Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study

Miceli, Alessio; Díez, José Luis Dueñas

doi:10.1007/s00192-019-03919-8

Cited by 18 publications

(23 citation statements)

References 28 publications

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“…In line with other studies, women opting for surgery are significantly younger, have a higher BMI and experience more bothersome symptoms at baseline 10,20,44 . Apparently, women who experience more bothersome symptoms are more likely to choose surgery.…”

Section: Discussionsupporting

confidence: 87%

“…This makes recommendations on the best treatment option for the patient for them to make an informed decision speculative. This has been recognised in two recent reviews, which both emphasise the urgent need for comparative studies between pessary and surgery for symptomatic POP 20,22,23 . The recent National Institute for Health and Care Excellence (NICE) guideline on the management of POP also urges clinicians to generate evidence on long‐term outcomes and patient satisfaction 24…”

Section: Introductionmentioning

confidence: 99%

“…Studies directly comparing pessary with surgery for symptomatic POP are scarce, are heterogenous, which complicates any comparison of the findings, are underpowered and have a high loss to follow‐up. 11 , 20 , 21 Moreover, outcomes of pessary therapy have mainly been reported in relation to the (dis‐)continuation of treatment, and to a much lesser extent in terms of symptom relief. This makes recommendations on the best treatment option for the patient for them to make an informed decision speculative.…”

Section: Introductionmentioning

confidence: 99%

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Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

Vaart

Vollebregt

Milani

et al. 2021

BJOG

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Objective To compare the 24‐month efficacy of pessary or surgery as the primary treatment for symptomatic pelvic organ prolapse (POP). Design Multicentre prospective comparative cohort study. Setting Twenty‐two Dutch hospitals. Population Women referred with symptomatic POP of stage ≥2 and moderate‐to‐severe POP symptoms. Methods The primary outcome was subjective improvement at the 24‐month follow‐up according to the Patient Global Impression of Improvement (PGI‐I) scale. Secondary outcomes included improvement in prolapse‐related symptoms measured with the Pelvic Floor Distress Inventory (PFDI‐20), improvement in subjective severeness of symptoms according to the Patient Global Impression of Severity (PGI‐S) scale and crossover between therapies. The primary safety outcome was the occurrence of adverse events. Main outcome measure PGI‐I at 24 months. Results We included 539 women, with 335 women (62.2%) in the pessary arm and 204 women (37.8%) in the surgery arm. After 24 months, subjective improvement was reported by 134 women (83.8%) in the surgery group compared with 180 women (74.4%) in the pessary group (risk difference 9.4%, 95% CI 1.4–17.3%, P < 0.01). Seventy‐nine women (23.6%) switched from pessary to surgery and 22 women (10.8%) in the surgery group underwent additional treatment. Both groups showed a significant reduction in bothersome POP symptoms (P ≤ 0.01) and a reduction in the perceived severity of symptoms (P ≤ 0.001) compared with the baseline. Conclusions Significantly more women in the surgery group reported a subjective improvement after 24 months. Both therapies, however, showed a clinically significant improvement of prolapse symptoms. Tweetable abstract Pessary treatment and vaginal surgery are both efficacious in reducing the presence and severity of prolapse symptoms, although the chance of significant improvement is higher following surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

Vaart

Vollebregt

Milani

et al. 2021

BJOG

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“…Pessary management offers women with prolapse comparable treatment outcomes to surgery in terms of reported symptoms and quality of life 2 and absence of bulge and no desire for further treatment. 3 This may be a particularly desirable option for women who have not completed their family, are unfit for surgical management or would simply prefer to avoid the risks that POP surgery entails. 4 There are a wide variety of pessaries available, offering a conservative, long-term management option to women.…”

Section: Introductionmentioning

confidence: 99%

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

2022

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IntroductionPelvic organ prolapse (POP) can be managed with a pessary; however, regular follow-up may deter women from pessary management due to the inconvenience of frequent appointments, as well as preventing pessary users from autonomous decision-making. Pessary self-management, whereby the woman removes and inserts her own pessary may be a solution to these issues. However, there remains a number of uncertainties regarding the potential benefits and risks of pessary self-management. This scoping review aims to map available evidence about the subject of pessary self-management for POP to identify knowledge gaps providing the basis for future research.Methods and analysisThe scoping review will be conducted using the Joanna Briggs Institute scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A search of Medline, CINAHL, Embase and PsycInfo will be undertaken to identify relevant articles which meet the eligibility criteria using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’. A hand search of the reference list of non-original research identified during the search but excluded, will be conducted for additional publications which meet the inclusion and exclusion criteria. Data relevant to the topic of pessary self-management will be extracted and critical appraisal of all included publications undertaken.Ethics and disseminationNo ethical or Health Research Authority approval is required to undertake the scoping review. However, it has been registered with The Open Science Framework (DOI 10.17605/OSF.IO/DNGCP). The findings will inform future research exploring pessary self-management and be disseminated via both a presentation at a national conference and publications in peer reviewed journals.

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“…Risk factors include pregnancy, successive vaginal childbirth, congenital or acquired connective tissue abnormalities, Women with BMI >25 were more likely to experience uterine prolapse, connective tissue disorders such as Marfan syndrome and Ehler"s Danlos syndrome. Advancing age has been shown to correlate markedly with rates of prolapse, menopause and factors associated with chronically raised intra -abdominal pressure from chronic coughing, straining with constipation, and repeated heavy lifting (Miceli & Diez 2019).…”

Section: Introductionmentioning

confidence: 99%

Effect of Nursing Intervention Package on Prevention of Uterine Prolapse among Pregnant Women in Third Trimester

Saeed

Fahmy

Said

et al. 2022

Journal of Nursing Science Benha University

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Background: Uterine prolapse occurs when the uterus descends towards or through the opening of the vagina below its normal anatomical position. Aim of study: Was to evaluate effect of nursing intervention package on prevention of uterine prolapse among pregnant women in third trimester. Design: A quasi experimental design was utilized to fulfill the aim of the study: two groups were studied (study and control group) with pre, post and follow up test. Setting: The study was conducted at obstetrics and gynecology outpatient clinic at Benha university hospital. Sample: A purposive sample of 90 women was selected according to the inclusion criteria. Tools of data collection: Four tools were included, a structured interviewing questionnaire sheet, women's reported practices sheet toward prevention of uterine prolapse, modified Likert scale and assessment tool for uterine displacement. Results: There were a highly statistical correlation between total knowledge, total practices, and total attitude among studied women (study and control groups) as (p ≤0.000) and (p ≤ 0.006) .Also women who applied the nursing intervention package (study group) had no degrees of uterine prolapse in the follow up test. Conclusion: There was a highly statistical improvement in the study group than control group regarding the total level of knowledge, practice and attitude about prevention of uterine prolapse post-test. Recommendation: Develop awareness programs for the pregnant women to improve their knowledge, practice and attitude about uterine prolapse.

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Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study

Cited by 18 publications

References 28 publications

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

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

Effect of Nursing Intervention Package on Prevention of Uterine Prolapse among Pregnant Women in Third Trimester

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