Iatrogenic vesico-vaginal fistula caused by shelf pessary

Ray, Arpita; Esen, Umo I; Nwabineli, J. N.

doi:10.1080/01443610600559826

Cited by 16 publications

(13 citation statements)

References 8 publications

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“…Thirteen papers discussed complications related to pessary size. [20][21][22][23][24][25][26][27][28][29][30][31] By combining the data in both case reports and case studies, we found that the most frequent complications were: vaginal discharge, bleeding, vesicovaginal fistula, erosion, ulceration, and foul odor (Table 1). We graded the reported complications using the Clavien-Dindo classification (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…35 Fistula formation may also be associated with fecal impaction, hydronephrosis, and urosepsis, 32 however, these complications were generally reported in the setting of neglect. 22,23 Although serious complications caused by neglected pessaries are rare, 49 in case reports describing VVFs, bowel fistulae, and incarcerated pessaries, 91% were correlated to neglected pessaries, 12 and patients with dementia and nursing home residents could be at higher risk. 39 Several reports implicated pessaries as a causal mechanism for both vaginal and cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

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An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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Introduction: Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of shortand long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. Methods: A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. Results: In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. Conclusion: There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

View full text Add to dashboard Cite

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“…[3][4][5] Rare instances of bowel incarceration through a ring pessary and even cancer of vagina have been reported. 6,7 Vaginal pessary may improve the quality of life but command proper care in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Neglected vaginal pessary

Jain

Rani

Sehgal

2014

Int J Reprod Contracept Obstet Gynecol

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“…We describe a case of large VVF secondary to a Gellhorn pessary neglected for 3 years. It appears that five cases of VVF have been reported in association with a neglected vaginal pessary [10][11][12][13]15]. However, it is likely that many cases go unreported and that the true incidence is actually higher.…”

Section: Commentmentioning

confidence: 99%

“…Sixteen cases underwent office removal and conservative management. The other 23 cases required operative management (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. All but two of these complications were related to a neglected pessary (21/23, 91.3%).…”

Section: Commentmentioning

confidence: 99%

Complications of neglected vaginal pessaries: case presentation and literature review

2008

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Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.

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Iatrogenic vesico-vaginal fistula caused by shelf pessary

Cited by 16 publications

References 8 publications

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Neglected vaginal pessary

Complications of neglected vaginal pessaries: case presentation and literature review

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