Ring pessary for all pelvic organ prolapse

Manchana, Tarinee

doi:10.1007/s00404-010-1675-y

Cited by 64 publications

(53 citation statements)

References 14 publications

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“…Thirteen papers discussed complications related to pessary size. [20][21][22][23][24][25][26][27][28][29][30][31] By combining the data in both case reports and case studies, we found that the most frequent complications were: vaginal discharge, bleeding, vesicovaginal fistula, erosion, ulceration, and foul odor (Table 1). We graded the reported complications using the Clavien-Dindo classification (Table 3).…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…A ring pessary (Chinda Dispensary Registered Ordinary Partnership, Bangkok, Thailand) was used. The detail of this pessary was described in our previous study [2]. Retrospective observational study was conducted that was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University.…”

Section: Methodsmentioning

confidence: 99%

“…Successful fitting was defined as follows: (1) a patient who continued the pessary use for more than 2 weeks and (2) a patient who had pessary expulsion and was refitted with a new size of pessary at the second visit and continued use for more than 2 weeks. Patients who discontinued pessary within the first 2 weeks and were not able to be refitted were categorized as unsuccessful fitting [2]. Pessary care techniques were explained to the patients and caregivers.…”

Section: Methodsmentioning

confidence: 99%

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Impact on quality of life after ring pessary use for pelvic organ prolapse

Manchana

Bunyavejchevin

2012

Int Urogynecol J

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“…In addition, the predictors of unsuccessful fitting have been inconsistent among studies. The predictors include a short vagina and wide vaginal hiatus [9, 13, 14], genital hiatus/total vaginal length (GH/TVL) ratio >0.8 [11], lower prolapse Pelvic Organ Prolapse Quantification system (POP-Q) stage [11], posterior wall prolapse [17], previous prolapse repair and hysterectomy [10, 12, 14–16], coexistent stress urinary incontinence [16], increased parity [10], age 65 years or younger [11], and smoking [11]. …”

Section: Introductionmentioning

confidence: 99%

Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice

et al. 2016

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Introduction and hypothesisPelvic organ prolapse is a common condition. There is inconsistency between predictors of unsuccessful pessary fitting in urological/gynaecological clinics. Research in general practice is scarce. The aim was to estimate the proportion of women in general practice with a symptomatic pelvic organ prolapse and unsuccessful pessary fitting, and to identify characteristics associated with unsuccessful pessary fitting.MethodsA cross-sectional study in general practice (n = 20) was carried out among women (≥55 years) with symptomatic prolapse (n = 78). Multivariate logistic regression analysis was used to identify predictors of unsuccessful pessary fitting.ResultsIn total, 33 women (42 %) had unsuccessful pessary fitting. Factors associated with unsuccessful pessary fitting were age (per year, OR 0.93 [95 % CI 0.87–1.00]), body mass index (per kg/m2, OR 1.14 [95 % CI 1.00–1.30]), and having underactive pelvic floor muscles (OR 2.60 [95 % CI 0.81–8.36]).ConclusionsPessary fitting was successful in 58 %, indicating that pessary treatment may be suitable for many, but not for all women in general practice with symptomatic prolapse. The condition of the pelvic floor probably plays a role in the success of pessary fitting, as demonstrated by the association with underactive pelvic floor muscles, and body mass index. The association with age may reflect the higher acceptance of conservative treatments for prolapse in older women. This is the first study on predictive factors for unsuccessful pessary fitting in general practice. Therefore, further research should seek to confirm these associations before we can recommend the use of this information in patient counselling.

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Ring pessary for all pelvic organ prolapse

Cited by 64 publications

References 14 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

Impact on quality of life after ring pessary use for pelvic organ prolapse

Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice

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