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Patel UJ, Moureau MK, Neuner JM, Brown HW. Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity. OBM GERIATRICS 2023; 7:252. [PMID: 38567050 PMCID: PMC10986360 DOI: 10.21926/obm.geriatr.2304252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.
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Affiliation(s)
- Ushma J Patel
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Madeline K Moureau
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Joan M Neuner
- Medical College of Wisconsin, Division of General Internal
Medicine, Milwaukee, WI, USA
| | - Heidi W Brown
- Kaiser Permanente, Department of Obstetrics and
Gynecology, 3250 Fordham Street, San Diego, CA, USA
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McEvoy K, Griffin R, Harris M, Moger H, Wright O, Nurkic I, Thompson J, Das R, Neumann P. Pessary management practices for pelvic organ prolapse among Australian health care practitioners: a cross-sectional study. Int Urogynecol J 2023; 34:2519-2527. [PMID: 37222737 PMCID: PMC10590327 DOI: 10.1007/s00192-023-05540-2] [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: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal pessaries are a low-cost, effective treatment for pelvic organ prolapse (POP) and an alternative to surgery. Whilst traditionally pessary management (PM) has been provided by medical professionals, particularly gynaecologists, recent international studies found other professionals, including physiotherapists and nurses, may be involved. It is unknown which health care practitioners (HCPs) provide PM for POP in Australia or the distribution of services. METHODS In a cross-sectional study design, a self-reported electronic survey investigated Australian HCPs providing PM for POP. Purposive and snowball sampling targeted HCPs, professional organisations and health care facilities. Descriptive statistics described PM in relation to HCP professional profile, PM provision and geographical location. RESULTS There were 536 respondents (324 physiotherapists, 148 specialists, 33 general practitioners (GPs) and 31 nurses providing PM. Most worked within metropolitan regions (n = 332, 64%), 140 (27%) in rural, 108 (21%) in regional and 10 (2%) in remote areas. Most worked privately (n = 418, 85%), 153 (46%) worked publicly and 85 (17%) in both. Ring pessaries were most commonly used, followed by cube and Gellhorn. HCPs reported variable training in PM, and 336 (69%) had no mandatory workplace competency standard; however, 324 (67%) wanted further training. Women travelled long distances to access services. CONCLUSIONS Doctors, nurses and physiotherapists provided PM in Australia. HCPs had variable training and experience in PM, with rural and remote HCPs particularly wanting further training. This study highlights the need for accessible PM services, standardised and competency-based training for HCPs, and governance structures ensuring safe care.
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Affiliation(s)
| | | | | | | | | | | | | | - Rebekah Das
- University of South Australia, Adelaide, SA, Australia
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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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Barger MK. Systematic Reviews to Inform Practice, January/February 2023. J Midwifery Womens Health 2023; 68:140-145. [PMID: 36606662 DOI: 10.1111/jmwh.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Mary K Barger
- Midwifery researcher and consultant, San Diego, California
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Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic. Female Pelvic Med Reconstr Surg 2021; 28:121-125. [PMID: 34171881 PMCID: PMC8808767 DOI: 10.1097/spv.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives The aim of the study was to describe time intervals between pessary maintenance visits in racially diverse women receiving care in a U.S. epicenter of the COVID-19 pandemic. We secondarily aimed to determine whether time interval between pessary changes is associated with adverse outcomes and to identify factors associated with adverse pessary outcomes. Methods We performed a retrospective study of women undergoing pessary care after the COVID-19 pandemic began. Time between the most recent visit before the pandemic and first visit after the pandemic began was recorded. Pessary care data were collected from the latter visit, including vaginal bleeding, vaginal discharge, and erosion. Patient-reported symptoms and demographics were also recorded. The relationship between time interval between pessary visits and adverse outcomes as well as between adverse outcomes and demographic data was assessed. Results We identified 104 women undergoing pessary care, of which 35.6% were Hispanic and 32.7% were Black and 26.2% ± 10.5% lived in poverty. The median time to in-person visit was 4.5 months (interquartile range, 3.7–5.3 months). Seven women (8.7%) had vaginal bleeding, 15 (14.6%) had vaginal discharge, and 7 (6.8%) had erosions. There was no significant association between time interval between pessary visits and adverse outcomes or between adverse outcomes and patient characteristics (all P > 0.05). Conclusions Longer duration of time between pessary maintenance visits is not associated with increased adverse outcomes in this group of racially diverse women. Extended intervals between pessary visits can be considered to minimize risk and maintain patient safety during challenging circumstances, such as the COVID-19 pandemic.
