High risk of bias 4 Applicability concerns * No studies reported outcome of surgery of no residual macroscopic disease and performed the reference standard in all women ** Only two studies performed the reference standard in all women, sensitivity and specificity are based on these two studies 1 Non of the studies performed the reference standard in test-positive women 2 Applicability concerns based on inclusion of not only women planned for primary debulking surgery or conventional diagnostic work-up not conclusive 3 Only 2 studies performed the reference standard in test-positive women 4 Three studies did not perform the reference standard in test-positive women Cochrane Library Trusted evidence. Informed decisions. Better health.
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 9month 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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