A vesicovaginal fistula and intravesical foreign body. A rare case of the neglected pessary

Goldstein, I; Gj, Wise; Ml, Tancer

doi:10.1016/0020-7292(91)90863-z

Cited by 23 publications

(28 citation statements)

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“…Meanwhile, some researchers suggested that a pessary should not be used for dementia patients as a specific case [11,14,15] while others said that a pessary was indicated for such patients [8]. In this context, Heit et al (2003) attempted to investigate the objective predictive factors in the selection of treatment for POP patients [16].…”

Section: Discussionmentioning

confidence: 99%

Survey of the characteristics and satisfaction degree of the patients using a pessary

et al. 2004

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The objective of this study was to evaluate characteristics, satisfaction degree, and problems of patients using a pessary for pelvic organ prolapse. A total of 104 patients who had been fitted with a pessary and available for follow-up for pelvic organ prolapse management were enrolled. The patients answered questions on general characteristics, indications for pessary use, complications from pessary use, satisfaction degree, and frequency of removal. The results indicated that 76 (73.0%) patients had at least more than one medical illness and 86 (82.7%) patients complained of lower urinary symptoms such as incontinence, urgency, frequency, or nocturia. Eighty-four (80.7%) patients used pessaries as they were not surgical candidates due to poor medical status or old age. After using a pessary, 76 (73.1%) patients had symptoms such as bleeding, erosion, or foul odor; 70.2% of the women answered that they were satisfied or more than satisfied and 19.1% of the patients removed their pessaries, of whom 80.0% were unable to continue use due to repeated expulsion of the pessary and uncomfortable fitting. These data suggest that the pessary tends to be used for high-risk patients due to medical problems or old age. Despite the high frequency of complications from pessary use, it was seen that the frequency of removing the pessary was low and the satisfaction degree was high. Most of the complications were not thought to be serious. To decrease the frequency of complications, the regular follow-up visit and proper management of pessary use were thought to be needed. Further studies are warranted on tailor-fitting the pessary by variable use and relieving the symptoms associated with the lower urinary tract.

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Section: Discussionmentioning

confidence: 99%

Survey of the characteristics and satisfaction degree of the patients using a pessary

et al. 2004

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“…Sehr selten können Vesikovaginalfisteln auch bei Fremdkörpererosionen, z. B. verursacht durch Pessare [9] oder durch heftigen traumatischen Geschlechtsverkehr, auftreten.…”

Section: äTiologie Und Epidemiologieunclassified

Vesikovaginale Fisteln

et al. 2005

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Vesicovaginal fistulas are often the result of obstetric trauma in third world countries or gynaecologic surgery in developed countries. The incidence of obstetric trauma is approximately 3-4/1000 births in West Africa. The incidence of fistulas as a result of surgery has remained relatively unchanged for years; 75% occur during gynaecologic procedures. The main clinical symptom of a vesicovaginal fistula is urine loss. Different surgical techniques with similar repair results are available: transvaginal approach, transvesical approach and transperitoneal approach. Irrespective of the approach used, requirements for successful repair include adequate surgical exposure, wide mobilization of the bladder and vagina, excision of the fistula tract, tension-free closure of the bladder and vagina, and placement of an interposition flap, i.e. Martius flap, omentum, peritoneum, when indicated. Using these surgical techniques, around 85% of women can be cured from their vesicovaginal fistula with a single operation.

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“…Sixteen cases underwent office removal and conservative management. The other 23 cases required operative management (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. All but two of these complications were related to a neglected pessary (21/23, 91.3%).…”

Section: Commentmentioning

confidence: 99%

“…We describe a case of large VVF secondary to a Gellhorn pessary neglected for 3 years. It appears that five cases of VVF have been reported in association with a neglected vaginal pessary [10][11][12][13]15]. However, it is likely that many cases go unreported and that the true incidence is actually higher.…”

Section: Commentmentioning

confidence: 99%

Complications of neglected vaginal pessaries: case presentation and literature review

2008

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Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.

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A vesicovaginal fistula and intravesical foreign body. A rare case of the neglected pessary

Cited by 23 publications

References 0 publications

Survey of the characteristics and satisfaction degree of the patients using a pessary

Survey of the characteristics and satisfaction degree of the patients using a pessary

Vesikovaginale Fisteln

Complications of neglected vaginal pessaries: case presentation and literature review

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