Continence Pessaries in the Management of Urinary Incontinence in Women

Farrell, Scott A.; Singh, Baljit; Aldakhil, Lateefa O.

doi:10.1016/s1701-2163(16)30486-8

Cited by 45 publications

(18 citation statements)

References 12 publications

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“…It was speculated that women with previous surgery may have had lower urethral closure pressures or lower urethral mobility resulting in an altered urethral continence mechanism suboptimally managed with a pessary. (9) Other investigators have noted that hysterectomy or other pelvic surgery predisposes to weakness of the pelvic floor affecting the ability to optimally retain a pessary. (21)…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical trials have shown that SUI symptoms improve when women are taught how to actively use their pelvic floor muscles to prevent urine loss. (4–8) Likewise, continence pessaries have been successfully used to manage SUI (9–11) although few randomized trials exist on this modality. (12,13) A recent multicenter, randomized trial comparing the effectiveness of continence pessary to behavioral therapy to combined therapy (behavioral + pessary), the Ambulatory Treatments for Leakage Associated With Stress incontinence study showed that behavioral therapy resulted in greater patient satisfaction and fewer bothersome SUI symptoms compared to pessary at three months, the primary outcome time-point, but these differences did not persist at one year.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Success and Satisfaction of Nonsurgical Therapy for Stress Urinary Incontinence

Schaffer

Nager

Fang

et al. 2012

Obstetrics & Gynecology

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Objective To identify factors that may predict success and satisfaction in women undergoing nonsurgical therapy for stress urinary incontinence (SUI). Methods Baseline demographic and clinical characteristics of women participating in a multicenter randomized trial of pessary, behavioral, or combined therapy for SUI were evaluated for potential predictors of success and satisfaction. Success and satisfaction outcomes were assessed at 3 months and included the Patient Global Impression of Improvement (PGI-I), stress incontinence subscale of the Pelvic Floor Distress Inventory (PFDI), and Patient Satisfaction Questionnaire (PSQ). Logistic regression was performed to identify predictors, adjusting for treatment and other important clinical covariates. Adjusted odds ratios (AOR), 95% confidence intervals (CI), and associated P-values are presented. Results Four hundred forty-six women were randomized. College education or higher and no previous UI surgery predicted success based on the stress subscale of the PFDI (AOR=1.61, 95% CI 1.01 to 2.55; p=0.04; AOR=3.15, 95% CI 1.04 to 9.53; p=0.04, respectively). Menopausal status predicted success using the PGI-I (AOR=2.52 postmenopausal vs premenopausal, 95% CI 1.29 to 4.95; AOR=1.32 unsure menopausal status vs pre-menopausal, 95% CI 0.65 to 2.66; p=0.03 across all three groups). Less than 14 incontinence episodes per week predicted satisfaction with the PSQ (AOR=1.97, 1.21 to 3.19; p=0.01). These predictors did not differ across the three treatment groups. Conclusions Menopause, higher education, no previous UI surgery and lower incontinence frequency were found to be predictors of success and satisfaction with nonsurgical therapy for SUI. This information may help better align provider and patient expectations with nonsurgical treatment outcomes. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT00270998.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of Success and Satisfaction of Nonsurgical Therapy for Stress Urinary Incontinence

Schaffer

Nager

Fang

et al. 2012

Obstetrics & Gynecology

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“…Although primarily used for pelvic organ prolapse, pessaries are found to improve stress incontinence in women. 16 Appropriate device and size selection is important to optimize outcome. Care should be taken in the elderly population, as adequate dexterity and cognitive function are essential to care for the device to avoid devastating complications from the neglected pessary.…”

Section: Treatment Of Stress Urinary Incontinencementioning

confidence: 99%

Urinary Incontinence and Pelvic Organ Prolapse

Anderson

Davis

Flynn

2015

Medical Clinics of North America

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“…It is an effective, self-managed option for SUI which is often underused due to a lack of knowledge regarding pessary fitting and its use in SUI. 26,27 A major limitation is the difficulty in inserting it properly and correctly positioning the device. 27 Nevertheless, more than half of the women who were successfully fitted with a pessary for SUI used it for the next 1 to 2 years.…”

Section: Incontinence Pessarymentioning

confidence: 99%

Conservative treatment for female stress urinary incontinence:

Friedman

2013

CUAJ

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Continence Pessaries in the Management of Urinary Incontinence in Women

Cited by 45 publications

References 12 publications

Predictors of Success and Satisfaction of Nonsurgical Therapy for Stress Urinary Incontinence

Predictors of Success and Satisfaction of Nonsurgical Therapy for Stress Urinary Incontinence

Urinary Incontinence and Pelvic Organ Prolapse

Conservative treatment for female stress urinary incontinence:

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