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Renouf C, Ballard P, Khunda A, Kershaw V, Shawer S, Rees J. Patient experience of pain during vaginal pessary removal and insertion: a service evaluation study. Int Urogynecol J 2024; 35:327-332. [PMID: 37659003 DOI: 10.1007/s00192-023-05643-w] [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: 05/12/2023] [Accepted: 07/30/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse is a common problem affecting women, but there is currently a lack of research focusing on patient experience of pessary changes. This study was aimed at capturing the patient perspective of pessary changes and formally assessing pain during pessary removal and insertion. METHODS A service evaluation request was granted by South Tees Hospitals NHS Trust. Patients undergoing pessary change (ring, shelf, or Gellhorn) in gynaecology outpatient clinics over a 6-month period were asked to rate their pain scores on a ten-point numerical pain-rating scale. Other associated data were collected. RESULTS Out of 213 women, 58.2% reported that pessary removal was more painful than insertion, 30.5% reported equal pain, and 10.8% reported that insertion was more painful than removal. Pain scores were significantly higher for removal (mean 4.37, median 4, IQR 4-7) than for insertion (mean 2.66, median 2, IQR 2-4, p <0.001). Ring pessaries were significantly less painful to both remove and insert than shelf and Gellhorn pessaries. Smaller pessaries were more painful to both remove and insert. There was no significant difference in pain scores reported by those with or without diagnosed vulval conditions. CONCLUSIONS Pessary removal causes most women moderate pain, which should be communicated to patients beforehand. Ring pessaries are significantly less painful to change than other pessary types. Clinicians should consider pain as a factor in their decision-making surrounding pessary choice and when counselling patients. Future research should focus on ways to reduce pain during pessary removal.
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Affiliation(s)
| | - Paul Ballard
- South Tees NHS Foundation Trust, Middlesbrough, UK
| | | | | | - Sami Shawer
- South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Jon Rees
- University of Sunderland, Sunderland, UK
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Sappenfield EC, Mellen C, Wilcox J, O'Hanlon DE, O'Sullivan DM, Tunitsky-Bitton E. The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:50-58. [PMID: 37493229 DOI: 10.1097/spv.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Pessary-related adverse effects are common, and treatment options are limited. Probiotics may improve pessary-related adverse effects by altering the vaginal microenvironment. OBJECTIVE This study aimed to evaluate the effect of a vaginal probiotic suppository on the vaginal microenvironment among pessary users. STUDY DESIGN Women who used pessaries were randomized to vaginal probiotic suppository use versus without use. The intervention was a vaginal probiotic suppository and moisturizing vaginal gel. The vaginal microenvironment was assessed using Gram stain and Nugent's criteria at baseline and 3 months by a microbiologist blinded to group allocation. Symptoms and experience with use of the probiotic were assessed using questionnaires. The primary outcome was change in lactobacilli count on Nugent subscore at 3 months. RESULTS A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%. CONCLUSION Vaginal probiotic suppository use did not affect the composition of the vaginal microenvironment, patient satisfaction, or vaginal symptoms after 3 months of use in pessary users.
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Affiliation(s)
- Elisabeth C Sappenfield
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Colleen Mellen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | - Jennifer Wilcox
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| | | | - David M O'Sullivan
- Department of Research Administration, Hartford HealthCare, Hartford, CT
| | - Elena Tunitsky-Bitton
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
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Sung VW, Jeppson P, Madsen A. Nonoperative Management of Pelvic Organ Prolapse. Obstet Gynecol 2023; 141:724-736. [PMID: 36897185 DOI: 10.1097/aog.0000000000005121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 03/11/2023]
Abstract
Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior, posterior, or apical vagina. It is a common condition, with up to 50% of women having prolapse on examination in their lifetimes. This article provides an overview of the evaluation and discussion of nonoperative management of POP for the obstetrician-gynecologist (ob-gyn), with consideration of recommendations from the American College of Obstetricians and Gynecologists, the American Urogynecologic Society, and the International Urogynecological Association. The initial evaluation of POP requires a history documenting whether the patient is experiencing symptoms and what they are, and discovery of which symptoms they believe are attributable to prolapse. Examination determines the vaginal compartment(s) and to what degree prolapse exists. In general, only patients who have symptomatic prolapse or medical indication should be offered treatment. Although surgical options exist, all patients who are symptomatic and desire treatment should be offered nonsurgical treatment first, including pelvic floor physical therapy or a pessary trial. Appropriateness, expectations, complications, and counseling points are reviewed. Educational opportunities between the patient and the ob-gyn include disentangling common beliefs that the bladder is dropping or that concomitant urinary or bowel symptoms are necessarily caused by prolapse. Improving patient education can lead to a better understanding of their condition and better alignment of treatment goals and expectations.
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Affiliation(s)
- Vivian W Sung
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of New Mexico Health Sciences, Albuquerque, New Mexico; and the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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Vaginal Pessary Use and Management for Pelvic Organ Prolapse: Developed by the joint writing group of the American Urogynecologic Society and the Society of Urologic Nurses and Associates. Individual writing group members are noted in the Acknowledgments section. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:5-20. [PMID: 36548101 DOI: 10.1097/spv.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Over the past 50 years, pessary use has increased in popularity and has become an essential pelvic organ prolapse (POP) management tool. However, evidence is lacking to define care standardization, including pessary fitting, routine maintenance, and management of pessary-related complications. This clinical consensus statement (CCS) on vaginal pessary use and management for POP reflects statements drafted by content experts from the American Urogynecologic Society and Society of Urologic Nurses and Associates. The purpose of this CCS is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited. The American Urogynecologic Society and Society of Urologic Nurses and Associates' vaginal pessary for POP writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 31 statements were assessed and divided into 3 categories: (1) fitting and follow-up, (2) complications, and 3) quality of life. Of the 31 statements that were assessed, all statements reached consensus after 2 rounds of the Delphi survey. This CCS document hopefully serves as a first step toward standardization of pessary care, but the writing group acknowledges that improved research will grow the base of knowledge and evidence providing clinicians a foundation to manage pessary care effectively and confidently.
