Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse

Chien, Chih-Wei; Lo, Tsia‐Shu; Tseng, Ling-Hong; Lin, Yi‐Hao; Hsieh, Wu‐Chiao; Lee, Shu-Jane

doi:10.1097/spv.0000000000000770

Cited by 16 publications

(20 citation statements)

References 27 publications

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“…In a study examining 289 women fitted with ring pessaries for symptomatic POP, Manonai et al found that only 61.7% were still using them 5 years later and that self-care was the only significant factor that was predictive of continued compliance for 3 years [ 15 ]. In a study of 93 patients who opted for self-management of Gellhorn pessaries to treat symptomatic POP, Chien et al found that only 47.2% of the study participants were still using their pessaries after 5 years [ 16 ]. Our relatively high continuation rate in the present study (82.2%) compared with those reported previously could be attributed, at least in part, to the use of a different type of pessary.…”

Section: Discussionmentioning

confidence: 99%

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

et al. 2022

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Introduction and hypothesis Loss of anatomical support for the pelvic organs results in pelvic organ prolapse (POP). We hypothesized that daily self-management of a cube pessary might be a safe, feasible long-term treatment in women with symptomatic POP. Methods A cohort of 214 symptomatic POP patients (stage 2+) were enrolled prospectively (January to December 2015). Each patient was size-fitted with a space-filling cube pessary and completed a questionnaire online or by phone ≥5 years after her initial fitting. Change in quality of life (QoL) was measured with the Patient Global Impression of Improvement (PGI-I). Results Of 185 women included in our analyses, 174 (94%) were continuing to use their pessary 4 weeks post-insertion. Among those, 143 (82.2%) used the pessary successfully for ≥5 years. A large majority of these patients (88.8% [127 out of 143]) described their condition as much or very much improved compared with their pretreatment status (PGI–I). Adverse secondary effects (ASEs) were infrequent [15.4% (22 out of 143)]; when they did occur, they were mild, including smelly vaginal discharge (15 out of 22) and slight vaginal bleeding caused by the fitting procedure (6 out of 22). Conclusions Daily self-management of cube pessaries was found to be a safe and effective treatment for improving POP-related symptoms and QoL in the long term.

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Section: Discussionmentioning

confidence: 99%

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

et al. 2022

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“…Seven studies provided data on risk of adverse events with long-term pessary use (without removal or cleaning) [17][18][19][20][21][22][23]. Nine additional articles were reviewed that provided information of interest during the pandemic [24][25][26][27][28][29][30][31][32].…”

Section: Pessary Managementmentioning

confidence: 99%

“…Based on review of the literature (16 studies) and expert consensus: [16]. Use of a specific telemedicine encounter is preferred for tracking and reimbursement purposes over a telephone encounter (typically used for sharing of discrete information) & Patients can safely extend the time interval between pessary cleanings to 6 months (and, in some cases, up to 24 months) with minimal risk of adverse events [17][18][19][20][21][22][23]. & Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35].…”

Section: Pessary Managementmentioning

confidence: 99%

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

et al. 2020

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Introduction and hypothesis The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission.Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.

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Section: Pessary Managementmentioning

confidence: 99%

“…& Patients can safely extend the time interval between pessary cleanings to 6 months (and, in some cases, up to 24 months) with minimal risk of adverse events [17][18][19][20][21][22][23]. & Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35].…”

Section: Pessary Managementmentioning

confidence: 99%

A Guide for Urogynecologic Patient Care Utilizing Telemedicine During the COVID-19 Pandemic: Review of Existing Evidence

Grimes

Balk

Crisp

et al. 2020

Obstetrical &Amp; Gynecological Survey

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Introduction and hypothesisThe COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.

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Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse

Cited by 16 publications

References 27 publications

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

A Guide for Urogynecologic Patient Care Utilizing Telemedicine During the COVID-19 Pandemic: Review of Existing Evidence

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