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Vardon D, Martin-Lasnel M, Agostini A, Fauvet R, Pizzoferrato AC. Vaginal pessary for pelvic organ prolapse: A survey among french gynecological surgeons. J Gynecol Obstet Hum Reprod 2021; 50:101833. [PMID: 32585395 DOI: 10.1016/j.jogoh.2020.101833] [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: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Because pessaries may offer symptomatic improvement for women with pelvic organ prolapse (POP), the study aimed to assess the opinion and knowledge of participants to a french general surgical gynecological congress, about this device. MATERIAL AND METHODS An anonymous survey was carried out near 150 surgeons attending a congress by handing them a questionnaire. RESULTS The average age of the 70 respondents was 50 years. 87.7 % were comfortable with fitting and monitoring pessary, 54.3 % think that a pessary can be offered as a first-line treatment in the management of POP. However, main indications of vaginal device are still old women and contraindications to surgery ; 31.4 % do not associate local estrogen therapy with a pessary for postmenopausal women. CONCLUSION The majority declares to be comfortable with pessaries, is ready to prescribe it as a first-line treatment and use local estrogen if necessary. Even if change of ideas seems to emerge about pessary, a change in beliefs and habits is still necessary. This progress can be achieved through doctors fully informed.
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Affiliation(s)
- Delphine Vardon
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
| | - Mathilde Martin-Lasnel
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, AP-HM, 147 Boulevard Baille, 13 005 Marseille, France; Aix-Marseille Medical University, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Raffaèle Fauvet
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France; Caen Medical University, 19 Rue Claude Blosh, 14000 Caen, France
| | - Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Harvey MA, Lemieux MC, Robert M, Schulz JA. Guideline No. 411: Vaginal Pessary Use. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:255-266.e1. [PMID: 33248302 DOI: 10.1016/j.jogc.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the use, care, and fitting of pessaries. TARGET POPULATION Women requiring the use of vaginal pessaries for pelvic organ prolapse and/or stress urinary incontinence. Use may also be indicated for women with certain pregnancy-related clinical scenarios, including incarcerated uterus. OPTIONS Pessaries are an option for women presenting with prolapse and/or stress urinary incontinence. In addition, certain types of pessaries can be considered for patients with cervical insufficiency or incarcerated uterus. OUTCOMES Most women with prolapse or stress urinary incontinence can be successfully fitted with a pessary and experience excellent symptom relief, high satisfaction rates, and minimal complications. BENEFITS, HARMS, AND COSTS Women with pelvic organ prolapse and/or stress urinary incontinence may choose to use a pessary to manage their symptoms rather than surgery or while waiting for surgery. Major complications have been seen only when pessaries are neglected. Minor complications such as vaginal discharge, odour, and erosions can usually be successfully treated. EVIDENCE Medline was searched for relevant articles up to December 2018. This is an update of the SOGC technical update published in 2013, which was the first internationally published guidance on pessary use. Subsequently, an Australian guideline on the use of pessaries for the treatment of prolapse was published later in 2013. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the approach of the Canadian Task Force on Preventive Health Care (Appendix A). INTENDED AUDIENCE Gynaecologists, obstetricians, family physicians, physiotherapists, residents, and fellows. SUMMARY STATEMENTS RECOMMENDATION.