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Outcomes of Pessary Use at 1 Year in Women Treated for Pelvic Organ Prolapse in a Large Multicenter Registry: Developed by the Pelvic Floor Disorders Registry. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:800-810. [PMID: 36409637 DOI: 10.1097/spv.0000000000001279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE There is a lack of high-quality long-term follow-up regarding pessary treatment. Most studies are case series or retrospective with a small sample size and short-term follow-up. OBJECTIVES This study aimed to evaluate differences in women who continue versus discontinue pessary use and the effectiveness, quality of life, and safety associated with pessary management at 1 year. STUDY DESIGN This study analyzed a multicenter national registry following women for 3 years with vaginal prolapse treated with a pessary or surgery. The primary outcome of this analysis was to compare the difference in characteristics among those who continue versus discontinue pessary use at 12 months. RESULTS Among 1,153 participants enrolled, 376 (32.6%) opted for a pessary, and 296 (78.7%) were successfully fitted. Data were available for 240 participants (81%). At 1 year, 62% (n = 148) were still using pessaries, and 38% (n = 92) had stopped with 25% opting for surgery. Most commonly reported de novo adverse effects were urinary leakage (16%), feeling or seeing a bulge (12%), and vaginal discharge (11%). There was no difference in baseline characteristics among women who continued versus discontinued pessary use. At 12 months, subjective symptoms were similar between groups, with similar change in symptoms from baseline on most validated instruments. Those who continued to use a pessary reported worse urinary symptoms due to de novo urinary leakage ( P = 0.01). CONCLUSIONS At 1 year, most women successfully fitted with a pessary continued pessary use. Although there was a significant improvement in condition-specific quality of life and low rates of complications, approximately 40% of women discontinued pessary use by 12 months. We were unable to identify any baseline characteristics associated with pessary discontinuation.
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Long J, Zidan G, Seyfoddin A, Tong S, Brownfoot FC, Chowdary P. An estriol-eluting pessary to treat pelvic organ prolapse. Sci Rep 2022; 12:20021. [PMID: 36414726 PMCID: PMC9681886 DOI: 10.1038/s41598-022-23791-9] [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: 05/05/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
Pelvic organ prolapse affects up to 50% of parous women. Commonly used treatment options have unwelcome attributes; pessaries can cause erosion and estrogen creams need to be applied frequently, which is inconvenient and difficult to administer. This study involved the development of an estriol-releasing pessary utilising 3D printing molds. We incorporated varying amounts of estriol (1%, 10% and 15%) into the silicone pessary. We optimised the mechanical aspects of the pessary so it had a similar strength to commercially available pessaries. We investigated estriol release from the pessary over 3 months. We explored possible interactions between the drug and polymers via FTIR. The MED-4870 silicone ring with similar mechanical strength to pessaries currently used to treat pelvic organ prolapse. The medical pessaries present a sustained release in simulated vaginal fluid over 3 months. The pessary with 10% estriol delivered the optimal dose at 0.8 mg each week. Mechanical strength of this pessary showed no difference after emersion in simulated vaginal fluid for 3-month, supporting the long-term application. An estriol-loaded pessary was successfully developed to treat pelvic organ prolapse with sustained release of estriol over 3 months. This pessary provides promising potential to treat pelvic organ prolapse and vaginal atrophy.
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Affiliation(s)
- Jingjunjiao Long
- grid.252547.30000 0001 0705 7067Drug Delivery Research Group, Faculty of Health and Environmental Sciences, School of Science, Auckland University of Technology, Auckland, New Zealand ,grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Ghada Zidan
- grid.252547.30000 0001 0705 7067Drug Delivery Research Group, Faculty of Health and Environmental Sciences, School of Science, Auckland University of Technology, Auckland, New Zealand
| | - Ali Seyfoddin
- grid.252547.30000 0001 0705 7067Drug Delivery Research Group, Faculty of Health and Environmental Sciences, School of Science, Auckland University of Technology, Auckland, New Zealand
| | - Stephen Tong
- grid.1008.90000 0001 2179 088XTranslational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC 3084 Australia
| | - Fiona C. Brownfoot
- grid.1008.90000 0001 2179 088XObstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC 3084 Australia
| | - Prathima Chowdary
- grid.9654.e0000 0004 0372 3343Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Ziv E, Erlich T. Novel, disposable, self-inserted, vaginal device for the non-surgical management of pelvic organ prolapse: efficacy, safety, and quality of life. BMC Womens Health 2022; 22:459. [DOI: 10.1186/s12905-022-02057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
We evaluated a novel disposable, collapsible, ring-shaped vaginal device that is self-inserted within an applicator and removed with a string. The device was developed to overcome the drawbacks of existing ring pessaries for non-surgical pelvic organ prolapse management (POP).
Methods
The primary objective efficacy endpoint of this prospective, interventional, multicenter, self-controlled, and home-use study was the proportion of subjects with improved staging on the Pelvic Organ Prolapse Quantification (POP-Q) scale. Subjective efficacy was assessed using the POP symptoms alleviation score. Safety was evaluated by recording the rate and incidence of adverse events (AEs) in a daily diary, and quality of life (QoL) was evaluated using the modified Pelvic Floor Impact (PFIQ-7) and Pelvic Floor Disability Index (PFDI-20) questionnaires.
