The Dangerous Vaginal Pessary

Russell, J. K.

doi:10.1136/bmj.2.5267.1595

Cited by 55 publications

(22 citation statements)

References 1 publication

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“…50 It has been proposed that wearing a vaginal ring or cup-and-stem pessary for a long time may cause cancer of the vagina, ulcerative vaginitis, or fistulae. Primary cancer of the vagina was reported in 6 women among a group of 13 with major pelvic complications correlated to long-term pessary use, 38 and in a women who developed vaginal and cervical cancer after 18 years of pessary use. 50 Other mechanisms proposed included the generation of metaplastic and subsequent dysplastic change of the squamous mucosa, 51 and the potential In the case where multiple instances of a single complication was reported, the complication may appear in more than 1 grade based on how the complication was managed as reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…20 A 77-year-old using a shelf pessary for 18 years reported vaginal bleeding and a foulsmelling discharge; examination revealed a vesicovaginal and a rectovaginal fistula, and she also died from acute pyelonephritis and hydronephrosis. 38 Also, an 88-year-old patient died following erosion of a pessary into the upper rectum. 53 The literature reviewed contained sparse information regarding the materials used in pessaries causing complications.…”

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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“…Russell reported seeing patients with complications such as a rectovaginal fistula,vaginal cancer and chronic vaginitis [11]. Other complications are incarceration, ulceration and metaplasia, urosepsis and hydronephrosis [12].…”

Section: Discussionmentioning

confidence: 99%

Bizarre Foreign Objects in the Genital Tract—Our Experience and Review of Literature

Sankhwar¹,

Devyani²,

Pyari³

et al. 2014

OJOG

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Foreign objects in the genital tract are commonly encountered by clinicians in all age groups. Patients may or may not be aware of its presence in the body. Usually presenting as offensive vaginal discharge, rare misplacement of these objects may result in fatal complications. Detailed history and clinical examination are central to diagnosis although imaging modalities may be required in misplaced objects. Proper management can prevent morbidity and mortality resulting from complications. Presented here is a series of three cases where patients presenting with varied complaints were diagnosed with genital foreign bodies and managed.

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“…We describe a case of large VVF secondary to a Gellhorn pessary neglected for 3 years. It appears that five cases of VVF have been reported in association with a neglected vaginal pessary [10][11][12][13]15]. However, it is likely that many cases go unreported and that the true incidence is actually higher.…”

Section: Commentmentioning

confidence: 98%

“…Sixteen cases underwent office removal and conservative management. The other 23 cases required operative management (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. All but two of these complications were related to a neglected pessary (21/23, 91.3%).…”

Section: Commentmentioning

confidence: 99%

Complications of neglected vaginal pessaries: case presentation and literature review

2008

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Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.

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The Dangerous Vaginal Pessary

Cited by 55 publications

References 1 publication

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

Bizarre Foreign Objects in the Genital Tract—Our Experience and Review of Literature

Complications of neglected vaginal pessaries: case presentation and literature review

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