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Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse

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Abstract

Introduction and hypothesis

The aim of this study was to investigate factors associated with long-term pessary use in patients with advanced pelvic organ prolapse (POP).

Methods

This was a retrospective chart review of patients with POP of stage ≥2 managed with a pessary. Patients were excluded if the date of fitting or follow-up was unavailable. Long-term use was defined as more than 1 year. Patient demographics, pessary fitting, and follow-up visit dates were collected. The primary end point was the duration of use and the prognostic impact of pessary type. Secondary objectives addressed other influencing factors including age, estrogen use, and prolapse stage. The data were analyzed using SPSS version 21.

Results

The final analysis included 311 patients. The mean (± standard deviation, SD) duration of pessary use was 7.0 ± 0.72 years (median 5.7 years). Long-term use was found in 76 % (164) of these patients. Factors associated with longer use were age >65 years (p = 0.004) and estrogen use (p = 0.048). The estimated mean (± SD) durations of use of the Gellhorn, open ring, ring with support, cube and donut pessaries were 10.5 ± 0.7 years, 3.4 ± 0.6 years, 1.8 ± 0.2 years, 1.8 ± 0.3 years and 1.7 ± 0.5 years, respectively. The Gellhorn pessary was associated with significantly longer use than other pessary types (10.5 ± 0.7, p < 0.0000001); this finding was independent of age, prolapse stage, hysterectomy, and vaginal estrogen use.

Conclusions

In this retrospective analysis, the duration of use was longest with the Gellhorn pessary. Older age and vaginal estrogen use were associated with longer pessary use.

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References

  1. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277–285. doi:10.1067/mob.2000.107583.

    Article  CAS  PubMed  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–506. doi:10.1016/S0029-7844(97)00058-6.

    Article  CAS  PubMed  Google Scholar 

  3. Bai SW, Yoon BS, Kwon JY, Shin JS, Kim SK, Park KH. Survey of the characteristics and satisfaction degree of the patients using a pessary. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):182–186. doi:10.1007/s00192-004-1226-9. discussion 186.

    Article  PubMed  Google Scholar 

  4. Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG. 2009;116(13):1715–1721. doi:10.1111/j.1471-0528.2009.02380.x.

    Article  CAS  PubMed  Google Scholar 

  5. Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e171–170.e177. doi:10.1016/j.ajog.2010.02.037.

    Article  Google Scholar 

  6. Manchana T, Bunyavejchevin S. Impact on quality of life after ring pessary use for pelvic organ prolapse. Int Urogynecol J. 2012;23(7):873–877. doi:10.1007/s00192-011-1634-6.

    Article  PubMed  Google Scholar 

  7. Hanson LA, Schulz JA, Flood CG, Cooley B, Tam F. Vaginal pessaries in managing women with pelvic organ prolapse and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):155–159. doi:10.1007/s00192-005-1362-x.

    Article  CAS  PubMed  Google Scholar 

  8. Robert M, Schulz JA, Harvey MA, Urogynaecology Committee, et al. Technical update on pessary use. J Obstet Gynaecol Can. 2013;35(7):664–674.

    Article  PubMed  Google Scholar 

  9. Manchana T. Ring pessary for all pelvic organ prolapse. Arch Gynecol Obstet. 2011;284(2):391–395. doi:10.1007/s00404-010-1675-y.

    Article  PubMed  Google Scholar 

  10. Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(1):56–59. doi:10.1016/j.ijgo.2011.02.006.

    Article  PubMed  Google Scholar 

  11. Wang XQ, Zhu L, Li B, Tang X, Xu T. A prospective study of pessary treatment for pelvic organ prolapse and health-related quality-of-life. Zhonghua Yi Xue Za Zhi. 2013;93(37):2982–2985.

    PubMed  Google Scholar 

  12. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–99. doi:10.1097/01.AOG.0000222903.38684.cc.

    Article  PubMed  Google Scholar 

  13. Friedman S, Sandhu KS, Wang C, Mikhail MS, Banks E. Factors influencing long-term pessary use. Int Urogynecol J. 2010;21(6):673–678. doi:10.1007/s00192-009-1080-x.

    Article  PubMed  Google Scholar 

  14. Clemons JL, Aguilar VC, Sokol ER, Jackson ND, Myers DL. Patient characteristics that are associated with continued pessary use versus surgery after 1 year. Am J Obstet Gynecol. 2004;191(1):159–164.

    Article  PubMed  Google Scholar 

  15. Brazell HD, Patel M, O’Sullivan DM, Mellen C, LaSala CA. The impact of pessary use on bowel symptoms: one-year outcomes. Female Pelvic Med Reconstr Surg. 2014;20(2):95–98. doi:10.1097/SPV.0000000000000060.

    Article  PubMed  Google Scholar 

  16. Geoffrion R, Zhang T, Lee T, Cundiff GW. Clinical characteristics associated with unsuccessful pessary fitting outcomes. Female Pelvic Med Reconstr Surg. 2013;19(6):339–345. doi:10.1097/SPV.0b013e3182a26174.

    Article  PubMed  Google Scholar 

  17. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–350. doi:10.1016/j.ajog.2003.08.034.

    Article  PubMed  Google Scholar 

  18. Dessie SG, Armstrong K, Modest AM, Hacker MR, Hota LS. Effect of vaginal estrogen on pessary use. Int Urogynecol J. 2016;27(9):1423–1429. doi:10.1007/s00192-016-3000-1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Abdool Z, Thakar R, Sultan AH, Oliver RS. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22(3):273–278. doi:10.1007/s00192-010-1340-9.

    Article  PubMed  Google Scholar 

  20. Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, 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.e401–405.e408. doi:10.1016/j.ajog.2007.02.018.

    Article  Google Scholar 

  21. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(2), CD004010. doi:10.1002/14651858.CD004010.pub3.

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Acknowledgements

The authors thank Cynthia Brincat of Loyola University Medical Center for support with project planning and completion.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology and Urology, Loyola University Medical Center, Maywood, IL, USA

    Birte Wolff

  2. Division of Urogynecology, Northwell Health System, Manhasset, NY, USA

    Kathryn Williams, Allen Winkler, Lawrence Lind & Dara Shalom

  3. Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA

    Birte Wolff

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  1. Birte Wolff
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  2. Kathryn Williams
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  3. Allen Winkler
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  4. Lawrence Lind
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Correspondence to Birte Wolff.

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Wolff, B., Williams, K., Winkler, A. et al. Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse. Int Urogynecol J 28, 993–997 (2017). https://doi.org/10.1007/s00192-016-3228-9

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  • DOI: https://doi.org/10.1007/s00192-016-3228-9

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