Results
A total of 94 usage cycles were observed in a group of 52 participants (mean age 60.2 ± 10.5 years, 81.1% postmenopausal) who used the device for 3558 days. Of these, 24 participants completed one usage cycle, 14 completed two usage cycles, and 14 completed three usage cycles with 28–45 days of ProVate use in each usage cycle. All patients experienced greater than two POP-Q stage reductions. The descent was completely reduced to POP-Q stage 0 in 97.8% of participants. The POP symptom alleviation questionnaire showed significant subjective efficacy (P < 0.0001). The modified PFDI-20 and PFIQ-7 scores also improved substantially (P < 0.0001 for both). There were 91 nonserious device-related AEs: 98.9% were mild and 87.9% anticipated, with no vaginal infection, and one case of urinary tract infection.
Conclusion
The novel device substantially reduces prolapse and provides significant subjective POP symptom relief and QoL improvement, with minimal AEs. The device may enable women to self-manage their prolapse with a small, disposable device that minimizes self-touching and frequent dependency on the clinic.
Trial registration
Clinical.Trials.gov, NCT02239133, posted September 12, 2014 (retrospectively registered).
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Dabic S, Sze C, Sansone S, Chughtai B. Rare complications of pessary use: A systematic review of case reports. BJUI COMPASS 2022; 3:415-423. [PMID: 36267197 PMCID: PMC9579882 DOI: 10.1002/bco2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events. Methods We performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level. Results Overall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications. Conclusion Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.
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Affiliation(s)
- Stefan Dabic
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Christina Sze
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Stephanie Sansone
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Bilal Chughtai
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
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Ai F, Wang Y, Wang J, Zhou L, Wang S. Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis. Climacteric 2022; 25:533-542. [PMID: 35695119 DOI: 10.1080/13697137.2022.2079973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to systematically review the impact of local estrogen use in combination with a pessary on vaginal complications in postmenopausal women with pelvic organ prolapse (POP). METHODS We searched databases including Medline, Embase, PubMed, Clinical Trials and the Cochrane Central Register of Controlled Trials for relevant literature published in English from inception to 31 May 2021. Only randomized controlled trials (RCTs) and cohort studies were included. RESULTS In total, five studies were included (three RCTs, one prospective study and one retrospective cohort study). The meta-analysis was performed with subgroups. Our results indicated a significantly lower incidence of bacterial vaginosis (BV) among postmenopausal women who used estrogen than among controls, with a total pooled odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.11-0.72; I2 = 38%; p = 0.008). The summary ORs of the estrogen use group were 0.98 (95% CI: 0.59-1.63; I2 = 41%; p = 0.95) for vaginal ulceration, 0.80 (95% CI: 0.42-1.54; I2 = 29%; p = 0.50) for vaginal bleeding and 0.74 (95% CI: 0.35-1.58; I2 = 35%; p = 0.44) for vaginal discharge. CONCLUSIONS Local estrogen in combination with a pessary could decrease the BV rate among postmenopausal women with POP. However, consensus regarding the value of estrogen use for decreasing other pessary complications has not yet been reached. Additional multicenter RCTs with large sample sizes should be conducted to better understand the effect of estrogen use on reducing pessary-related complications.
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Affiliation(s)
- F Ai
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Y Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - J Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - L Zhou
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - S Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Female Pelvic Med Reconstr Surg 2022. [PMID: 35420550 DOI: 10.1097/spv.0000000000001180.10.1097/spv.0000000000001180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. OBJECTIVE The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. STUDY DESIGN We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). CONCLUSIONS Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.
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The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Female Pelvic Med Reconstr Surg 2022; 28:e171-e178. [PMID: 35420550 DOI: 10.1097/spv.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. OBJECTIVE The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. STUDY DESIGN We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). CONCLUSIONS Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.
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Host inflammatory response in women with vaginal epithelial abnormalities after pessary use. Int Urogynecol J 2021; 33:2151-2157. [PMID: 34748034 DOI: 10.1007/s00192-021-05001-8] [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: 03/18/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA. METHODS Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1β. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA. RESULTS We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR <2.9 [the lower limit of detection, LLD]-14.2) and < 2.9 (LLD) (IQR <2.9 [LLD]-5.5), IFNα2: 8.2 (IQR 6.1-13.9) and 7.9 (IQR 3.9-13.6), TNFα: 15.2 (IQR 6.1-30.4) and 4.68 (IQR <2.3 [LLD]-16.3), IL1β 195.7 (IQR 54.5-388.6) and 38.5 (IQR 6.7-154.9). The differences in median cytokine levels were statistically higher in cases for IL6, TNFα, and IL1β (all p < 0.001) compared to controls. Older age (OR: 1.062, 95% CI, 1.015-1.112), lower BMI (OR: 0.910, 95% CI, 0.839-0.986) and presence of VEA at last check (OR: 5.377, 95% CI, 2.049-14.108) were associated with higher odds of having VEA on multivariate analysis. CONCLUSION Pro-inflammatory cytokines, specifically IL6, TNFα, and IL1β, are elevated in pessary-wearing patients who have VEA. Additional prospective studies are needed to assess baseline vaginal inflammatory profiles before and after pessary placement to understand VEA formation in pessary patients.
