Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse

Yimphong, Theerarat; Temtanakitpaisan, Teerayut; Buppasiri, Pranom; Chongsomchai, Chompilas; Kanchaiyaphum, Supparaluck

doi:10.1007/s00192-017-3445-x

Cited by 29 publications

(16 citation statements)

References 21 publications

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“…Traits of those who discontinue use include a history of hysterectomy, history of SUI, sexual inactivity and age less than 65 [194][195][196][197]. Early complications that prompt discontinuation include repeated expulsion, discomfort, inability to personally insert or remove the pessary, vaginal discharge/odour and de novo urinary incontinence [178,179,[198][199][200]. The most common long-term complication is painless vaginal ulceration or erosion, an outcome associated with device neglect that occurs in 2-24% of patients [201].…”

Section: Clinical Outcomesmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

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Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.

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Section: Clinical Outcomesmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

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“…Jüngere Patientinnen, Nullipara und Frauen mit massiven Senkungsbeschwerden neigen eher zur Ablehnung der Pessaroder Würfeltherapie. Komplikationen wie vaginale Ulzerationen, Blutungen, Erosionen und Fistel werden mit bis zu 56 % angegeben [11]. Zur Vermeidung dieser Komplikationen ist die simultane vaginale Östrogenisierung beim Tragen der Pessare essenziell erforderlich.…”

Section: Discussionunclassified

Chirurgische Therapie des urogenitalen Deszensus

et al. 2018

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Female pelvic organ prolapse is a widely prevalent condition and is associated with variable morbidity. It encompasses a number of clinical conditions, including subvesical obstruction, overactive bladder symptoms, sexual dysfunction and urinary und fecal incontinence. The prevalence of pelvic insufficiency is estimated to be between 30 and 50 %. As life expectancy is increasing and the elderly population is growing, there will be an increased incidence of the condition and growing demand for pelvic floor treatment in the future. The incidence of recurrent pelvic floor prolapse is also growing. The goal of surgical management is the restoration of pelvic anatomy and bladder, vaginal and bowel function, resolution of patient symptoms and improvement in quality of life. The objective of this review is to present the main surgical procedures for different subtypes of genital prolapse and to evaluate their outcomes and complications. During the last ten years, technologies for the minimally invasive approach have advanced and robotic assisted sacrocolpopexy is now equivalent to classical vaginal and transabdominal procedures.

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“…All women who were randomised into the self-management group and received the intervention accordingly were contacted by telephone after 2 weeks to check whether they had been able to remove and insert the pessary independently at home and whether they had experienced any difficulties or required further support. Complications such as discharge, discomfort or pain and bleeding are common amongst pessary users [33]. However, when supported to manage these issues, this need not result in pessary discontinuation [33].…”

Section: Medical Managementmentioning

confidence: 99%

Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse

Dwyer

Bugge²,

Hagen³

et al. 2022

Trials

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Background Pelvic organ prolapse (POP) is a common condition in women, where the downward descent of pelvic organs into the vagina causes symptoms which impacts quality of life. Vaginal pessaries offer an effective alternative to surgery for the management of POP. However, the need for regular follow-up can be burdensome for women and requires significant healthcare resources. The TOPSY study is a randomised controlled trial which aims to determine the clinical and cost-effectiveness of self-management of vaginal pessaries. This paper describes the theoretical and practical development of the self-management intervention. Methods The intervention was developed using the MRC complex intervention framework, normalisation process theory (NPT) and self-management theory. The intervention aims to boost perceived self-efficacy in accordance with Bandura’s social cognitive theory and is guided by the tasks and skills Lorig and Hollman describe as necessary to self-manage a health condition. Results The TOPSY intervention was designed to support women to undertake the medical management, role management and emotional management of their pessary. The six self-management skills described by Lorig and Hollman: problem-solving, decision-making, resource utilisation, formation of a patient-provider partnership role, action planning and self-tailoring, are discussed in detail, including how women were supported to achieve each task within the context of pessary self-management. The TOPSY intervention includes a self-management support session with a pessary practitioner trained in intervention delivery, a follow-up phone call 2 weeks later and ongoing telephone or face-to-face support as required by the woman initiated by contacting a member of the research team. Conclusions The TOPSY study intervention was developed utilising the findings from a prior service development project, intervention development and self-efficacy theory, relevant literature, clinician experience and feedback from pessary using women and members of the public. In 2022, the findings of the TOPSY study will provide further evidence to inform this important aspect of pessary management. Trial registration ISRCTN Registry ISRCTN62510577. Registered on June 10, 2017

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Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse

Abstract: The discontinuation rate of pessary use in the case of pelvic organ prolapse was low after 1 year. Abnormal vaginal discharge was the most common adverse side effect. Lower BMI and history of hysterectomy were factors significantly associated with the discontinuation.

Cited by 29 publications

References 21 publications

Managing female pelvic floor disorders: a medical device review and appraisal

Managing female pelvic floor disorders: a medical device review and appraisal

Chirurgische Therapie des urogenitalen Deszensus

Theoretical and practical development of the TOPSY self-management intervention for women who use a vaginal pessary for pelvic organ prolapse

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