Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

Abstract

OBJECTIVE: To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP). METHODS: A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries. RESULTS: Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p =0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p <0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p =0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p =0.05) prescribed more pessaries. CONCLUSIONS: Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.

Qualidade de vida das pacientes com distopias vaginais tratadas com pessário

“…Tendo em vista que, apesar de dez pacientes terem sido selecionadas para o estudo, houveram a exclusão de sete pacientes, limitando assim os achados referente a qualidade de vida das pacientes com essa condição tratadas na instituição. Além disso, alinhado a essa baixa quantidade de pacientes que foram submetidas ao tratamento com pessário em nossa instituição, observa-se também que no Brasil ainda há uma deficiência muito grande em relação a quantidade de pessários indicados como opção conservadora no tratamento de correção de distopias vaginais (COELHO SA, et al, 2019). Desta forma, mesmo a amostra do presente estudo ter sido pequena, essa se torna significativa para encorajar os ginecologistas a indicarem o pessário como primeira opção no tratamento conservador de distopias vaginais.…”

Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting

“…Most reported that they did not have enough experience. 29 A recent study from the US showed patients who had seen a gynecologist before urogynecology assessment were significantly more likely to be pessaryaverse. 28 However, in some countries, access to both urogynecologists and conservative treatment is still limited.…”

“…In Brazil, most gynecologists, despite knowing about pessaries and their use for POP treatment, do not prescribe them. Most reported that they did not have enough experience 29 . A recent study from the US showed patients who had seen a gynecologist before urogynecology assessment were significantly more likely to be pessary‐averse 28 .…”

Utilisation du pessaire gynécologique en cas de prolapsus génital : une enquête auprès des internes

“…Or il constitue une véritable alternative entre expectative et chirurgie. Différentes études exposent les pratiques des professionnels utilisant le pessaire aux Etats-Unis, au Royaume Unis, aux Pays-Bas ou encore au Brésil (9)(10)(11)(12)(13)(14), et une seule récente en France (15). Dans Concernant la surveillance et le rythme de suivi après pose d'un pessaire il n'y a actuellement aucun consensus.…”