Timing of Office-Based Pessary Care: A Randomized Controlled Trial

Propst, Katie; Mellen, Colleen; O’Sullivan, David

doi:10.1097/01.ogx.0000658028.79421.21

Cited by 10 publications

(32 citation statements)

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“…We defined adverse outcomes as any of the following: vaginal examination findings of blood, discharge, erosion, or pessary dislodgment, need for pessary holiday, and fistula formation. We defined erosion using a system proposed by Propst et al, 23 rating them from epithelial erythema to epithelial breaks or erosions. To compare patterns observed during the COVID-19 pandemic to those before the pandemic, we recorded these pessary outcomes from the same group of women 1 year prior in order to establish a baseline.…”

Section: Methodsmentioning

confidence: 99%

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Halani

Gelman

Duchein

et al. 2021

Female Pelvic Med Reconstr Surg

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Objectives The aim of the study was to describe time intervals between pessary maintenance visits in racially diverse women receiving care in a U.S. epicenter of the COVID-19 pandemic. We secondarily aimed to determine whether time interval between pessary changes is associated with adverse outcomes and to identify factors associated with adverse pessary outcomes. Methods We performed a retrospective study of women undergoing pessary care after the COVID-19 pandemic began. Time between the most recent visit before the pandemic and first visit after the pandemic began was recorded. Pessary care data were collected from the latter visit, including vaginal bleeding, vaginal discharge, and erosion. Patient-reported symptoms and demographics were also recorded. The relationship between time interval between pessary visits and adverse outcomes as well as between adverse outcomes and demographic data was assessed. Results We identified 104 women undergoing pessary care, of which 35.6% were Hispanic and 32.7% were Black and 26.2% ± 10.5% lived in poverty. The median time to in-person visit was 4.5 months (interquartile range, 3.7–5.3 months). Seven women (8.7%) had vaginal bleeding, 15 (14.6%) had vaginal discharge, and 7 (6.8%) had erosions. There was no significant association between time interval between pessary visits and adverse outcomes or between adverse outcomes and patient characteristics (all P > 0.05). Conclusions Longer duration of time between pessary maintenance visits is not associated with increased adverse outcomes in this group of racially diverse women. Extended intervals between pessary visits can be considered to minimize risk and maintain patient safety during challenging circumstances, such as the COVID-19 pandemic.

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Section: Methodsmentioning

confidence: 99%

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Halani

Gelman

Duchein

et al. 2021

Female Pelvic Med Reconstr Surg

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“…Whereas there is no universal timing that is used, studies have reported similar outcomes for 3-and 6-month evaluations for patients managed with continuous pessary wear. 22 In appropriate candidates, vaginal estrogen therapy may be helpful in preventing pessary-related erosions in women with atrophic vaginal tissues.…”

Section: Pessary Usementioning

confidence: 99%

Evaluation and Management of Pelvic Organ Prolapse

Raju

Linder

2021

Mayo Clinic Proceedings

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“…Seven studies provided data on risk of adverse events with long-term pessary use (without removal or cleaning) [17][18][19][20][21][22][23]. Nine additional articles were reviewed that provided information of interest during the pandemic [24][25][26][27][28][29][30][31][32].…”

Section: Pessary Managementmentioning

confidence: 99%

“…& Patients can safely extend the time interval between pessary cleanings to 6 months (and, in some cases, up to 24 months) with minimal risk of adverse events [17][18][19][20][21][22][23]. & Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35].…”

Section: Pessary Managementmentioning

confidence: 99%

“…& Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35]. & Providers should consider empiric vaginal estrogen to minimize adverse events for patients not already using vaginal estrogen [17,18,28,31,33]. & For patients reporting copious vaginal discharge or bleeding, it may be appropriate to encourage home self-removal and to observe for symptoms such as voiding dysfunction until patients can safely be evaluated in the office (EC).…”

Section: Pessary Managementmentioning

confidence: 99%

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A Guide for Urogynecologic Patient Care Utilizing Telemedicine During the COVID-19 Pandemic: Review of Existing Evidence

Grimes

Balk

Crisp

et al. 2020

Obstetrical &Amp; Gynecological Survey

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Introduction and hypothesisThe COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.

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Timing of Office-Based Pessary Care: A Randomized Controlled Trial

Cited by 10 publications

References 0 publications

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic

Evaluation and Management of Pelvic Organ Prolapse

A Guide for Urogynecologic Patient Care Utilizing Telemedicine During the COVID-19 Pandemic: Review of Existing Evidence

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