Pessaries (mechanical devices) for pelvic organ prolapse in women

Abstract

The review authors identified one randomised controlled trial comparing ring and Gellhorn pessaries. The results of the trial showed that both pessaries were effective for the approximately 60% of women who completed the study with no significant differences identified between the two types of pessary. However, methodological flaws were noted in the trial, as elaborated under risk of bias assessment. There is no consensus on the use of different types of device, the indications nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of pessaries in comparison with no treatment, surgery and conservative measures.

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

“…One out of five women switched from pessary to surgery within 24 months. However, both interventions showed significant reductions in the presence and severity of prolapse symptoms, consistent with results of other comparative studies 10,22,41,42 . Surgery was more effective on secondary outcomes, as shown by significant reductions on the PGI‐S and PFDI‐20 scales.…”

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

“…One out of five women switched from pessary to surgery within 24 months. However, both interventions showed significant reductions in the presence and severity of prolapse symptoms, consistent with results of other comparative studies 10,22,41,42 . Surgery was more effective on secondary outcomes, as shown by significant reductions on the PGI‐S and PFDI‐20 scales.…”

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

“…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.…”

Transvaginal management of severe pelvic organ prolapse in nulliparous women

“…25 Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term. 26 In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal. Although, the Gh length is not associated and a predictor of unsuccessful pessary insertion.…”

“…The success rate for fitting and continuous use of vaginal pessary in management of POP was reported in a prospective study of 100 women with symptomatic ≥stage 2 at >70% . Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term . In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal.…”

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

“…One out of five women switched from pessary to surgery within 24 months. However, both interventions showed significant reductions in the presence and severity of prolapse symptoms, consistent with results of other comparative studies 10,22,41,42 . Surgery was more effective on secondary outcomes, as shown by significant reductions on the PGI‐S and PFDI‐20 scales.…”

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

“…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.…”

Transvaginal management of severe pelvic organ prolapse in nulliparous women

“…25 Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term. 26 In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal. Although, the Gh length is not associated and a predictor of unsuccessful pessary insertion.…”

“…The success rate for fitting and continuous use of vaginal pessary in management of POP was reported in a prospective study of 100 women with symptomatic ≥stage 2 at >70% . Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term . In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal.…”

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study

“…One out of five women switched from pessary to surgery within 24 months. However, both interventions showed significant reductions in the presence and severity of prolapse symptoms, consistent with results of other comparative studies 10,22,41,42 . Surgery was more effective on secondary outcomes, as shown by significant reductions on the PGI‐S and PFDI‐20 scales.…”

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

“…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.…”

Transvaginal management of severe pelvic organ prolapse in nulliparous women

“…25 Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term. 26 In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal. Although, the Gh length is not associated and a predictor of unsuccessful pessary insertion.…”

“…The success rate for fitting and continuous use of vaginal pessary in management of POP was reported in a prospective study of 100 women with symptomatic ≥stage 2 at >70% . Regardless of pessary type, 60% of women who chose vaginal pessary continued to use it in the long term . In the present study, however, the narrow vaginal outlet, especially in the case of Gh <4.5 cm, was a risk factor for discontinuing pessary as a treatment option because of the general discomfort and pain during insertion and removal.…”