Unilateral acute pyelonephritis associated with a neglected pessary

Vaginal pessaries for treatment of pelvic organ prolapse in elderly women

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.

Vaginal pessaries for pelvic organ prolapse and urinary incontinence: a multiprofessional survey of practice

INTRODUCTION AND HYPOTHESIS

Vaginal pessaries may offer symptomatic improvement for women with pelvic organ prolapse (POP) or urinary incontinence (UI). This study aimed to investigate multidisciplinary perspectives on vaginal pessary use in clinical practice and to understand the service organisation of vaginal pessary care for women with these conditions.

METHODS

A pretested, anonymous survey was e-mailed to members of the Royal College of Obstetrics and Gynaecology, the Association for Continence Advice and the Association of Chartered Physiotherapists in Women's Health in the UK.

RESULTS

A total of 678 respondents, from medical, nursing and physiotherapy professions, consented to survey participation and provided useable data (response rate 20.7 %). Doctors were significantly more likely to report involvement in pessary care than nurses or physiotherapists. Respondents were optimistic about the success of pessary treatment; however, a lower proportion reported using pessaries for UI than for prolapse. The majority of respondents used ring pessaries and shelf pessaries, most recipients were older women, and commonly an indication for fitting a pessary was that the woman was unfit for surgery. More than 15 % of respondents providing pessary care had not received training. Follow-up services for women with pessaries varied considerably.

CONCLUSIONS

The variation in pessary care delivery and organisation requires further study in order to maximise efficiency and effectiveness. The development of nurse- or physiotherapist-led models of care may be appropriate, but the effectiveness of such models requires testing. Furthermore, to potentially improve outcomes of pessary care, a greater understanding of the availability, content and process of training may be warranted.