Pessaries in the Geriatric Patient

Zeitlin, Michael P.; Lebherz, Thomas B.

doi:10.1111/j.1532-5415.1992.tb02118.x

Cited by 44 publications

(14 citation statements)

References 16 publications

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“…This is an omission as pessaries are manufactured from an assortment of materials, including fruit, metal, porcelain, rubber, and acrylic, 54 with each material having certain advantages and disadvantages. Most are made of medical grade silicone covering components of surgical steel; 55 some pessaries are radiolucent with elements of silicone, rubber, acrylic, latex, or plastic. 51 Medical-grade silicone pessaries are long-lasting, biologically inactive, do not cause allergy, and are not carcinogenic.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, a large number of physical shapes exist; the American Medical Association had identified 123 types of pessaries by 1867. 55 Pessary shapes can be classified as supportive or space-occupying, with or without mechanisms to reduce urinary incontinence. Supportive pessaries consist of ring and lever designs, including the Smith, Hodge, Risser, and Gehrung.…”

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: Discussionmentioning

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

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“…Use of vaginal pessaries dates back before the time of Hippocrates [9] as a way to support the uterus and or bladder [10]. In an ongoing attempt to improve efficacy as well as comfort of wear, 123 kinds of pessaries had been developed by 1867 [10].…”

Section: Discussionmentioning

confidence: 99%

A Disposable Intravaginal Device for the Management of Stress Urinary Incontinence

Farage¹,

Aronstein²,

Miller³

et al. 2011

TOWHJ

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Urinary incontinence affects many women over the age of 50 with a substantial detrimental effect on daily activities and the quality of life. Surgical treatments are invasive, expensive, and not always successful. Patients are also treated with a variety of nonsurgical therapies (physical therapy, pharmaceutical interventions, and various vaginal and urethral inserts), but these have poor compliance rates and limited efficacy in patients with mild to moderate stress urinary incontinence (SUI). Incontinence pessaries have demonstrated efficacy in the treatment of SUI but can cause vaginal erosion, foul vaginal odors, and other complications associated with their prolonged residence in the vagina.A novel disposable intravaginal device, which can be worn during active hours and then discarded, was evaluated in this study for safety, ease of use, and efficacy in the treatment of SUI. Fifty-seven women with an average of one episode of SUI per day were fitted with the device, allowed to acclimate to wearing it during the day, and then asked wear the device and pre-weighed incontinence pads for 12 hours a day.Use of this device was significantly associated with a statistically significant decrease in SUI episodes, a decrease in unintentional urine output, a decrease in self-reported bladder control difficulty, and a self-reported improvement in quality of life. Subjects rated the comfort of device use during the fitting period, as well as during later device usage. No serious adverse events were reported. Results show that the intravaginal device is safe, relatively comfortable, and effective at reducing the frequency and psychosocial impact of SUI.

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“…However, most internal physicians have little experience with these devices; furthermore, pelvic examination tends to be omitted in elderly patients unless specifically indicated. When an elderly woman is fitted with a pessary, long-term follow-up is desirable-especially if she has dementia 2,3 .…”

Section: Commentmentioning

confidence: 99%

An Erosive Pessary

Kankam

Geraghty

2002

J R Soc Med

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Pessaries inserted for uterine prolapse are easily forgotten in the old, and can be hazardous. CASE HISTORYA woman of 88 was admitted after a fall at home. Her medical history included chronic atrial fibrillation, cerebrovascular disease, osteoarthritis, and utero-vaginal prolapse. She reported a three-month history of constipation interrupted by bouts of diarrhoea, weight loss, lethargy and a decline in mobility. On examination she was frail, malnourished and dehydrated. There were hard faeces in the rectum. Respiratory and abdominal examinations were normal. Plasma urea was 13.37 mmol/L, albumin 27 g/L. Abdominal X-ray revealed faecal loading throughout the colon.The patient was rehydrated and her constipation was treated with faecal softeners and enemas. It was then noticed that she was passing faeces per vaginam. On enquiry she said this had happened on several previous occasions. A hard rubbery object was now felt in the rectum, and a soluble-contrast enema established the presence of a rectovaginal fistula. On colonoscopy a vaginal pessary was identified eroding through the upper rectum; impacted faeces were evacuated and multiple biopsies were taken (no evidence of malignancy). A pelvic examination was performed simultaneously and a shelf pessary was removed. The cervix was normal, the uterus was small and mobile, and no adnexal masses were palpated. Closure of the fistula was attempted per rectum but this subsequently failed. Pneumonia and upper gastrointestinal bleeding complicated her postoperative recovery and she died two months later. COMMENTVaginal pessaries are devices of varying composition (rubber, clear plastic, silicone, or soft plastic with internal mouldable steel reinforcement) that serve to reposition and support prolapsed genitourinary organs 1 . Various shapes and sizes are available to provide comfortable anatomical support. In the UK, ring and shelf pessaries are commonly used.Although surgery is the definitive treatment for severe uterine prolapse, pessaries can give satisfactory results in women who wish or need to avoid surgery 2 . Complications are usually due to inadequate hygiene-e.g. leucorrhoea, cellulitis, abscess formation. Others are incarceration, ulceration and metaplasia 3 , intestinal obstruction 4,5 , urosepsis and hydronephrosis 6-8 . Russell 9 reported seeing 14 patients with complications over a 4-year period: one woman had a rectovaginal fistula, the pessary having been in place for 18 years; the others had vaginal cancer (7) or chronic vaginitis (6).In retrospect, questioning our patient about pessary use at the time of admission could have resulted in more prompt diagnosis. However, most internal physicians have little experience with these devices; furthermore, pelvic examination tends to be omitted in elderly patients unless specifically indicated. When an elderly woman is fitted with a pessary, long-term follow-up is desirable-especially if she has dementia 2,3 .

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Pessaries in the Geriatric Patient

Cited by 44 publications

References 16 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

A Disposable Intravaginal Device for the Management of Stress Urinary Incontinence

An Erosive Pessary

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