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Pizzoferrato AC, Nyangoh-Timoh K, Martin-Lasnel M, Fauvet R, de Tayrac R, Villot A. Vaginal Pessary for Pelvic Organ Prolapse: A French Multidisciplinary Survey. J Womens Health (Larchmt) 2021; 31:870-877. [PMID: 34569823 DOI: 10.1089/jwh.2021.0229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Pessary fitting and follow-up for women with pelvic organ prolapse (POP) can be performed by different health care practitioners (HCPs). We aimed to investigate knowledge and current practices among the main HCPs involved in pessary use in France. Materials and Methods: We sent an electronic questionnaire about pessary use to the members of eight French learned societies between April and October 2020. Results: During the study period, 1017 HCPs responded to the questionnaire: 712 (70.0%) were doctors, 208 (20.4%) physiotherapists, 95 (9.3%) midwives, and 7 (0.6%) nurses. Of the respondents, 69.1% claimed to be comfortable with pessary fitting and follow-up, and 54.1% think that a pessary can be offered as a first-line treatment in the management of POP. However, 60.1% reported that the main indications for pessaries were "older women," 71.3% for women with contraindications to surgery, and 60.5% for women waiting for surgery. 23.9% do not prescribe local estrogen therapy with a pessary for postmenopausal women. The main pessaries used are the ring and cube types (63.7 and 57.5%, respectively). Wide introitus (53.3%), difficulties of use (56.3%), a short vagina (41.4%), and major unmasked urinary incontinence (47.2%) are considered to be the main risk factors for pessary failure. The most common complications related to pessaries reported by the patients are vaginal discharge (48.6%) and pain or discomfort (40.6%). Up to 43.4% of respondents considered that a follow-up visit every 3-6 months was optimal. The need for training ranged from 42.8% for nurses to 65.2% for general practitioners. Conclusions: This national multidisciplinary survey revealed that HCPs in France are on the whole comfortable with pessaries and mainly prescribe the ring and cube form. Even if opinion about pessaries appears to be changing, HCPs would welcome additional training to improve knowledge and practices.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - Krystel Nyangoh-Timoh
- Inserm, LTSI-UMR 1099 Unit, Department of Obstetrics and Gynecology, Rennes Hospital, Rennes University 1, Rennes, France
| | - Mathilde Martin-Lasnel
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - Raffaèle Fauvet
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France.,Inserm U1086 ANTICIPE Unit, Caen Normandie University, Caen, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynaecology, Carémeau University Hospital, Nîmes, France
| | - Anne Villot
- Department of Obstetrics and Gynecology, Cotentin Public Hospital Center, Cherbourg, France
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Marschalek ML, Bodner K, Kimberger O, Zehetmayer S, Morgenbesser R, Dietrich W, Obruca C, Husslein H, Umek W, Koelbl H, Bodner-Adler B. Does preoperative locally applied estrogen treatment facilitate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse? A randomised controlled double-masked, placebo-controlled, multicentre study. BJOG 2021; 128:2200-2208. [PMID: 34464489 PMCID: PMC9293194 DOI: 10.1111/1471-0528.16894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether locally applied vaginal estrogen affects prolapse-associated complaints compared with placebo treatment in postmenopausal women prior to surgical prolapse repair. DESIGN Randomised, double-masked, placebo-controlled, multicentre study. SETTING Urogynaecology unit at the Medical University of Vienna and University Hospital of Tulln. POPULATION Postmenopausal women with symptomatic pelvic organ prolapse and planned surgical prolapse repair. METHODS Women were randomly assigned local estrogen cream or placebo cream 6 weeks preoperatively. MAIN OUTCOME MEASURES The primary outcome was differences in subjective prolapse-associated complaints after 6 weeks of treatment prior to surgery, assessed with the comprehensive German pelvic floor questionnaire. Secondary outcomes included differences in other pelvic floor-associated complaints (bladder, bowel or sexual function). RESULTS Out of 120 women randomised, 103 (86%) remained for the final analysis. After 6 weeks of treatment the prolapse domain score did not differ between the estrogen and the placebo groups (4.4 ± 0.19 versus 4.6 ± 0.19; mean difference, -0.21; 95% CI -0.74 to 0.33; P = 0.445). Multivariate analysis, including only women receiving the intervention, showed that none of the confounding factors modified the response to estradiol. CONCLUSIONS These results demonstrate that preoperative locally applied estrogen does not ameliorate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse. TWEETABLE ABSTRACT Preoperative local estrogen does not ameliorate prolapse-associated symptoms in postmenopausal women with pelvic organ prolapse.
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Affiliation(s)
- M-L Marschalek
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - K Bodner
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - O Kimberger
- Department of Anaesthesiology, Medical University of Vienna, Vienna, Austria
| | - S Zehetmayer
- Centre for Medical Statistics, Informatics and Intelligent Systems (Institute of Medical Statistics), Medical University of Vienna, Vienna, Austria
| | - R Morgenbesser
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - W Dietrich
- Department of Gynaecology and Obstetrics, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - C Obruca
- Department of Gynaecology and Obstetrics, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - H Husslein
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - W Umek
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria.,Department of Special Gynaecology and Obstetrics, Karl Landsteiner Institute, Währinger Gürtel, Austria
| | - H Koelbl
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - B Bodner-Adler
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria.,Department of Special Gynaecology and Obstetrics, Karl Landsteiner Institute, Währinger Gürtel, Austria
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Development of a multinational, multidisciplinary competency framework for physiotherapy training in pessary management: an E-Delphi study. Int Urogynecol J 2021; 33:253-265. [PMID: 34089340 DOI: 10.1007/s00192-021-04843-6] [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: 02/17/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal support pessaries are intravaginal devices designed to relieve symptoms of pelvic organ prolapse, but they can cause serious medical complications if not managed well. Physiotherapists are well placed to manage pessaries, but there are no guidelines on the training required for competency in pessary management (PM). METHODS A scoping review of current literature on PM training was conducted to develop draft competency standards, which were reviewed by a multidisciplinary focus group. Using e-Delphi methodology, a multidisciplinary and multinational expert panel then refined the standards. Three rounds of e-Delphi online surveys were conducted, with individual participant feedback and one videoconference to discuss items that did not reach consensus. Consensus was set at 80% agreement and stability measured using kappa coefficient. RESULTS Pessary training competency standards, developed by 29 experts, covered three key domains including: (1) prerequisite knowledge and understanding; (2) entrustable professional activities; (3) pessary-specific standards under ten key roles. Consensus was reached on all 73 (100%) competency standards and stability demonstrated for 95.9% of standards. There was no attrition of expert panel participants through the e-Delphi rounds. CONCLUSIONS This e-Delphi study provides the first, robust recommendations on training standards for physiotherapists in PM. These competency standards will provide clinicians with a self-assessment tool, and educators and training institutions with a benchmark in training for PM, which should improve options and reduce risk for women with prolapse being managed with a pessary.
