25: Pessary use and severity of pelvic organ prolapse over time: a retrospective study

Boyd, Sarah S.; Propst, Katie; O’Sullivan, David

doi:10.1016/j.ajog.2019.01.055

Cited by 6 publications

(7 citation statements)

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“… 1 Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms, and prevent the progression of prolapse after long-term use. 2 Due to its efficacy and safety, it is used as a first-line treatment for symptomatic POP. 3 Pessaries can be categorized into the following two types: support and space-occupying, and they appear equally effective in relieving symptoms of genital prolapse and voiding dysfunction.…”

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confidence: 99%

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A predictive model of choosing pessary type for women with symptomatic pelvic organ prolapse

Wang³

et al. 2021

Menopause

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Objective: To investigate clinical factors including translabial ultrasound parameters, which are predictive for choosing pessary type (Ring or Gellhorn) in the fitting trial, and to establish a predictive model. Methods: A retrospective study was conducted on symptomatic women with pelvic organ prolapse (POP) at the Pelvic Floor Disease Diagnosis and Treatment Center (Liaoning Province, China) between May 2018 and December 2020 who were successfully fitted with pessaries. This retrospective study was supplemented with a prospective cohort study on women seeking pessary for first-line treatment of POP at the above tertiary center between December 2020 and April 2021 for validation. Enrolled participants were grouped by their fitted type of pessary. Demographic and clinical parameters between groups, including pelvic organ prolapse quantification and translabial ultrasound, were analyzed using logistic regression. A receiver operating characteristic curve was calculated using predictive values obtained by regression as the predictor for choosing pessary type in the pessary fitting trial. Results: The 181 participants included in the retrospective analysis were randomly divided into the “Development” and “Validation” datasets. In the “Development” set, multivariable logistic regression analyses showed that a younger age (odds ratio [OR]: 0.950; 95% confidence interval [CI]: 0.908-0.995; P = 0.026), a larger hiatal circumference on Valsalva (OR: 1.348; 95% CI: 1.103-1.647; P = 0.004), and a higher POP-Q stage (OR: 2.963; 95% CI: 1.210-7.255; P = 0.017) were independent predictors for successful fitting with the Gellhorn pessary. The predictive model was P = exp(Z)/[1 + exp(Z)], Z = −0.051 × Age (y) + 0.298 × hiatal circumference on Valsalva (cm) + 1.086 × pelvic organ prolapse stage (2, 3, or 4) − 5.490. The area under the receiver operating characteristic curves (AUC) was 0.776 ( P < 0.001) and 0.705 ( P < 0.001) based on the “Development” dataset and “Validation” datasets, respectively. The AUC was 0.815 ( P < 0.001) based on the prospective cohort validation. Conclusions: For severe POP, women with younger age and larger hiatal circumference, Gellhorn pessaries should be their first choice instead of ring ones in pessary fitting trials.

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confidence: 99%

“…The vaginal pessary has been used as a conservative treatment of symptomatic POP for thousands of years 1 . Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms, and prevent the progression of prolapse after long-term use 2 . Due to its efficacy and safety, it is used as a first-line treatment for symptomatic POP 3 .…”

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confidence: 99%

A predictive model of choosing pessary type for women with symptomatic pelvic organ prolapse

Wang³

et al. 2021

Menopause

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“…A variety of urinary, bowel, and sexual symptoms associated with prolapse not only cause significant impairment in patients' quality of life but also have a negative effect on their mental health 3,4 . Despite significant advances in prolapse surgery, a vaginal pessary is often chosen as the first‐line treatment for symptomatic POP due to its efficacy and safety 5‐7 . According to a survey conducted by the American Urogynecologic Society, nearly twothirds of American physicians would choose a vaginal pessary as the first‐line treatment for symptomatic POP 8 …”

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confidence: 99%

“…3,4 Despite significant advances in prolapse surgery, a vaginal pessary is often chosen as the first-line treatment for symptomatic POP due to its efficacy and safety. [5][6][7] According to a survey conducted by the American Urogynecologic Society, nearly twothirds of American physicians would choose a vaginal pessary as the first-line treatment for symptomatic POP. 8 Vaginal pessaries can be broadly divided into two types: support pessaries and space-occupying pessaries.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with pessary fitting in women with symptomatic pelvic organ prolapse: A large prospective cohort study

