossRefGoogle Scholar
  23. 23.
    Khaja A, Freeman RM. How often should shelf/Gellhorn pessaries changed? A survey of IUGA urogynecologists. Int Urogynecol J. 2014;25:941–6.CrossRefGoogle Scholar
  24. 24.
    Meriwether KV, Komesu YM, Craig E, et al. Sexual function and pessary management among women using a pessary for pelvic floor disorders. J Sex Med. 2015;12:2339–49.CrossRefGoogle Scholar
  25. 25.
    Cundiff GW, Amundsen CL, Bent AE, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007;196(4):405.e1–8.CrossRefGoogle Scholar
  26. 26.
    Cundiff WG, Weidner AC, Visco AG, et al. A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol. 2000;95(6 pt 1):931–5.PubMedGoogle Scholar
  27. 27.
    Wiegersma M, Panman CMCR, Kollen BJ, et al. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2014;77:168–73.CrossRefGoogle Scholar
  28. 28.
    Nager CW, Richter HE, Nygaard I, et al. Incontinence pessaries: size, POPQ measures, and successful fitting. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1023–8.CrossRefGoogle Scholar
  29. 29.
    Geoffrion R, Zhang T, Lee T, et al. Clinical characteristics associated with unsuccessful pessary fitting outcomes. Female Pelvic Med Reconstr Surg. 2013;19(6):339–45.CrossRefGoogle Scholar
  30. 30.
    Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–60.CrossRefGoogle Scholar
  31. 31.
    Barber MD, Walters MD, Cundiff GW. Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women under-going vaginal surgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol. 2006;194(5):1492–8.CrossRefGoogle Scholar
  32. 32.
    Komesu YM, Rogers RG, Rode MA, et al. Pelvic floor symptom changes in pessary users. Am J Obstet Gynecol. 2007;197:620.e1–6.CrossRefGoogle Scholar
  33. 33.
    Brazell HD, Patel M, O’sullivan DM, et al. The impact of pessary use on bowel symptoms: one-year outcome. Female Pelvic Med Reconstr Surg. 2014;20(2):95–8.CrossRefGoogle Scholar
  34. 34.
    Kuhn A, Bapst D, Stadlmayr W, et al. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril. 2009;91(5):1914–8.CrossRefGoogle Scholar
  35. 35.
    Clemons JL, Aguilar VC, Tillinghast TA, et al. Patient satisfaction and changes in prolapse and urinary symptoms in women who were successfully fitted with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190:1025–9.CrossRefGoogle Scholar
  36. 36.
    Donnelly MJ, Powell-Morgan S, Olsen AL, et al. Vaginal pessaries for the management of stress and mixed urinary incontinence. Int Urogynecol J. 2004;15:302–7.Google Scholar
  37. 37.
    Manchana T, Bunyavejchevin S. Impact on quality of life after ring pessary use for pelvic organ prolapse. Int Urogynecol J. 2012;2:873–7.CrossRefGoogle Scholar
  38. 38.
    Friedman S, Sandhu C, Wang C, et al. Factors influencing long-term pessary use. Int Urogynecol J. 2010;21:673–8.CrossRefGoogle Scholar
  39. 39.
    Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(2):CD004010.  https://doi.org/10.1002/14651858.CD004010.pub3.
  40. 40.
    Continence Foundation of Australia and International Centre for Allied Health Evidence, University of South Australia. Guidelines for the use of support pessaries in the management of pelvic organ pro-lapse. 2012. http://w3.unisa.edu.au/cahe/Resources/GuidelinesiCAHE/Pessary%20Guidelines.pdf.
  41. 41.
    Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–501.CrossRefGoogle Scholar
  42. 42.
    Abdool Z, Thakar R, Sultan AH. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22:273–8.CrossRefGoogle Scholar
  43. 43.
    Mamik MM, Rogers RG, Qualls CR, et al. Goal attainment after treatment in patients with symptomatic pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(488):e1–5.Google Scholar
  44. 44.
    Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65-74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J. 2016;27(8):1201–7.  https://doi.org/10.1007/s00192-016-2970-3.CrossRefPubMedGoogle Scholar
  45. 45.
    Handa VL, Jones M. Do pessaries prevent the progression of pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(6):349–51.CrossRefGoogle Scholar
  46. 46.
    Bo K, Majida M, Ellstrom ME. Does a ring pessary in situ influence the pelvic floor muscle function of women with pelvic organ prolapse when tested in supine? Int Urogynecol J. 2012;23:573–7.CrossRefGoogle Scholar
  47. 47.
    Jones K, Yang L, Lowder JL, et al. Effect of pessary use on genital hiatus measurements in women with pelvic organ prolapse. Obstet Gynecol. 2008;112(3):630–6.CrossRefGoogle Scholar
  48. 48.
    Gorti M, Hundelist G, Simons A. Evaluation of vaginal pessary management: a UK-based survey. J Obstet Gynaecol. 2009;29(2):129–31.CrossRefGoogle Scholar
  49. 49.