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Effect of vaginal estrogen in postmenopausal women using vaginal pessary for pelvic organ prolapse treatment: a randomized controlled trial. Int Urogynecol J 2021; 33:1833-1838. [PMID: 33991221 DOI: 10.1007/s00192-021-04821-y] [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: 02/08/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Evidence and recommendations for the use of intravaginal estrogen for prevention of bacterial vaginosis and pessary-related complications are limited and controversial. We hypothesized that adding intravaginal estrogen to pessary use would decrease the incidence of bacterial vaginosis and other pessary-related complications. METHODS A single-center, open-label, randomized, parallel study was conducted between April 2018 and August 2020. Participants were randomized to either receive intravaginal estriol 0.03 mg plus Lactobacillus acidophilus 100 million viable cell vaginal tablets or have no treatment. The Amsel criteria, normal flora index, visual analog scale, Thai version of the ICIQ-VS (International Consultation on Incontinence Questionnaire-Vaginal symptoms) questionnaire, vaginal abrasions and vaginal bleeding were evaluated at entry and at 2- and 14-week follow-up. RESULTS Seventy-eight women were included and randomized to two groups (39 women per group). At 2-week follow-up, one participant in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (2.7% vs. 5.7%, p = 0.609). At 14-week follow-up, two participants in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (5.7% vs. 6.2%, p = 0.926). Normal flora index was significantly different at 2-week follow-up [8 (6.3) vs. 5 (6.0), p = 0.032]. There was no significant difference in the visual analog scale, Thai version of the ICIQ-VS, vaginal abrasions and vaginal bleeding between the 2- and 14-week follow-ups. CONCLUSIONS This study shows no benefit of intravaginal estrogen in reducing bacterial vaginosis, vaginal abrasions, vaginal bleeding and pain in postmenopausal women using a vaginal pessary for pelvic organ prolapse treatment.
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The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. ACTA ACUST UNITED AC 2021; 27:976-992. [PMID: 32852449 DOI: 10.1097/gme.0000000000001609] [Citation(s) in RCA: 190] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To update and expand the 2013 position statement of The North American Menopause Society (NAMS) on the management of the genitourinary syndrome of menopause (GSM), of which symptomatic vulvovaginal atrophy (VVA) is a component. METHODS A Panel of acknowledged experts in the field of genitourinary health reviewed the literature to evaluate new evidence on vaginal hormone therapies as well as on other management options available or in development for GSM. A search of PubMed was conducted identifying medical literature on VVA and GSM published since the 2013 position statement on the role of pharmacologic and nonpharmacologic treatments for VVA in postmenopausal women. The Panel revised and added recommendations on the basis of current evidence. The Panel's conclusions and recommendations were reviewed and approved by the NAMS Board of Trustees. RESULTS Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life. Genitourinary syndrome of menopause is likely underdiagnosed and undertreated. In most cases, symptoms can be effectively managed. A number of over-the-counter and government-approved prescription therapies available in the United States and Canada demonstrate effectiveness, depending on the severity of symptoms. These include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and the estrogen agonist/antagonist ospemifene. Long-term studies on the endometrial safety of vaginal estrogen, vaginal DHEA, and ospemifene are lacking. There are insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on efficacy and safety or to make treatment recommendations. CONCLUSIONS Clinicians can resolve many distressing genitourinary symptoms and improve sexual health and the quality of life of postmenopausal women by educating women about, diagnosing, and appropriately managing GSM. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for the individual patient, and patient preference. Nonhormone therapies available without a prescription provide sufficient relief for most women with mild symptoms. Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy, and ospemifene are effective treatments for moderate to severe GSM. When low-dose vaginal estrogen or DHEA or ospemifene is administered, a progestogen is not indicated; however, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data at present to confirm the safety of vaginal estrogen or DHEA or ospemifene in women with breast cancer; management of GSM should consider the woman's needs and the recommendations of her oncologist.
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Cross sectional study on assessment of ring pessary cleaning and removal every six months: adverse events and complications. Int Urogynecol J 2021; 33:397-403. [PMID: 33830303 DOI: 10.1007/s00192-021-04775-1] [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: 12/29/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Despite its frequent use, there is little evidence of adequate management of pessaries for treating pelvic organ prolapse (POP). Thus, the aims the study were to assess the rate of complications in women using ring-type pessaries with cleaning and monitoring every 6 months and to correlate the time of use of the pessary with possible complications. METHODS This is a cross-sectional study including women diagnosed with stage 3 or 4 genital prolapse, who were already in outpatient follow-up and who used a ring pessary. We excluded patients using another type of pessary, with severe comorbidities and with POP-Q ≤ 2 staging. The chi-square test or Fisher exact test was applied for categorical variables, the t-test for continuous variables with normal distribution and Mann-Whitney test for non-parametric variables. RESULTS A total of 83 women using a ring pessary were assessed. The mean in months of pessary use was 31.8 ± 14.9 months. Vaginal discharge was the most frequent complaint representing 26.5%, followed by foul smell in 13.3%. No significant correlation was found between length of pessary use and clinical variables. However, a significant correlation was found between immediate complications and the length of pessary use (21.3 ± 5.9 months; p < 0.0044). CONCLUSION There was no increase in complication rate in the continuous use of a ring pessary with cleaning and monitoring every 6 months. Determining a follow-up time that reduces the risk of complications is necessary not only for the organization of the attendance services, allowing a greater number of monitored patients, but also for the access of patients who need regular monitoring.
