Management of Incarcerated Vaginal Pessaries

Poma, Pedro A.

doi:10.1111/j.1532-5415.1981.tb01274.x

Cited by 35 publications

(21 citation statements)

References 5 publications

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“…Meanwhile, some researchers suggested that a pessary should not be used for dementia patients as a specific case [11,14,15] while others said that a pessary was indicated for such patients [8]. In this context, Heit et al (2003) attempted to investigate the objective predictive factors in the selection of treatment for POP patients [16].…”

Section: Discussionmentioning

confidence: 99%

Survey of the characteristics and satisfaction degree of the patients using a pessary

et al. 2004

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The objective of this study was to evaluate characteristics, satisfaction degree, and problems of patients using a pessary for pelvic organ prolapse. A total of 104 patients who had been fitted with a pessary and available for follow-up for pelvic organ prolapse management were enrolled. The patients answered questions on general characteristics, indications for pessary use, complications from pessary use, satisfaction degree, and frequency of removal. The results indicated that 76 (73.0%) patients had at least more than one medical illness and 86 (82.7%) patients complained of lower urinary symptoms such as incontinence, urgency, frequency, or nocturia. Eighty-four (80.7%) patients used pessaries as they were not surgical candidates due to poor medical status or old age. After using a pessary, 76 (73.1%) patients had symptoms such as bleeding, erosion, or foul odor; 70.2% of the women answered that they were satisfied or more than satisfied and 19.1% of the patients removed their pessaries, of whom 80.0% were unable to continue use due to repeated expulsion of the pessary and uncomfortable fitting. These data suggest that the pessary tends to be used for high-risk patients due to medical problems or old age. Despite the high frequency of complications from pessary use, it was seen that the frequency of removing the pessary was low and the satisfaction degree was high. Most of the complications were not thought to be serious. To decrease the frequency of complications, the regular follow-up visit and proper management of pessary use were thought to be needed. Further studies are warranted on tailor-fitting the pessary by variable use and relieving the symptoms associated with the lower urinary tract.

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Section: Discussionmentioning

confidence: 99%

Survey of the characteristics and satisfaction degree of the patients using a pessary

et al. 2004

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“…Although rare, unusual complications of neglected pessary include vesicovaginal fistula [1][2][3], rectovaginal fistula [1,2], cervical entrapment [4] and pessary incarceration [5]. A search of the Medline database from 1966 to the present revealed only three other cases of vesicovaginal fistula secondary to a neglected pessary.…”

Section: Discussionmentioning

confidence: 99%

Intravesical Foreign Body and Vesicovaginal Fistula: A Rare Complication of a Neglected Pessary

Grody

Nyirjesy

Chatwani

1999

International Urogynecology Journal and Pelvic Floor Dysfunctio

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A silicone Gellhorn pessary, 3 inches in diameter, neglected for several years in an elderly woman, eroded through the anterior vaginal wall, ultimately to lie entirely within the bladder. General anesthesia and bilateral deep full-length Schuchardt's incisions were required to remove it. A Latzko procedure was done at a later date to close the large vesicovaginal fistula; similar Schuhardt's incisions were again used.

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“…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. 25 Chronic inflammation in association with viral infections has been suggested to predispose patients to such cancers as the tumours appeared at the site of pessary placement.…”

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

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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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Management of Incarcerated Vaginal Pessaries

Cited by 35 publications

References 5 publications

Survey of the characteristics and satisfaction degree of the patients using a pessary

Survey of the characteristics and satisfaction degree of the patients using a pessary

Intravesical Foreign Body and Vesicovaginal Fistula: A Rare Complication of a Neglected Pessary

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

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