Position and orientation of vaginal pessaries in situ on magnetic resonance imaging

Hong, Christopher X.; Meer, Elana; Cioban, Max; Tischfield, David J.; Hassani, Daisy; Harvie, Heidi S.

doi:10.1007/s00192-021-04888-7

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…The orientation of the ring pessary found in this study differs slightly compared with those found in Hong et al [16], who performed an MRI study in fitting pessaries. In their study a mean (sagittal) angle of 57.0° at rest was found based on 21 MRI of patients with a fitting pessary, compared with 78.7° in this study.…”

Section: Discussioncontrasting

confidence: 95%

“…The position of the inferior cross section of the ring pessary was comparable in the fitting group of this study and in Hong et al The findings in this study are in agreement with the statement made by Hong et al that support pessaries (i.e. ring pessaries) do not support against the pubic bone, as the inferior cross-section of the pessaries was not near the pubic bone [16]. This statement is further confirmed by the position found of the pessary inferior cross section, which suggests that there might be no support of the pubic bone.…”

Section: Discussionsupporting

confidence: 92%

“…A recent study by Hong et al, however, showed that the pubic symphysis plays a limited role in the mechanism of action of the ring pessary based on static MRI data. Instead, owing to the ring pessary resting in the posterior fornix, it is likely that the uterus serves as a lever and thereby plays a role in ring pessary retention [ 16 ]. This lever mechanism may help to push the cervix posteriorly, allowing the uterus to rise [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Location and motion of vaginal pessaries in situ in women with successful and unsuccessful pessary treatment for pelvic organ prolapse

et al. 2023

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Introduction and hypothesis The objective was to compare the location and motion of pessaries between women with pelvic organ prolapse (POP) with a successful (fitting) and unsuccessful (non-fitting) pessary treatment on dynamic magnetic resonance imaging (dMRI). Methods A cross-sectional exploratory study of 15 women who underwent a mid-sagittal dMRI of the pelvic floor at rest, during contraction and during Valsalva with three different types of pessaries. The coordinates of the pessaries cross section, inferior pubic point (IPP) and sacrococcygeal junction (SCJ) were obtained and the location (position, orientation) and the motion (translation and rotation) were calculated. Differences between the groups and between the pessaries within the groups were compared. Results Nine women with a fitting pessary and 6 women with a non-fitting pessary were selected. In the non-fitting group, the pessaries were positioned more caudally and rotated more in clockwise direction and descended more, but not significantly, during Valsalva compared with the fitting group. The Falk pessary was positioned more anteriorly in the fitting group and more cranially in the non-fitting group compared with the ring and ring with support pessary. Conclusions A non-fitting pessary was positioned more caudally at rest; on Valsalva, it rotated more clockwise and moved more caudally, suggesting that the dynamic characteristics of the pessary might play an important role in its effectiveness. Findings of this study serve as a basis for the development of new pessary designs.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Location and motion of vaginal pessaries in situ in women with successful and unsuccessful pessary treatment for pelvic organ prolapse

et al. 2023

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“…In addition, although patient-specific pessaries were specifically designed for individual patients, they remain modifications of existing design concepts (eg, ring, Gellhorn). With ongoing research in pessary and pelvic floor biomechanics and continued advancements in 3D printing technologies, we anticipate the ability to develop new classes of adaptive pessaries 17 , 18 for an expanding global population of pessary users (“Pessary Market Size & Share, Industry Report, 2021–2028,” GVR-4-68038-299-0). 19 These pessaries may have applications beyond the treatment of pelvic organ prolapse, including use in obstetrics, the management of stress urinary incontinence, and as prophylaxis for the pelvic floor during weight-bearing activities.…”

Section: Discussionmentioning

confidence: 99%

Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study

Hong

Zhang²,

Eltahawi³

et al. 2023

UROGC

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Importance Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse (POP) when properly fitted. However, pessary fitting and use are often unsuccessful or imperfect. Objective The objective of this study was to assess the feasibility of using patient-specific pessaries fabricated from three-dimensional (3D)-printed molds to improve POP symptoms and increase overall satisfaction of pessary treatment in patients using standard vaginal pessaries. Study Design Patients undergoing POP treatment with standard vaginal pessaries were enrolled in this pilot prospective study. Patient-specific pessaries were designed and fabricated for each patient using patient input, physician input, and anatomic measurements from clinical assessment. Pessary fabrication involved injection of biocompatible liquid silicone rubber into 3D-printed molds followed by a biocompatible silicone coating. Pelvic organ prolapse symptomatic distress and pessary treatment satisfaction were evaluated before and after a 3-week patient-specific pessary home trial using the validated Pelvic Organ Prolapse Distress Inventory-6 form and a visual analog scale, respectively. Results Eight women were included in this study. Changing from standard pessary to patient-specific pessary treatment was associated with an improvement in prolapse symptoms on the Pelvic Organ Prolapse Distress Inventory-6 (median change, −3.5; interquartile range, −5 to −2.5; P = 0.02) and an increase in overall pessary satisfaction on a visual analog scale (median change, +2.0; interquartile range, +1.0 to +3.0; P = 0.02). All patients reported either an improvement or no change in pessary ease of use, comfort, and the feeling of support provided by the pessary. Conclusion Patient-specific vaginal pessaries are a promising alternative to standard pessaries for alleviating POP symptoms and improving patient satisfaction with pessary use.

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Pelvic inclination correction system for magnetic resonance imaging analysis of pelvic organ prolapse in upright position

et al. 2022

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Introduction and hypothesis Pelvic organ prolapse quantification by means of upright magnetic resonance imaging (MRI) is a promising research field. This study determines the angle for the pelvic inclination correction system (PICS) for upright patient position, which is hypothesized to deviate from the supine PICS angle. The necessity of different PICS angles for various patient positions will also be discussed. Methods Magnetic resonance scans of 113 women, acquired in an upright patient position, were used to determine the upright PICS angle, defined as the angle between the sacrococcygeal–inferior pubic point (SCIPP) line and the horizontal line. The difference and correlation between the upright and supine PICS angles were calculated using the paired Student’s t-test and the Pearson’s correlation coefficient (r) respectively. The effect of the difference between the upright and supine PICS angle on the measured pelvic organ extent was calculated using goniometry. Results The mean (interquartile range) PICS angles were 29° (26–35°) for the upright and 33° (30–37°) for the supine patient position. They were significantly different (p<0.001) and very strongly correlated (r = 0.914, p<0.001). The 4° difference between the average upright and supine PICS angle results in an average underestimation of the measured cervix height of approximately 0.5 cm for patients scanned in upright position. Conclusions The PICS angle for the upright patient position is 29°. The use of a dedicated PICS angle for different patient positions allows for more accurate pelvic organ extent analysis in patients with prolapse.

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Position and orientation of vaginal pessaries in situ on magnetic resonance imaging

Cited by 3 publications

References 24 publications

Location and motion of vaginal pessaries in situ in women with successful and unsuccessful pessary treatment for pelvic organ prolapse

Location and motion of vaginal pessaries in situ in women with successful and unsuccessful pessary treatment for pelvic organ prolapse

Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study

Pelvic inclination correction system for magnetic resonance imaging analysis of pelvic organ prolapse in upright position

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