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Martin-Lasnel M, Nyangoh-Timoh K, Fauvet R, Pizzoferrato AC. [The use of pessaries for treatment of pelvic organ prolapse: A survey from gynecologists and urologists residents]. ACTA ACUST UNITED AC 2021; 49:763-766. [PMID: 33774264 DOI: 10.1016/j.gofs.2021.03.030] [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: 11/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition responsible for symptoms that significantly affect the quality of life in women. Despite its effectiveness, low cost and minor side effects, the pessary is little used in France. The objective of our study was to assess the knowledge, training and practices of residents regarding pessaries. MATERIAL AND METHODS This survey was conducted among residents in obstetrics gynecology, medical gynecology and urology in France between March and September 2020. RESULTS During the study period, 328 interns responded to the questionnaires. The majority of residents (52.1%) reported never having attended a consultation specializing in pelvicperineology. Only 31.7% felt comfortable having a pessary inserted. According to them, the pessary was indicated in 3 main situations: in case of contraindication to surgery (80%), while awaiting surgery (79%) and in women over 70 years old (62%). The pessary could be offered to all women for only 46.9% of them. Almost 53% of residents reported ignoring the main complications of pessaries and 83.5% felt they needed further training on the subject. CONCLUSION Interns seem to be generally aware of the use of the pessary. Their knowledge of the indications, complications or even monitoring leads us to believe that it is essential to promote their training so that the pessary becomes an integral part of the first-line therapeutic arsenal in the event of POPs.
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Affiliation(s)
- M Martin-Lasnel
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France.
| | - K Nyangoh-Timoh
- Inserm, LTSI-UMR 1099, département of obstetrics and gynecology, Rennes Hospital, Rennes, University 1, Rennes, France
| | - R Fauvet
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France; Université Caen Normandie, Inserm U1086 « ANTICIPE », unité de recherche Interdisciplinaire pour la prévention et le traitement des cancers, Axe 2 : biologie et thérapies innovantes des cancers localement agressifs (BioTICLA), 14000 Caen, France
| | - A-C Pizzoferrato
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France
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20
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ESTROgen use for complications in women treating pelvic organ prolapse with vaginal PESSaries (ESTRO-PESS)-a randomized clinical trial. Int Urogynecol J 2021; 32:1571-1578. [PMID: 33501563 DOI: 10.1007/s00192-020-04654-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the complications of new users' vaginal pessaries (VP), with and without the use of vaginal estrogen after a 6-month follow-up. METHODS A parallel, single-blinded, randomized, controlled trial. Symptomatic postmenopausal women (n = 98) with pelvic organ prolapse (POP) (stage 3/4) were recruited from August 2018 to October 2019. Patients were randomized into the local estrogen group (promestriene 3 × for a week) and the control group (no estrogen). They were evaluated for their vaginal symptoms at the baseline, after 3 months, and after 6 months, and a physical examination and vaginal sampling for microbiological analysis were done. Data were analyzed according to an intention-to-treat analysis (ITT). A 5% significance level was established for statistical analysis. RESULTS Twenty women discontinued treatment (20.4%), mainly due to pessary extrusion (n = 15) and 5 for other reasons (lost to follow-up, pain, and surgery). Baseline characteristics were not statistically different between the estrogen and control groups. Regarding the presence of complications, the presence of erosion was 10% in the control group, but there was no significant difference between the groups (p = 0.175) after 6 months. Bacterial vaginosis (BV) was more prevalent in the control group, according to the Nugent (p = 0.007) and Amsel (p = 0.014) criteria. Urinary urgency and increased urinary frequency were significantly improved in the estrogen group after 6 months. CONCLUSION There was no evident benefit related to complications such as ulcerations, itching, and vaginal discharge/odor from the use of vaginal estrogen in POP women using pessaries.
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21
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An Arterial Vaginal Bleed Resulting from Short-Term Pessary Use: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:503-505. [PMID: 33153940 DOI: 10.1016/j.jogc.2020.08.018] [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: 07/14/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pessaries are commonly used for the management of pelvic organ prolapse. Complications are rare, with major complications usually related to long-term use and neglect. Complications related to short-term pessary use, as well as complications requiring surgical intervention, are even less common. CASE We present the case of a 58-year-old postmenopausal woman who presented with acute, arterial vaginal bleeding requiring surgical intervention 3 weeks after being fitted for a pessary for management of pelvic organ prolapse. CONCLUSION Severe, short-term complications are rare, but can occur with pessary management of pelvic organ prolapse. To our knowledge, this is the first case to describe an acute arterial hemorrhage requiring surgical intervention following short-term placement of a vaginal pessary.
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22
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Fractional Pixel CO2 laser treatment for decubitus ulcer in advanced pelvic organ prolapse: a case report. Menopause 2020; 27:1093-1095. [PMID: 32852464 DOI: 10.1097/gme.0000000000001618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cervicovaginal decubitus ulceration is a complication of advanced pelvic organ prolapse that is very difficult to manage. Here, we report on the effectiveness of fractional CO2 laser treatment for a wide decubitus ulcer over an apical vaginal vault prolapse. METHODS We report a case of a postmenopausal woman with a wide decubitus ulcer over a vaginal vault prolapse. A fractional microablative CO2 Pixel laser system (Alma Lasers, Cesarea, Israel), equipped with an appropriate probe for the vulva, was used to treat the ulceration of a 78-year-old patient across three laser sessions with 30-day intervals. RESULTS A significant improvement in the decubitus ulcer was noted in a check-up held 2 months after the final laser session, with approximately 95% wound healing observed. No side effects were reported during or after the laser therapy. CONCLUSIONS This case demonstrates that fractional Pixel CO2 laser treatment is a viable option for managing decubitus ulcers before definitive surgery in postmenopausal women with advanced pelvic organ prolapse.