    Hagen S, Sinclair L, Glazener C, et al. A feasibility study for randomized controlled trial with pelvic organ prolapse. ICS Conference, Glasgow, UK. 2001. http://iwcsoffice.org/Abstracts/Publish/106/000616.pdf.
  50. 50.
    Sullivan SA, Davidson EWR, Bretscneider EM, et al. Patient characteristics associated with treatment choice for pelvic organ prolapse and urinary incontinence. Int Urogynecol J. 2016;27:811–6.CrossRefGoogle Scholar
  51. 51.
    Chan SS, Cheung RY, Yiu KW, et al. Symptoms, quality of life and factors affecting women’s treatment decisions regarding pelvic organ prolapse. Int Urogynecol J. 2012;23:1027–33.CrossRefGoogle Scholar
  52. 52.
    Brincat C, Kenton K, Pat Fitzgerald M, et al. Sexual activity predicts continued pessary use. Am J Obstet Gynecol. 2004;191(1):198–200.CrossRefGoogle Scholar
  53. 53.
    Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapsed. Am J Obstet Gynecol. 2013;209(5):470e1–6.CrossRefGoogle Scholar
  54. 54.
    Detollenaere RJ, denBoon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.  https://doi.org/10.1136/bmj.h3717.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Rahmanou P, Price N Jackson SR. Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study. Int Urogynecol J. 2015;26(11):1687–94.CrossRefGoogle Scholar
  56. 56.
    Clemons JL, Aguillar VC, Tillinghast TA, et al. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–50.CrossRefGoogle Scholar
  57. 57.
    Yamada T, Matsubara S. Rectocele, but not cystocele, may predict unsuccessful pessary fitting. J Obstet Gynaecol. 2011;31(5):441–2.CrossRefGoogle Scholar
  58. 58.
    Markle D, Skoczylas L, Goldsmith C, et al. Patients characteristics associated with successful pessary fitting. Female Pelvic Med Reconstr Surg. 2011;17(5):249–52.PubMedGoogle Scholar
  59. 59.
    Mutone MF, Terry C, Hale DS, et al. Factors which influence the short term success of pessary management of pelvic organ prolapse. Obstet Gynecol. 2005;193:89–94.Google Scholar
  60. 60.
    Hanson LM, Schultz J, Flood CG, et al. Vaginal pessaries in managing women with pelvic organ prolapsed and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J. 2006;17:155–9.CrossRefGoogle Scholar
  61. 61.
    Fitchett JR, Bhatta S, Sherpa TY, et al. Non-surgical interventions for pelvic organ prolapsed in rural Nepal: a prospective monitoring and evaluation study. JSRM Open. 2015;6(12):2054270415608117.  https://doi.org/10.1177/2054270415608117. eCollection 2015.CrossRefGoogle Scholar
  62. 62.
    Alnaif B, Drutz HB. Bacterial vaginosis increases in pessary users. Int Urogynecol J. 2000;11:219–23.CrossRefGoogle Scholar
  63. 63.
    Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1173–8.CrossRefGoogle Scholar
  64. 64.
    Penrose KJ, Tsokos N. Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J. 2014;25:291–3.CrossRefGoogle Scholar
  65. 65.
    Walker KF, Dasgupta J, Cust MP. A neglected shelf pessary resulting in a urethrovaginal fistula. Int Urogynecol J. 2011;22:1133–4.Google Scholar
  66. 66.
    Ambereen DF. Ureterovaginal fistula due to a cube pessary despite routine follow-up: but what is “routine”? J Obstet Gynaecol Res. 2014;40:2162–5.CrossRefGoogle Scholar
  67. 67.
    Ho MP. Unilateral acute pyelonephritis associated with neglected pessary. J Am Geriatr Soc. 2011;59:1962–3.CrossRefGoogle Scholar
  68. 68.
    Christ ML, Haja J. Cytological changes associated with vaginal pessary use with special reference to the presence of actinomyces. Acta Cytol. 1973;22(3):146–9.Google Scholar
  69. 69.
    Schraub S, Sun XS, Maingon PH, et al. Cervical and vaginal cancer associated with pessary use. Cancer. 1992;69:2505–9.CrossRefGoogle Scholar
  70. 70.
    Martin C, Hong L, Siddighi S. What is hiding behind the pessary? Int Urogynecol J. 2013;24:873–5.CrossRefGoogle Scholar
  71. 71.
    Jain A, Majoko F, Freites O. How innocent is the vaginal pessary? Two cases of vaginal cancer associated with the pessary use. J Obstet Gynaecol. 2006;26(8):829–30.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elena Cattoni
    • 1
    Email author
  • Paola Sorice
    • 2
  • Linda Leidi-Bulla
    • 1
  1. 1.Department of Gynecology and ObstetricsRegional Hospital of Lugano, EOCLuganoSwitzerland
  2. 2.Department of Gynecology and ObstetricsOspedale Giuseppe FornaroliMagentaItaly

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