An audit of vaginal support pessaries for pelvic organ prolapse in western Uganda

Goh, Judith; Thayalan, Krishanthy; Krause, Hannah

doi:10.33235/anzcj.26.2.46-50

Cited by 4 publications

(11 citation statements)

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“…Twenty per cent of women reported occasional difficulty removing their pessary or required assistance from a healthcare professional 42. After teaching, 17% of women initially found self-management difficult, however, this reduced significantly with repeated attempts 51. It is unclear why self-management ability may fluctuate.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, it was not always clear whether details of basic instructions were simply a brief description, or an accurate representation of the teaching provided. In all identified studies which provided details about the teaching, women were given instructions on removal and insertion of the pessary 2 29 51 56. Kearney and Brown2 specified that women were supervised practicing a pessary change, however, this was not mentioned elsewhere.…”

Section: Resultsmentioning

confidence: 99%

“…16 22 23 32 33 36 46-49 As suggested in the literature, it is unsurprising with increasing practice and confidence, self-management would get easier. 51 It may also be due to pessary-related factors such as the position of the pessary changing and becoming harder to reach or more immovable. Alternatively, it might be that dynamic characteristics of the woman such as hormonal changes affecting the flexibility or lack of, of the surrounding vaginal tissues, physical flexibility and dexterity fluctuations cause occasional difficulty.…”

Section: Cost Benefitmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

2022

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ObjectivesPelvic organ prolapse can be managed with a pessary. However, regular follow-up may deter women due to the inconvenience of frequent appointments, as well as preventing autonomous decision making. Pessary self-management may be a solution to these issues. However, there remains a number of uncertainties regarding pessary self-management. This scoping review aims to map available evidence about pessary self-management to identify knowledge gaps providing the basis for future research.DesignScoping review as detailed in the review protocol.Data sourcesA search of MEDLINE, CINAHL, EMBASE and PsycINFO databases and a handsearch were undertaken during May 2021 to identify relevant articles using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’.Data extraction and synthesisData relevant to pessary self-management was extracted and the Mixed Methods Appraisal Tool used to assess empirical rigour. Thematic analysis was performed to evaluate the results.ResultsThe database search identified 82 publications. After duplicates and articles not meeting the inclusion and exclusion criteria were removed, there were 23 eligible articles. A hand search revealed a further 19 articles, resulting in a total of 42 publications.Findings relevant to pessary self-management were extracted and analysed for the emergence of themes. Recurrent themes in the literature were; the characteristics of self-managing women; pessary care; factors associated with decision making about self-management; teaching self-management and cost benefit.ConclusionsPessary self-management may offer benefits to some women without increased risk. Some women do not feel willing or able to self-manage their pessary. However, increased support may help women overcome this. Further in-depth exploration of factors which affect women’s willingness to self-manage their pessary is indicated to ensure better understanding and support as available for other conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Cost Benefitmentioning

confidence: 99%

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

2022

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“…Therefore, symptomatic POP requires management which may be surgical or nonsurgical (conservative) to improve QOL. Conservative treatment options like pessaries, lifestyle change, and pelvic floor exercises have been shown to be effective as an alternative to surgery [ 19 – 21 ]. However, pessaries are not readily available and hence their use by clinicians in treatment of symptomatic POP in this setting is low [ 22 ], leaving surgery as the main mode of management of symptomatic POP.…”

Section: Introductionmentioning

confidence: 99%

Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study

et al. 2021

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Background Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life. Methods We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery. Results Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p < 0.001). The overall QOL improved by 38.9% after surgery (p < 0.001). Conclusions The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.

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“…One of the main modes of management of symptomatic POP is surgery. Conservative methods such as pessaries have also been shown to be effective in the management of POP as an alternative to surgery [ 4 , 5 ]. However, pessaries are not readily available; therefore, their use among clinicians in the treatment of symptomatic POP in our setting is low [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for recurrence of pelvic organ prolapse after vaginal surgery among Ugandan women: a prospective cohort study

Kayondo

Geissbühler²,

Migisha

et al. 2021

Int Urogynecol J

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Introduction and hypothesis This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting. Methods We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence. Results Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged <60 years (RR = 2.34; 95% CI: 1.16–4.72; p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5–4.3; p = 0.001) were at risk of recurrence. Conclusion Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.

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An audit of vaginal support pessaries for pelvic organ prolapse in western Uganda

Cited by 4 publications

References 0 publications

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study

Risk factors for recurrence of pelvic organ prolapse after vaginal surgery among Ugandan women: a prospective cohort study

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