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Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, Jeppson PC, Weber LeBrun EE, Raman S, Kim-Fine S, Iglesia C, Dieter AA, Yurteri-Kaplan L, Adam G, Meriwether KV. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J 2020; 31:1063-1089. [PMID: 32342112 PMCID: PMC7185267 DOI: 10.1007/s00192-020-04314-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic and the desire to “flatten the curve” of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
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Affiliation(s)
- Cara L Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Suite 2700 South Hawthorne, Valhalla, NY, 10532, USA.
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Catrina C Crisp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Miles Murphy
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela E Halder
- Department of Women's Health, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Peter C Jeppson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Emily E Weber LeBrun
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Sonali Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, KY, USA
| | - Shunaha Kim-Fine
- Section of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA
| | - Alexis A Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ladin Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gaelen Adam
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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Propst K, Mellen C, O'Sullivan DM, Tulikangas PK. Timing of Office-Based Pessary Care: A Randomized Controlled Trial. Obstet Gynecol 2020; 135:100-105. [PMID: 31809432 DOI: 10.1097/aog.0000000000003580] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities. METHODS We conducted a randomized, noninferiority trial of office-based pessary care. Eligible participants were adult women wearing a ring, Gellhorn, or incontinence dish pessary to treat pelvic organ prolapse or incontinence or both. Patients were randomized 1:1 to routine pessary care (office visits every 12 weeks, "routine" arm) or to extended pessary care (office visits every 24 weeks, "extended" arm). The primary study outcome was rate of vaginal epithelial abnormalities (epithelial break or erosion) at the final study visit (48 weeks). The predetermined noninferiority margin was 7.5%. RESULTS From January 2015 through June 2017, inclusive, 448 patients were screened and 130 were randomized, 64 to the routine arm and 66 to the extended arm. Baseline characteristics of the study arms were similar with the exception of pessary type, with ring pessary more common in the routine arm and Gellhorn pessary more common in the extended arm (P=.02). The rate of epithelial abnormalities at the final study visit (48 weeks) was 7.4% in the routine arm and 1.7% in the extended arm (difference, -5.7 percentage points; 95% CI -7.4 to -4), which met the criterion for noninferiority. Rates of all types of epithelial abnormalities did not differ between arms at any time point. Increasing duration of pessary use (P=.003) and history of prior epithelial abnormalities were associated with development of epithelial abnormalities (P=.01). Other than epithelial abnormalities, no adverse events related to pessary use occurred in either arm. CONCLUSION In women who receive office-based pessary care and are using a ring, Gellhorn, or incontinence dish pessary, routine follow-up every 24 weeks is noninferior to every 12 weeks based on incidence of vaginal epithelial abnormalities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02371083.
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Affiliation(s)
- Katie Propst
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, and the Department of Research Administration, Hartford Healthcare, Hartford, Connecticut
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Abstract
OBJECTIVES A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society. METHODS This review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels. RESULTS The abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established. CONCLUSIONS Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.
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Bodner-Adler B, Alarab M, Ruiz-Zapata AM, Latthe P. Effectiveness of hormones in postmenopausal pelvic floor dysfunction-International Urogynecological Association research and development-committee opinion. Int Urogynecol J 2019; 31:1577-1582. [PMID: 31392363 PMCID: PMC7363722 DOI: 10.1007/s00192-019-04070-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis There is clear evidence of the presence of estradiol receptors (ERs) in the female lower urinary and genital tract. Furthermore, it is a fact that estrogen deficiency after menopause may cause atrophic changes of the urogenital tract as well as various urinary symptoms. Moreover, the effect of hormone replacement therapy (HRT) on urinary incontinence (UI) symptoms as well as pelvic organ prolapse (POP), anal incontinence (AI) and vulvovaginal symptoms (VVS) is still a matter of debate. This committee opinion paper summarizes the best evidence on influence of sex steroids as well as hormonal treatment (local and systemic) in postmenopausal women with pelvic floor disorders. Methods A working subcommittee from the International Urogynecology Association (IUGA) Research and Development Committee was formed. A thorough literature search was conducted and an opinion statement expressed. The literature regarding hormones and pelvic floor disorders was reviewed independently and summarized by the individual members of the sub-committee. Results The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms. Definitive evidence on local estrogen application and prolapse treatment or prevention is lacking. A statistically significant increase in risk of worsening of UI as well as development of de novo incontinence was observed with estrogen-only or combination systemic HRT. Conclusions In summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.
