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Nemeth Z, Vida P, Markovic P, Gubas P, Kovacs K, Farkas B. Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis. Int Urogynecol J 2024:10.1007/s00192-024-05882-5. [PMID: 39101959 DOI: 10.1007/s00192-024-05882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/07/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing. METHODS We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I). RESULTS Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive. CONCLUSIONS The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.
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Affiliation(s)
- Zoltan Nemeth
- Department of Gynecology, Brothers of St. John of God Hospital Vienna, Vienna, Austria
| | - Peter Vida
- Department of Obstetrics and Gynecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary
| | - Predrag Markovic
- Department of Gynecology, Brothers of St. John of God Hospital Vienna, Vienna, Austria
| | - Peter Gubas
- Department of Obstetrics and Gynecology, B-A-Z County Teaching Hospital, Miskolc, Hungary
| | - Kalman Kovacs
- Department of Obstetrics and Gynecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 17 Édesanyak Str., 7624, Pecs, Hungary
- HUN-REN-PTE Human Reproduction Research Group, 17 Édesanyak Str., 7624, Pecs, Hungary
| | - Balint Farkas
- Department of Obstetrics and Gynecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary.
- National Laboratory on Human Reproduction, University of Pécs, 17 Édesanyak Str., 7624, Pecs, Hungary.
- HUN-REN-PTE Human Reproduction Research Group, 17 Édesanyak Str., 7624, Pecs, Hungary.
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Paulussen E, Börger R, van Eijndhoven H, Engberts M, Steures P, Weemhoff M. The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse-A retrospective cohort study. Int Urogynecol J 2024:10.1007/s00192-024-05864-7. [PMID: 39046489 DOI: 10.1007/s00192-024-05864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM). METHODS A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation. RESULTS A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01). CONCLUSIONS Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.
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Affiliation(s)
- Evy Paulussen
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Renée Börger
- Department of Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands.
- Department of Gynaecology, Jeroen Bosch Medical Centre, 's-Hertogenbosch, The Netherlands.
- GROW Maastricht University, Maastricht, The Netherlands.
| | | | - Marian Engberts
- Department of Gynaecology, Isala Medical Centre, Zwolle, The Netherlands
| | - Pieternel Steures
- Department of Gynaecology, Jeroen Bosch Medical Centre, 's-Hertogenbosch, The Netherlands
| | - Mirjam Weemhoff
- Department of Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Ruffolo AF, Lallemant M, Aurore D, Kerbage Y, Rubod C, Cosson M. Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:2367-2380. [PMID: 38634900 DOI: 10.1007/s00404-024-07506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary. METHODS We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis. RESULTS Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I2-test of 37% (p = 0.21). CONCLUSION Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.
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Affiliation(s)
| | - Marine Lallemant
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Deseure Aurore
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Yohan Kerbage
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Chrystèle Rubod
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
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Pizzoferrato AC, Sallée C, Thubert T, Fauconnier A, Deffieux X. Value of pelvic examination in women with pelvic organ prolapse: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38778697 DOI: 10.1002/ijgo.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination. OBJECTIVES The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse-associated symptoms in terms of diagnosis and predictability of treatment success. SEARCH STRATEGY The databases were queried similarly using Medical Subject Headings (MeSH) and non-MeSH terms broadly related to pelvic examination and POP management. SELECTION CRITERIA We included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery. DATA COLLECTION AND ANALYSIS We assessed peer-reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS-E or RoB2 tools. MAIN RESULTS In all, 67 studies were retained for the review. Prolapse-associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements. CONCLUSIONS In women complaining of prolapse-associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion-discernible on pelvic examination-are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, CHU de Poitiers, Poitiers, France
- Université de Poitiers, CIC-Inserm, DECLAN, Poitiers, France
| | - Camille Sallée
- Department of Obstetrics and Gynecology, Limoges University Hospital, Limoges, France
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Intercommunal Hospital Center of Poissy Saint-Germain-en-Laye, Poissy, France
- Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Xavier Deffieux
- Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France
