Defecatory dysfunction and other clinical variables are predictors of pessary discontinuation

Dengler, Erin; Mounsey, Louisa; Gines, Francesca; Agha, M.Akber; Long, Terri A.; Geller, Elizabeth J.

doi:10.1007/s00192-018-3777-1

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…maximum POP stage only in the posterior compartment, while women with multiple predominant compartments being excluded) are associated with unsuccessful fitting. These results confirm that pessary treatment is less effective in relieving colorectal symptoms [ 47 ].…”

Section: Discussionsupporting

confidence: 76%

Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis

et al. 2022

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Objectives To clarify which parameters are associated with unsuccessful pessary fitting for pelvic organ prolapse (POP) at up to 3 months follow-up. Methods Embase, PubMed and Cochrane CENTRAL library were searched in May 2020. Inclusion criteria were: (1) pessary fitting attempted in women with symptomatic POP; (2) pessary fitting success among the study outcomes with a maximal follow-up of 3 months; (3) baseline parameters compared between successful and unsuccessful group. A meta-analysis was performed using the random effects model. Main results Twenty-four studies were included in the meta-analysis. Parameters associated with unsuccessful pessary fitting were: age (OR 0.70, 95% CI 0.56–0.86); BMI (OR 1.35, 95% CI 1.08–1.70); menopause (OR 0.65 95% CI 0.47–0.88); de novo stress urinary incontinence (OR 5.59, 95% CI 2.24–13.99); prior surgery, i.e. hysterectomy (OR 1.88, 95% CI 1.48–2.40), POP surgery (OR 2.13, 95% CI 1.34–3.38), pelvic surgery (OR 1.81, 05% CI 1.01–3.26) and incontinence surgery (OR 1.87, 95% CI 1.08–3.25); Colorectal-Anal Distress Inventory-8 scores (OR 1.92, 95% CI 1.22–3.02); solitary predominant posterior compartment POP (OR 1.59, 95% CI 1.08–2.35); total vaginal length (OR 0.56, 95% CI 0.32–0.97); wide introitus (OR 4.85, 95% CI 1.60–14.68); levator ani avulsion (OR 2.47, 95% CI 1.35–4.53) and hiatal area on maximum Valsalva (OR 1.89, 95% CI 1.27–2.80). Conclusion During counselling for pessary treatment a higher risk of failure due to the aforementioned parameters should be discussed and modifiable parameters should be addressed. More research is needed on the association between anatomical parameters and specific reasons for unsuccessful pessary fitting.

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Section: Discussionsupporting

confidence: 76%

Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis

et al. 2022

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“…Another retrospective cohort study found a pessary discontinuation rate of 77% at 1 year. 23 We did not detect differences among baseline characteristics of participants associated with discontinuation; thus, a trial with pessary for all interested patients is reasonable.…”

Section: Discussionmentioning

confidence: 76%

“…24 Another retrospective study demonstrated pessary discontinuation due to discomfort in 29.6%, difficulty retaining a pessary in 23.7%, and worsening urinary incontinence in 14.0%. 23 A retrospective study of Thai women showed frequent expulsion (26.3%) and vaginal pain/discomfort (21.1%) to be the most common reasons for pessary discontinuation. 25 In our study, opting for surgery was the most common reason for pessary discontinuation, possibly related to enrolling patients in the registry who planned subsequent surgery, our study population, availability of resources, or local practice patterns.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study of Korean women with a median follow-up of 27 months, the most common causes of pessary discontinuation were vaginal erosion (45.3%) and urinary incontinence (26.5%) 24 . Another retrospective study demonstrated pessary discontinuation due to discomfort in 29.6%, difficulty retaining a pessary in 23.7%, and worsening urinary incontinence in 14.0% 23 . A retrospective study of Thai women showed frequent expulsion (26.3%) and vaginal pain/discomfort (21.1%) to be the most common reasons for pessary discontinuation 25 .…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Pessary Use at 1 Year in Women Treated for Pelvic Organ Prolapse in a Large Multicenter Registry

Yurteri-Kaplan

Meyn

Moalli

et al. 2022

UROGC

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Importance There is a lack of high-quality long-term follow-up regarding pessary treatment. Most studies are case series or retrospective with a small sample size and short-term follow-up. Objectives This study aimed to evaluate differences in women who continue versus discontinue pessary use and the effectiveness, quality of life, and safety associated with pessary management at 1 year. Study Design This study analyzed a multicenter national registry following women for 3 years with vaginal prolapse treated with a pessary or surgery. The primary outcome of this analysis was to compare the difference in characteristics among those who continue versus discontinue pessary use at 12 months. Results Among 1,153 participants enrolled, 376 (32.6%) opted for a pessary, and 296 (78.7%) were successfully fitted. Data were available for 240 participants (81%). At 1 year, 62% (n = 148) were still using pessaries, and 38% (n = 92) had stopped with 25% opting for surgery. Most commonly reported de novo adverse effects were urinary leakage (16%), feeling or seeing a bulge (12%), and vaginal discharge (11%). There was no difference in baseline characteristics among women who continued versus discontinued pessary use. At 12 months, subjective symptoms were similar between groups, with similar change in symptoms from baseline on most validated instruments. Those who continued to use a pessary reported worse urinary symptoms due to de novo urinary leakage (P = 0.01). Conclusions At 1 year, most women successfully fitted with a pessary continued pessary use. Although there was a significant improvement in condition-specific quality of life and low rates of complications, approximately 40% of women discontinued pessary use by 12 months. We were unable to identify any baseline characteristics associated with pessary discontinuation.

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“…Multiple studies have evaluated the risk factors that predict unsuccessful pessary fitting or long-term use. 12,[21][22][23][24][25][26][27][28][29][30][31][32][33] However, the writing group agreed that a pessaries should be offered to all women with prolapse, even if 1 or more of these risk factors is present.…”

Section: Resultsmentioning

confidence: 99%

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

2023

UROGC

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At present, guidance for pessary management has fallen to pessary manufacturers and the opinion of expert clinicians, leading to significant variation in recommendations for care.• The purpose of this clinical consensus statement is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited.• The recommendations, developed by the writing group, may support these efforts by providing consistent care guidelines and statements on pessary fitting and management, while highlighting areas for further research for current practitioners or those new to the use of pessaries.

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Defecatory dysfunction and other clinical variables are predictors of pessary discontinuation

Cited by 6 publications

References 16 publications

Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis

Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis

Outcomes of Pessary Use at 1 Year in Women Treated for Pelvic Organ Prolapse in a Large Multicenter Registry

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

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