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Affiliation(s)
- Barbara Bodner-Adler
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - May Alarab
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of OBS/GYN, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandra M Ruiz-Zapata
- Department of Obstetrics and Gynecology, Department of Urology, Radboud Institute for Molecular Life Science (RIMLS) Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pallavi Latthe
- Department of Urogynecology, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK
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The effect of time interval of vaginal ring pessary replacement for pelvic organ prolapse on complications and patient satisfaction: A randomised controlled trial. Maturitas 2019; 128:29-35. [PMID: 31561819 DOI: 10.1016/j.maturitas.2019.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/02/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Limited data are available on the effect of the time interval of vaginal ring pessary replacement for pelvic organ prolapse (POP). This study investigated the effect of different replacement intervals on complications and patient satisfaction. STUDY DESIGN A double-blinded, randomized controlled trial was conducted in a tertiary urogynecology center. Women with a vaginal ring pessary for POP (stage I to IV) were randomly allocated to two groups: 3-monthly or 6-monthly ring pessary replacement. All women were blinded to the replacement interval. Investigators were blinded during outcome assessment. Subjects were followed up for 6 months. MAIN OUTCOME MEASURES The primary outcomes were the complication rates and patient satisfaction scores at 6 months. Secondary outcomes were the change in patient-reported symptoms and staging of POP. RESULTS Of 101 women were screened from June 2016 to November 2017, 60 were recruited and randomly allocated: 30 to the 3-monthly replacement group and 30 to the 6-monthly replacement group. The overall complication rate in the 6-monthly group was higher than that in the 3-monthly group at the third visit (9 [30%] vs. 3[10.3%]; OR 3.71; 95%CI 0.89-15.58), but the difference was not statistically significant (p = 0.061). There were no statistically significant differences between groups in patient satisfaction scores, other prolapse-related symptoms or staging of POP. CONCLUSIONS We provide evidence on the effect of replacement interval for a vaginal pessary on complications and patient satisfaction. A higher complication rate was found in the 6-monthly group than in the 3-monthly group, although the difference was not statistically significant. Patient satisfaction scores were similar in both groups.
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Hsieh MF, Tsai HW, Liou WS, Lo CC, Lin ZH, An YF, Lin HY. Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter? Medicine (Baltimore) 2019; 98:e15063. [PMID: 30946355 PMCID: PMC6455947 DOI: 10.1097/md.0000000000015063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vaginal pessary treatment for pelvic organ prolapse (POP) is relatively safe and cost-effective. Since long-term use is an important key to keep the benefit of pessary treatment, we would like to investigate the factors which might affect the compliance of vaginal pessaries. In this retrospective study, 65 women were included, and we found poor compliance in women with severe stress urinary incontinence (SUI) after reduction (1-hour pad test >10 gm vs ≦10 gm, 57.1% vs. 84.3%, P = .027). Besides, women younger than 60 years-old also had poor compliance (age ≦60-year-old vs >60-year-old, 58.3% vs 83.0%, P = .04). Other factors such as POP stage, history of hysterectomy, and types of pessaries, did not show significant influence on the long-term compliance in this study. Therefore, to evaluate the severity of SUI after reduction before providing pessary treatment is important to predict long-term compliance. Meanwhile, long-term pessary treatment seems to be more acceptable to elderly patients.
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Affiliation(s)
- Ming-Fang Hsieh
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsiao-Wen Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang-Ming University, Taipei
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Wen-Shiung Liou
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang-Ming University, Taipei
| | - Ching-Chuan Lo
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Zi-Han Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ya-Fen An
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsin-Yin Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang-Ming University, Taipei
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
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Riazi H, Ghazanfarpour M, Taebi M, Abdolahian S. Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review. J Menopausal Med 2019; 25:109-116. [PMID: 32307935 PMCID: PMC6952708 DOI: 10.6118/jmm.19194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Abstract
Menopause is associated with the onset of climacteric symptoms due to low estradiol levels, which may cause insufficient maturation of the vaginal mucosa. Vitamin D may regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels, thereby restoring vaginal health. The objective of this systematic review, the first on this subject, was to investigate the effect of vitamin D on the vaginal health of menopausal women. PubMed, Embase, Scopus, Web of Science, and Google Scholar databases and reference lists of hand-searched articles were searched for published studies from February 2000 to November 2018. The selection criteria were as follows: randomized or quasi-randomized trials that compared the effects of vitamin D or related compounds, alone or with calcium, on vaginal health (growth and differentiation of epithelial cells, dryness, acidity [pH]) outcomes in menopausal women. The methodological quality of these studies was examined using the Cochrane tool checklist by two independent investigators, following which the data were extracted. Of six examined studies, two showed that vitamin D administration improved the growth and differentiation of vaginal epithelial cells, improved vaginal pH, and decreased vaginal dryness in menopausal women. Although the level of evidence for the effects of vitamin D on vaginal health is low in our study, we concluded that vitamin D may improve the vaginal health of women, especially during menopause.
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Affiliation(s)
- Hedyeh Riazi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masumeh Ghazanfarpour
- Department of Nursing and Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahboubeh Taebi
- Department of Midwifery and Reproductive Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Abdolahian
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Harvey MA. Unusual Perils of Pelvic Organ Prolapse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:538. [DOI: 10.1016/j.jogc.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 10/17/2022]
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Hooper GL, Atnip S, O'Dell K. Optimal Pessary Care: A Modified Delphi Consensus Study. J Midwifery Womens Health 2017; 62:452-462. [DOI: 10.1111/jmwh.12624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 02/24/2017] [Accepted: 03/02/2017] [Indexed: 12/01/2022]
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Wolff B, Williams K, Winkler A, Lind L, Shalom D. Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse. Int Urogynecol J 2016; 28:993-997. [PMID: 27942793 DOI: 10.1007/s00192-016-3228-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
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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Affiliation(s)
- Birte Wolff
- Department of Obstetrics & Gynecology and Urology, Loyola University Medical Center, Maywood, IL, USA. .,Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA.
| | - Kathryn Williams
- Division of Urogynecology, Northwell Health System, Manhasset, NY, USA
| | - Allen Winkler
- Division of Urogynecology, Northwell Health System, Manhasset, NY, USA
| | - Lawrence Lind
- Division of Urogynecology, Northwell Health System, Manhasset, NY, USA
| | - Dara Shalom
- Division of Urogynecology, Northwell Health System, Manhasset, NY, USA
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