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Nemeth Z, Kolumban S, Schmidt R, Gubas P, Kovacs K, Farkas B. Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study. Int Urogynecol J 2023; 34:921-927. [PMID: 35841400 PMCID: PMC9287815 DOI: 10.1007/s00192-022-05287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/22/2022] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Loss of anatomical support for the pelvic organs results in pelvic organ prolapse (POP). We hypothesized that daily self-management of a cube pessary might be a safe, feasible long-term treatment in women with symptomatic POP. METHODS A cohort of 214 symptomatic POP patients (stage 2+) were enrolled prospectively (January to December 2015). Each patient was size-fitted with a space-filling cube pessary and completed a questionnaire online or by phone ≥5 years after her initial fitting. Change in quality of life (QoL) was measured with the Patient Global Impression of Improvement (PGI-I). RESULTS Of 185 women included in our analyses, 174 (94%) were continuing to use their pessary 4 weeks post-insertion. Among those, 143 (82.2%) used the pessary successfully for ≥5 years. A large majority of these patients (88.8% [127 out of 143]) described their condition as much or very much improved compared with their pretreatment status (PGI-I). Adverse secondary effects (ASEs) were infrequent [15.4% (22 out of 143)]; when they did occur, they were mild, including smelly vaginal discharge (15 out of 22) and slight vaginal bleeding caused by the fitting procedure (6 out of 22). CONCLUSIONS Daily self-management of cube pessaries was found to be a safe and effective treatment for improving POP-related symptoms and QoL in the long term.
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Affiliation(s)
- Zoltan Nemeth
- Department of Gynaecology, Brothers of St. John of God Hospital Vienna, Vienna, Austria
| | - Szilard Kolumban
- Department of Obstetrics and Gynaecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary
| | - Roxana Schmidt
- Department of Gynaecology, Brothers of St. John of God Hospital Vienna, Vienna, Austria
| | - Peter Gubas
- Department of Obstetrics and Gynaecology, B-A-Z County Teaching Hospital, Miskolc, Hungary
| | - Kalman Kovacs
- Department of Obstetrics and Gynaecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary
- Member of the MTA-PTE Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (MTA), Pecs, Hungary
| | - Balint Farkas
- Department of Obstetrics and Gynaecology, University of Pecs School of Medicine, 17 Edesanyak Str., Pecs, Hungary.
- Member of the MTA-PTE Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (MTA), Pecs, Hungary.
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Dufour S, Clancy A, Wu M. Technical Update No. 433: eHealth Solutions for Urinary Incontinence Among Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:150-159.e1. [PMID: 36273716 DOI: 10.1016/j.jogc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women. TARGET POPULATION Women over 18 years with urinary incontinence. OPTIONS Websites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence. OUTCOMES Use of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system. BENEFITS, HARMS, AND COSTS Evidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit. EVIDENCE The Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Relevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Dufour S, Clancy A, Wu M. Mise à jour technique N o433 : Cybersanté et incontinence urinaire chez la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:160-171.e1. [PMID: 36925223 DOI: 10.1016/j.jogc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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McNeill ER, Lucocq J, Brown K, Kay V. The impact on complication rates of delayed routine pessary reviews during the COVID-19 pandemic. Int Urogynecol J 2022:10.1007/s00192-022-05333-z. [PMID: 36040505 PMCID: PMC9426366 DOI: 10.1007/s00192-022-05333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis During the COVID-19 pandemic, guidance was issued in the United Kingdom advising a delay in routine pessary reviews. The impact of this has not been fully explored. The null hypothesis for this study is that delayed routine pessary reviews during the COVID-19 pandemic did not result in a statistically significant increase in complication rate. Methods A retrospective comparative cohort study was conducted in NHS Tayside, Scotland, involving 150 patients pre-pandemic and 150 patients during the COVID-19 pandemic (before exclusions). Their notes were reviewed identifying age, care provider, pessary type, length of pessary usage, review date, time elapsed since the previous review, bleeding/infection/ulceration, removal issues, pessary replacement and outcome. Patients excluded were those with no pessary in situ at review, reviews at ≤4 months and >8 months (pre-pandemic) and reviews at ≤8 months (COVID-19 pandemic). Results The pre-pandemic group (n=106) had average review times of 10.1,6.2 and 6.2 months for cubes, rings and all others. Overall rates of bleeding/infection/ulceration; reported removal issues; and pessary subsequently not replaced were 9.4%, 11.3% and 5.7% respectively. The COVID-19 pandemic group (n=125) had average review times of 14.7, 10.8 and 11.4 months for cubes, rings and all others. Overall rates of bleeding/infection/ulceration; reported removal issues; and pessary subsequently not replaced were 21.6%, 16.0%, and 12.0% respectively. Conclusions Overall, there was a significant increase in rates of bleeding/ulceration/infection (p=0.01). When individual pessaries were considered, this only remained true for rings (p=0.02). Our data would suggest that routine ring pessary reviews should not be extended beyond 6 months or risk bleeding/ulceration/infection.