Kang

et al. 2020

Neurourology and Urodynamics

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Aim: To identify factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP). Methods: This prospective observational study included 611 consecutive women with symptomatic POP in a tertiary-care hospital. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted or refitted with a pessary and continued to use it 2 weeks later. Parametric and nonparametric tests were used for the data analysis. Results: A total of 524 patients had successful pessary fittings (85.8% success rate). The success rate of the ring pessary with support was 57.9%, of the Gellhorn pessary was 69.1%. Stage IV prolapse (odds ratio [OR], 2.12), posterior compartment prolapse (OR, 1.92), genital hiatus (OR, 1.41), and vaginal introitus (OR, 1.40) were independent predictors of unsuccessful ring with support pessary fitting. Vaginal length (OR, 0.74/0.60 for ring with support/ Gellhorn) and history of POP reconstructive surgery (OR, 2.50/2.58 for ring with support/Gellhorn) were independent predictors of both ring with support and Gellhorn pessary fitting. Conclusions: Stage IV prolapse, posterior compartment prolapse, large genital hiatus, and wide vaginal introitus were risk factors for unsuccessful fitting of ring pessary with support. Short vaginal length and a history of POP reconstructive surgery were risk factors for unsuccessful fitting of both pessaries.

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“…1 Not only is there immediate relief of symptoms, but some data suggest that long-term use of a pessary may prevent the progression of prolapse. 2 Given their efficacy and safety, vaginal pessaries are considered first-line treatment for symptomatic POP. 3 Furthermore, in nearly two-thirds of women with symptomatic POP, a pessary is preferred as initial treatment.…”

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confidence: 99%

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

Wang

et al. 2022

Menopause

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Objective: To investigate translabial ultrasound (TLUS) parameters that may predict failed pessary fittings in women with symptomatic pelvic organ prolapse (POP).Methods: All participants in this retrospective study presented to the Pelvic Floor Disease Diagnosis and Treatment Center (Liaoning Province, China) between May 2018 and December 2020 seeking treatment for symptomatic POP. Each had chosen vaginal pessary as first-line treatment, undergoing TLUS in advance of placement. Participants were grouped by outcomes of pessary fittings as successful or failed. Group-wise demographic and clinical characteristics, including TLUS parameters, were then subjected to uni-and multi-variate logistic regression.Results: A total of 373 women qualified for analysis, 255 (68.4%) achieved success, and were fitted with acceptable pessaries. Predictors of failed fittings included younger age (61.54 AE 10.25 y vs 64.72 AE 10.30 y; P ¼ 0.006), premenopausal status (14.4% vs 5.9%; P ¼ 0.006), sizeable hiatal circumference (20.36 AE 2.33 cm vs 19.70 AE 2.50 cm; P ¼ 0.02) and hiatal area (HA) (29.67 AE 7.14 cm 2 vs 27.27 AE 6.99 cm 2 ; P ¼ 0.003), levator ani muscle (LAM) avulsion (odds ratio [OR] ¼ 3.23, 95% confidence interval [CI] ¼ 1.62-6.46; P ¼ 0.001), enterocele (OR ¼ 2.51, 95% CI ¼ 1.11-5.68; P ¼ 0.03), and the inferiormost aspect of cervix situated below symphysis pubis (OR ¼ 0.52, 95% CI ¼ 0.29-0.95; P ¼ 0.03). In multivariate logistic regression, younger age (OR ¼ 0.98, 95% CI ¼ 0.95-1.00; P ¼ 0.04), sizeable HA on Valsalva (OR ¼ 1.04, 95% CI ¼ 1.01-1.08; P ¼ 0.02), LAM avulsion (OR ¼ 2.87, 95% CI ¼ 1.32-6.25; P ¼ 0.008), and enterocele (OR ¼ 2.70, 95% CI ¼ 1.12-6.50; P ¼ 0.03) emerged as independent predictors of failed pessary fittings.Conclusions: Younger age, LAM avulsion, enterocele, and sizeable HA on Valsalva proved independently predictive of failed pessary fittings in women with symptomatic POP.

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25: Pessary use and severity of pelvic organ prolapse over time: a retrospective study

Cited by 6 publications

References 0 publications

A predictive model of choosing pessary type for women with symptomatic pelvic organ prolapse

A predictive model of choosing pessary type for women with symptomatic pelvic organ prolapse

Factors associated with pessary fitting in women with symptomatic pelvic organ prolapse: A large prospective cohort study

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

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