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Directive clinique n° 411 : Utilisation des pessaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:267-280.e1. [PMID: 33248301 DOI: 10.1016/j.jogc.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIF Passer en revue l'utilisation, l'entretien et l'ajustement des pessaires. POPULATION CIBLE Les femmes qui ont besoin d'utiliser un pessaire en raison d'un prolapsus génital et/ou d'une incontinence urinaire d'effort. L'utilisation peut être indiquée chez les femmes enceintes dans certains scénarios cliniques liés à la grossesse, dont l'incarcération utérine et le risque de travail préterme liée à l'incompétence du col. OPTIONS Les pessaires constituent une option pour les femmes atteintes d'un prolapsus et/ou d'une incontinence urinaire d'effort. De plus, certains types de pessaires peuvent être utilisés chez des patientes atteintes d'incompétence du col ou d'une incarcération utérine. ISSUES Il est possible de trouver un pessaire efficace chez la plupart des femmes atteintes d'un prolapsus génital ou d'une incontinence urinaire d'effort de façon à obtenir un excellent soulagement des symptômes, un taux de satisfaction élevé et des complications minimes. BéNéFICES, RISQUES ET COûTS: Les femmes atteintes d'un prolapsus génital et/ou d'une incontinence urinaire d'effort peuvent choisir d'utiliser un pessaire pour traiter leurs symptômes au lieu de subir une intervention chirurgicale ou dans l'attente d'une telle intervention. Des complications majeures ont été observées seulement en cas de soins de pessaire négligés. Les complications mineures (telles que les pertes vaginales, les odeurs et les érosions) sont généralement traitables avec succès. DONNéES PROBANTES: Des recherches ont été effectuées dans la base de données Medline afin de récupérer les articles pertinents publiés jusqu'en décembre 2018. Le présent document constitue une mise à jour de la mise à jour technique de la SOGC publiée en 2013, laquelle a été la première directive clinique publiée à l'international relativement à l'utilisation des pessaires. Une ligne directrice australienne sur l'utilisation des pessaires pour le traitement du prolapsus a été publiée plus tard en 2013. MéTHODES DE VALIDATION: Les auteures ont évalué la qualité des données probantes et la solidité des recommandations au moyen des critères du cadre méthodologique du Groupe d'étude canadien sur les soins de santé préventifs (annexe A). PROFESSIONNELS CONCERNéS: Gynécologues, obstétriciens, médecins de famille, physiothérapeutes, résidents et moniteurs cliniques (fellows). DÉCLARATIONS SOMMAIRES: RECOMMANDATION.
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Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study. Int Urogynecol J 2020; 31:1567-1574. [PMID: 31907565 PMCID: PMC7363720 DOI: 10.1007/s00192-019-04200-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/25/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to determine the efficacy of routine follow-up visits for pessary cleaning, the effect of extended time intervals between visits and the proportion of patients being able to self-manage their pessary for pelvic organ prolapse (POP). METHODS We conducted a prospective cohort study in patients with a stage ≥II POP without previous POP surgery. All patients received a pessary as primary treatment. Our main outcome measure was a difference ≥2 in median visual analogue scale (VAS) scores (for pain, discharge, irritation) 1 week before and 1 week after cleaning. Measurements were performed after 3- and 9-month cleaning intervals. For the evaluation of the effect of cleaning, 132 patients (3 months' follow-up) and 87 patients (12 months' follow-up) were available for analysis. For the evaluation of the effect of the lengthening interval, 123 patients were available. RESULTS Self-management was performed in 45.2% of patients at 1 year. In 93.1% of patients, no differences were observed in pre-and post-cleaning VAS scores (effect of cleaning) on vaginal pain. Nor was there a difference in discharge (72.4%) or irritation 85.1% (p = 0.00). No differences were observed in pre-cleaning VAS scores for vaginal pain, discharge and irritation when the interval was lengthened from 3 to 9 months. No serious adverse events occurred. CONCLUSIONS There is no proven benefit of regular follow-up visits to clean a pessary. Also, the length of the cleaning interval does not seem to matter.
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Dwyer L, Kearney R, Lavender T. A review of pessary for prolapse practitioner training. ACTA ACUST UNITED AC 2019; 28:S18-S24. [PMID: 31070978 DOI: 10.12968/bjon.2019.28.9.s18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic organ prolapse is a significant quality of life issue for many women. Prolapse can be managed effectively with a mechanical device called a pessary therefore many women choose this as a conservative treatment option. Despite the extent to which pessaries are used in the UK, there are no clear guidelines regarding the training required for pessary practitioners. This article reviews literature related to pessary practitioner training. METHODS 13 publications were reviewed. RESULTS eight themes were identified, namely 'prevalence of pessary training', 'type of pessary training', confidence in pessary care provision', 'impact on pessary care', 'skills and knowledge required to be a pessary practitioner', 'barriers', 'speciality of pessary care providers', and 'ongoing support'. CONCLUSION at present practitioners report a lack of pessary training, which impacts on care. Effective training includes didactic learning of agreed knowledge requirements, practice of clinical skills and ongoing support.
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Affiliation(s)
- Lucy Dwyer
- Clinical Nurse Specialist in Urogynaecology, The Warrell Unit, Manchester University NHS Foundation Trust
| | - Rohna Kearney
- Consultant Urogynaecologist, The Warrell Unit, Manchester University NHS Foundation Trust and Honorary Senior Lecturer, University of Manchester
| | - Tina Lavender
- Professor of Midwifery, School of Nursing, Midwifery and Social Work, University of Manchester
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