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Affiliation(s)
- Esther R McNeill
- Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.
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Dwyer L, Dowding D, Kearney R. What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review. BMJ Open 2022; 12:e060223. [PMID: 35851026 PMCID: PMC9297214 DOI: 10.1136/bmjopen-2021-060223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Pelvic organ prolapse can be managed with a pessary. However, regular follow-up may deter women due to the inconvenience of frequent appointments, as well as preventing autonomous decision making. Pessary self-management may be a solution to these issues. However, there remains a number of uncertainties regarding pessary self-management. This scoping review aims to map available evidence about pessary self-management to identify knowledge gaps providing the basis for future research. DESIGN Scoping review as detailed in the review protocol. DATA SOURCES A search of MEDLINE, CINAHL, EMBASE and PsycINFO databases and a handsearch were undertaken during May 2021 to identify relevant articles using the search terms 'pessary' and 'self-management' or 'self-care'. DATA EXTRACTION AND SYNTHESIS Data relevant to pessary self-management was extracted and the Mixed Methods Appraisal Tool used to assess empirical rigour. Thematic analysis was performed to evaluate the results. RESULTS The database search identified 82 publications. After duplicates and articles not meeting the inclusion and exclusion criteria were removed, there were 23 eligible articles. A hand search revealed a further 19 articles, resulting in a total of 42 publications.Findings relevant to pessary self-management were extracted and analysed for the emergence of themes. Recurrent themes in the literature were; the characteristics of self-managing women; pessary care; factors associated with decision making about self-management; teaching self-management and cost benefit. CONCLUSIONS Pessary self-management may offer benefits to some women without increased risk. Some women do not feel willing or able to self-manage their pessary. However, increased support may help women overcome this. Further in-depth exploration of factors which affect women's willingness to self-manage their pessary is indicated to ensure better understanding and support as available for other conditions.
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Affiliation(s)
- Lucy Dwyer
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Nursing, Midwifery and Social Work, The University of Manchester School of Health Sciences, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester School of Health Sciences, Manchester, UK
| | - R Kearney
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, Manchester, UK
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Manzini C, Morsinkhof LM, van der Vaart CH, Withagen MIJ, Grob ATM. Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1719-1763. [PMID: 35037973 PMCID: PMC9270314 DOI: 10.1007/s00192-021-05015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Objectives To clarify which parameters are associated with unsuccessful pessary fitting for pelvic organ prolapse (POP) at up to 3 months follow-up. Methods Embase, PubMed and Cochrane CENTRAL library were searched in May 2020. Inclusion criteria were: (1) pessary fitting attempted in women with symptomatic POP; (2) pessary fitting success among the study outcomes with a maximal follow-up of 3 months; (3) baseline parameters compared between successful and unsuccessful group. A meta-analysis was performed using the random effects model. Main results Twenty-four studies were included in the meta-analysis. Parameters associated with unsuccessful pessary fitting were: age (OR 0.70, 95% CI 0.56–0.86); BMI (OR 1.35, 95% CI 1.08–1.70); menopause (OR 0.65 95% CI 0.47–0.88); de novo stress urinary incontinence (OR 5.59, 95% CI 2.24–13.99); prior surgery, i.e. hysterectomy (OR 1.88, 95% CI 1.48–2.40), POP surgery (OR 2.13, 95% CI 1.34–3.38), pelvic surgery (OR 1.81, 05% CI 1.01–3.26) and incontinence surgery (OR 1.87, 95% CI 1.08–3.25); Colorectal-Anal Distress Inventory-8 scores (OR 1.92, 95% CI 1.22–3.02); solitary predominant posterior compartment POP (OR 1.59, 95% CI 1.08–2.35); total vaginal length (OR 0.56, 95% CI 0.32–0.97); wide introitus (OR 4.85, 95% CI 1.60–14.68); levator ani avulsion (OR 2.47, 95% CI 1.35–4.53) and hiatal area on maximum Valsalva (OR 1.89, 95% CI 1.27–2.80). Conclusion During counselling for pessary treatment a higher risk of failure due to the aforementioned parameters should be discussed and modifiable parameters should be addressed. More research is needed on the association between anatomical parameters and specific reasons for unsuccessful pessary fitting.
