Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use

Abstract

Objectives: The aim of the study was (1) to evaluate continuation rates of vaginal ring pessary for pelvic organ prolapse (POP), and (2) to identify predictors for continued pessary use. Methods: This retrospective chart review study was conducted in a tertiary center. Women who had a ring with support pessary successfully fitted between January 2009 and December 2013 and had completed up to 3 years of follow-up care were included in the analysis. Demographic and obstetric data, body weight, pelvic organ prolapse stage, and associated symptoms were evaluated. All the women were followed until February 28, 2017, unless surgery to correct POP surgery was required, pessary use was discontinued, or the women died. Results: A total of 289 women with symptomatic POP (stages II, III, and IV) were evaluated. The median age was 71 years (range 34-83 y), and the median parity was 3 (range 0-8). Among the women with a successful initial fitting, the failure rate was 5.88% (17/289) at 6 months with most of these women choosing to have surgical intervention. This analysis indicates that the probability of the successful continuation of pessary use after 1, 2, 3, 4, and 5 years was 83.0%, 78.2%, 71.3%, 65.3%, and 61.7%, respectively, reported using a Kaplan–Meier plot. The main cause for discontinuation of pessary use before 3 years was the election for surgical intervention. With regard to predictors for continued pessary use, self-care was the only factor that influenced compliance rates after treatment of 3 years. Conclusion: A ring with support pessary can be used successfully to alleviate symptoms of advanced stage prolapse for 3 years or longer. In addition, proper self-management was found to be a strong predictor for prolonged pessary use.

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

“…Another limitation is that not all women completed follow‐up. In our optimistic scenario we would have a continuation rate of 69.5% at 24 months, which is comparable with other literature reporting continuation rates of between 64.0 and 75.4% 18,19 . Therefore, it is likely that we underestimated the continuation rate, assuming that women who did not return to the hospital remained satisfied with a pessary.…”

“…Adverse events with pessary treatment may occur in up to 54% of women and include pessary expulsion, discomfort, pressure ulcer, micturition disorders and vaginal discharge 16,17 . After 24 months 24.5–36.0% of women stopped using a pessary 18,19 …”

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

“…They found that, after 6 months, women practicing self-management reported higher levels of convenience, accessibility, support, and comfort than those who had their pessaries changed by a health care professional [ 14 ]. In a study examining 289 women fitted with ring pessaries for symptomatic POP, Manonai et al found that only 61.7% were still using them 5 years later and that self-care was the only significant factor that was predictive of continued compliance for 3 years [ 15 ]. In a study of 93 patients who opted for self-management of Gellhorn pessaries to treat symptomatic POP, Chien et al found that only 47.2% of the study participants were still using their pessaries after 5 years [ 16 ].…”

Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse?

“…Evidence on pessary self-management is limited and from small non-randomised studies7891011 (table 1, supplementary file). The studies mainly report on the length of time for which women continue to use a pessary.…”

“…Overall, self-management may improve pessary continuation rates and enhance patient satisfaction and quality of life, but it is difficult to generalise these findings. The studies were conducted in different populations, were small, and lacked randomised comparison groups 7891011. Uncertainty exists over optimal follow-up intervals, if they are required, for women who are self-managing.…”