Optimal Pessary Care: A Modified Delphi Consensus Study

Hooper, Gwendolyn; Atnip, Shanna; O’Dell, Katharine K.

doi:10.1111/jmwh.12624

Cited by 11 publications

(23 citation statements)

References 21 publications

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“…Overall, consensus on the optimal interval is lacking. 17,21,22 Based on our results, practitioners can consider extending follow-up periods for pessary cleanings beyond 3 months without incurring increased risk of adverse outcomes in racially/ethnically diverse women. An extended interval may increase pessary acceptance given the convenience of fewer in-person office visits, including decreased transportation costs, less time off work, and reduced need for caregiver or family accompaniment.…”

Section: Discussionmentioning

confidence: 79%

“…17 The optimal duration between pessary maintenance visits to minimize risk of adverse events is unknown. 17,[21][22][23] The lack of consensus on pessary care posed a unique challenge in March 2020 when the coronavirus disease 2019 (COVID-19) pandemic unexpectedly mandated changes in standard clinical practice. New York City was declared the U.S. epicenter of the pandemic in March 2020.…”

mentioning

confidence: 99%

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Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Halani

Gelman

Duchein

et al. 2021

Female Pelvic Med Reconstr Surg

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Objectives The aim of the study was to describe time intervals between pessary maintenance visits in racially diverse women receiving care in a U.S. epicenter of the COVID-19 pandemic. We secondarily aimed to determine whether time interval between pessary changes is associated with adverse outcomes and to identify factors associated with adverse pessary outcomes. Methods We performed a retrospective study of women undergoing pessary care after the COVID-19 pandemic began. Time between the most recent visit before the pandemic and first visit after the pandemic began was recorded. Pessary care data were collected from the latter visit, including vaginal bleeding, vaginal discharge, and erosion. Patient-reported symptoms and demographics were also recorded. The relationship between time interval between pessary visits and adverse outcomes as well as between adverse outcomes and demographic data was assessed. Results We identified 104 women undergoing pessary care, of which 35.6% were Hispanic and 32.7% were Black and 26.2% ± 10.5% lived in poverty. The median time to in-person visit was 4.5 months (interquartile range, 3.7–5.3 months). Seven women (8.7%) had vaginal bleeding, 15 (14.6%) had vaginal discharge, and 7 (6.8%) had erosions. There was no significant association between time interval between pessary visits and adverse outcomes or between adverse outcomes and patient characteristics (all P > 0.05). Conclusions Longer duration of time between pessary maintenance visits is not associated with increased adverse outcomes in this group of racially diverse women. Extended intervals between pessary visits can be considered to minimize risk and maintain patient safety during challenging circumstances, such as the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Halani

Gelman

Duchein

et al. 2021

Female Pelvic Med Reconstr Surg

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“…36 In a study of nurses who manage pessaries, there was 100% consensus for obtaining a PVR before and after fitting a pessary. 37 The reasoning is that although vaginal pessary is likely to resolve urinary retention by relieving a kinked urethra and restoring normal anatomy, that urethral obstruction can still occur; therefore, clinicians should assess the PVR after a pessary fitting in symptomatic or at-risk women.…”

Section: Resultsmentioning

confidence: 99%

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

2023

UROGC

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At present, guidance for pessary management has fallen to pessary manufacturers and the opinion of expert clinicians, leading to significant variation in recommendations for care.• The purpose of this clinical consensus statement is to identify areas of expert consensus and nonconsensus regarding pessary fitting, follow-up, and management of pessary complications to improve the safety and quality of care where evidence is currently limited.• The recommendations, developed by the writing group, may support these efforts by providing consistent care guidelines and statements on pessary fitting and management, while highlighting areas for further research for current practitioners or those new to the use of pessaries.

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“…It was shown that an interval of 3 months versus a 9-month interval did not influence the severity of pessary-related side effects. In the literature, it is often recommended to apply intervals of between 3 to 6 months [ 1 , 12 , 16 , 17 ]. However, we found no evidence to support these recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Equally important, we do not know whether these visits are effective in reducing pessary related side effects. Further, intervals between these follow-up visits vary widely and studies about the ideal length of such intervals are lacking [ 1 , 7 , 11 , 16 , 17 ]. Nor is it known what proportion of patients is willing and able to learn how to clean and replace the pessary themselves.…”

Section: Introductionmentioning

confidence: 99%

Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study

et al. 2020

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Introduction and hypothesis The objective of this study was to determine the efficacy of routine follow-up visits for pessary cleaning, the effect of extended time intervals between visits and the proportion of patients being able to self-manage their pessary for pelvic organ prolapse (POP). Methods We conducted a prospective cohort study in patients with a stage ≥II POP without previous POP surgery. All patients received a pessary as primary treatment. Our main outcome measure was a difference ≥2 in median visual analogue scale (VAS) scores (for pain, discharge, irritation) 1 week before and 1 week after cleaning. Measurements were performed after 3-and 9month cleaning intervals. For the evaluation of the effect of cleaning, 132 patients (3 months' follow-up) and 87 patients (12 months' follow-up) were available for analysis. For the evaluation of the effect of the lengthening interval, 123 patients were available. Results Self-management was performed in 45.2% of patients at 1 year. In 93.1% of patients, no differences were observed in pre-and post-cleaning VAS scores (effect of cleaning) on vaginal pain. Nor was there a difference in discharge (72.4%) or irritation 85.1% (p = 0.00). No differences were observed in pre-cleaning VAS scores for vaginal pain, discharge and irritation when the interval was lengthened from 3 to 9 months. No serious adverse events occurred. Conclusions There is no proven benefit of regular follow-up visits to clean a pessary. Also, the length of the cleaning interval does not seem to matter.

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Optimal Pessary Care: A Modified Delphi Consensus Study

Cited by 11 publications

References 21 publications

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Vaginal Pessary Use and Management for Pelvic Organ Prolapse

Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study

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