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Affiliation(s)
- Claudia Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,, Utrecht, The Netherlands
| | - Lisan M Morsinkhof
- Magnetic Detection and Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - C Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mariëlla I J Withagen
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Anique T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Bugge C, Dembinsky M, Kearney R, Hagen S. Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse? BMJ 2021; 372:n310. [PMID: 33608314 DOI: 10.1136/bmj.n310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Melanie Dembinsky
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Rohna Kearney
- Warrell Unit, St Mary's Hospital, Manchester University NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Developmental Biology and Medicine, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice. Int Urogynecol J 2020; 32:1015-1022. [PMID: 33034677 DOI: 10.1007/s00192-020-04537-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Symptomatic vaginal prolapse affects 6-28% of women and significantly impacts their quality of life. Pessaries for prolapse are used by three-quarters of clinicians as a first-line treatment; however, current clinical use in the UK is unknown and there is a lack of clinical guidance or training. This study is aimed at informing the upcoming UK Clinical Guidance on best practice for the use of pessaries document. METHODS A 19-question, anonymised, electronic survey was sent to members of the nine professional bodies delivering pessary care in the UK. RESULTS Of 917 respondents, 403 (246 nurses, 134 doctors, 22 physiotherapists and 1 other profession) currently deliver pessary care. PVC/vinyl ring, silicone ring, Gellhorn and shelf pessaries are most popular, and are used frequently by 93% of respondents. Further pessary training was deemed necessary by 62% of those currently providing pessary care, and 70% of those who do not. The most highly rated method for previous and future training is shadowing another clinician. One in three respondents receive no ancillary support and nearly 1 in 7 (predominantly nurses) report the absence of cross-cover arrangements, leaving a gap in care provision. CONCLUSIONS Service provision, support and pessary training in the UK vary greatly. This calls for the standardisation of care, training and development of a national guideline. We present a clear rationale and need for a UK guideline on pessary management of vaginal prolapse and a standardised pessary training model for multi-professional use.
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Can we define excess vaginal space? - Genital hiatus size and prolapse severity are correlated with cube pessary size. Eur J Obstet Gynecol Reprod Biol 2020; 253:61-64. [PMID: 32791394 DOI: 10.1016/j.ejogrb.2020.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prior studies demonstrated a positive association between increased genital hiatus (GH), advanced prolapse stage and levator ani muscle injury. Moreover wide GH is an established risk factor for recurrent pelvic organ prolapse (POP). Since excess vaginal space is not yet a dimension to estimate in Pelvic Organ Prolapse, we hypothesized that excess vaginal space has a positive correlation with increased GH and could be a new aspect for the assessment of the severity of POP and underlying pelvic muscle damage. We attempted to quantify excess vaginal space by different volumes of different cube pessary sizes. STUDY DESIGN In a prospective study, 716 symptomatic POP patients without any prior operations were enrolled from January 2011 to December 2017. All patients suffered from stage 2 POP or greater, where either the anterior, middle or posterior compartments or combinations of these were affected. As a conservative self-therapy, space-filling (Dr. Arabin®) cube pessaries were fitted. The size of each was individually adapted for each woman. For data analysis we used Spearman correlation test and Nonparametric statistical test. RESULTS All patients included in the study were asymptomatic one week after fitting the pessary. We revealed a positive significant correlation between the genital hiatus (GH) and the size of the cube pessary (ƍ = 0.777,p ≤ 0.001). We also found a positive significant correlation between the size of the cube pessaries and the POP-Q stage. We also managed to find significant differences between cube pessary sizes and corresponding GH values. CONCLUSIONS Cube pessary sizes may indicate the amount of excess vaginal space. Since excess vaginal space significantly correlates with the increase of the genital hiatus, it could be consider - as well as GH - as a marker for advanced prolapse stage, and a risk factor for the recurrence of pelvic organ prolapse.More studies are needed to identify factors related to excess vaginal space.
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Murray C, Thomas E, Pollock W. Vaginal pessaries: can an educational brochure help patients to better understand their care? J Clin Nurs 2016; 26:140-147. [DOI: 10.1111/jocn.13408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Wendy Pollock
- Mercy Hospital for Women; Heidelberg Vic. Australia
- La Trobe University; Bundoora Vic. Australia
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Nemeth Z, Farkas N, Farkas B. Is hysterectomy or prior reconstructive surgery associated with unsuccessful initial trial of pessary fitting in women with symptomatic pelvic organ prolapse? Int Urogynecol J 2016; 28:757-761. [DOI: 10.1007/s00192-016-3184-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW Pelvic organ prolapse (POP) is a common clinical condition that is highly prevalent in the geriatric female population. The condition can have substantial negative influence on multiple symptom and quality-of-life parameters. There are various treatment options for POP, including observation, pessary placement, and surgical treatments with either vaginal reconstruction or colpocleisis resulting in vaginal vault closure. This review examines current literature about pessary use for treatment of POP in elderly women. RECENT FINDINGS Pessary use appears to be successful for many women and is often associated with improvements in various clinical parameters, including decreased sensation of vaginal bulge and enhanced quality of life. Some patients may experience improvements in bladder or bowel symptoms, although a small percentage may develop new urinary incontinence, constipation, or other defecation problems. Complications of pessary use are generally minor and can usually be successfully treated with targeted therapy such as vaginal estrogen supplementation. Continuity of clinical care is important to help maintain clinical success and prevent potential complications. SUMMARY Pessaries are a viable conservative form of treatment for POP for many older women. Pessary use can lead to substantial improvements in quality of life and other clinical outcomes in geriatric patients.
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Abstract
OBJECTIVES Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence; however, few data exist describing long-term pessary use. Our aim was to describe symptom bother and quality of life (QoL) in women using pessaries for urinary incontinence and/or prolapse for at least 12 months. METHODS Consecutive women who met inclusion criteria were approached for this observational cross-sectional study. Wilson and Cleary's Health-Related Quality of Life Model guided the inclusion of biologic, functional, and individual factors that impact the health-related QoL. Consenting participants completed a generalized QoL index, the Center for Epidemiologic Depression Symptoms, Medical Outcomes Study Social Support Survey, and condition-specific measures; the Pelvic Floor Distress Inventory (PFDI-20-SF) and the Pelvic Floor Impact Questionnaire. RESULTS Fifty-six women, mean age 74.4 years (range, 47-89 years), completed the survey. Mean length of time for pessary use was 4.5 years (1-15 years). Most of the women (n = 31, 55.4%) returned to the clinic for pessary care every 3 months. There was no difference in generalized QoL nor condition-specific total PFDI-20 in women performing self-care versus routine follow-up. Almost one third (29%) of participants reported complications related to pessary use (eg, vaginal erosion), and 41%were considering surgical repair in the near future. Women who were considering surgery had higher PFDI-20 scores relating to more bothersome prolapse symptoms than those not considering surgery (Pelvic Organ Prolapse Distress Inventory 6, 33.91 vs 24.73, P = 0.03). CONCLUSIONS Pessaries can be used to control pelvic floor symptoms for extended periods. Complication rates in this study were lower than previously reported, even in women not doing self-care. Not surprisingly, women considering surgical intervention reported greater symptom bother despite pessary use.
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