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Obstetrics and Gynecology Clinics of... Sep 2009Pessary is a low-risk and effective non-surgical treatment option for pelvic organ prolapse. Indications for pessary include symptomatic prolapse, if surgery is not...
Pessary is a low-risk and effective non-surgical treatment option for pelvic organ prolapse. Indications for pessary include symptomatic prolapse, if surgery is not desired or recommended, and use as a diagnostic tool to predict surgical outcomes. Evidence for pessary selection and management is incomplete so trial and error, expert opinion, and experience remain the best guides for use and management of the pessary. With proper training and understanding of pessary management, most patients can be successfully fitted and taught to manage the pessary either for short- or long-term relief of symptoms. Patient satisfaction is high making pessary an important tool in treating prolapse.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Urinary Incontinence, Stress
PubMed: 19932415
DOI: 10.1016/j.ogc.2009.08.010 -
Obstetrics and Gynecology Mar 2018Pessaries are a treatment option for pelvic organ prolapse, stress urinary incontinence (SUI), and cervical incompetence. An effective pessary is comfortable, corrects...
BACKGROUND
Pessaries are a treatment option for pelvic organ prolapse, stress urinary incontinence (SUI), and cervical incompetence. An effective pessary is comfortable, corrects the presenting problem, does not cause adverse effects, and is easy to remove. Discomfort and poor fit limit the usefulness of pessaries for many women. Each patient presents with unique anatomy and thus the effectiveness of commercially available pessaries may be limited by lack of customization.
METHOD
A patient presenting with SUI and failed commercial pessary fittings desired nonsurgical treatment. Using a mold fabricated with a three-dimensional printer and polylactic acid filament, a medical-grade silicone pessary was custom-made for the patient.
EXPERIENCE
The silicone pessary was placed vaginally in the patient for a period of 48 hours. The patient did not report any discomfort or bladder leakage. In addition, the pessary did not dislodge with coughing, sneezing, or straining. After removal, a speculum examination showed normal epithelium.
CONCLUSION
We report the successful insertion of a customized three-dimensional-printed pessary in a patient with SUI. Three-dimensional-printed pessaries are feasible and their utility may extend to the patient with anatomy incompatible with commercially available pessaries.
Topics: Aged, 80 and over; Female; Humans; Pessaries; Printing, Three-Dimensional; Urinary Incontinence, Stress
PubMed: 29420400
DOI: 10.1097/AOG.0000000000002461 -
Archives of Gynecology and Obstetrics Dec 2023
Topics: Humans; Female; Pessaries; Pelvic Organ Prolapse; Vagina; Sutures
PubMed: 36583765
DOI: 10.1007/s00404-022-06904-7 -
Archivos Espanoles de Urologia Jun 2022Pelvic organ prolapse (POP) has a general incidence of > 10% in the female population of the Western world. The pessary is a silicone device, it is inserted into the... (Observational Study)
Observational Study
INTRODUCTION
Pelvic organ prolapse (POP) has a general incidence of > 10% in the female population of the Western world. The pessary is a silicone device, it is inserted into the vagina to provide support to the pelvic organs. It is used as a conservative treatment to improve prolapse symptoms.
OBJECTIVE
To evaluate urination among women with a pessary and women without a pessary and to evaluate the effectiveness of pessary treatment in pelvic organ prolapse with voiding difficulties.
MATERIAL AND METHODS
A prospective and quasi-experimental observational study of an analytical nature was conducted. It will consist of analyzing the results of treatment with vaginal pessaries in women with POP. A total of 60 women were chosen as a sample of the study, 50% were placed with the pessary. PGI test and uroflujometry were used.
RESULTS
The placement of pessary shows how there is a significant correlation between the quality of life of women and urination.
CONCLUSIONS
There is a relationship between the improvement of the quality of life and the improvement of the mycological dynamics of women in pessary treatment. However, the improvement in the quality of life cannot be attributed solely to the improvement of urinary flow, but also to the well-being caused by the reduction of POP.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Prospective Studies; Quality of Life; Treatment Outcome; Urination
PubMed: 35983816
DOI: 10.56434/j.arch.esp.urol.20227505.64 -
Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice.International Urogynecology Journal Apr 2021Symptomatic vaginal prolapse affects 6-28% of women and significantly impacts their quality of life. Pessaries for prolapse are used by three-quarters of clinicians as a...
INTRODUCTION AND HYPOTHESIS
Symptomatic vaginal prolapse affects 6-28% of women and significantly impacts their quality of life. Pessaries for prolapse are used by three-quarters of clinicians as a first-line treatment; however, current clinical use in the UK is unknown and there is a lack of clinical guidance or training. This study is aimed at informing the upcoming UK Clinical Guidance on best practice for the use of pessaries document.
METHODS
A 19-question, anonymised, electronic survey was sent to members of the nine professional bodies delivering pessary care in the UK.
RESULTS
Of 917 respondents, 403 (246 nurses, 134 doctors, 22 physiotherapists and 1 other profession) currently deliver pessary care. PVC/vinyl ring, silicone ring, Gellhorn and shelf pessaries are most popular, and are used frequently by 93% of respondents. Further pessary training was deemed necessary by 62% of those currently providing pessary care, and 70% of those who do not. The most highly rated method for previous and future training is shadowing another clinician. One in three respondents receive no ancillary support and nearly 1 in 7 (predominantly nurses) report the absence of cross-cover arrangements, leaving a gap in care provision.
CONCLUSIONS
Service provision, support and pessary training in the UK vary greatly. This calls for the standardisation of care, training and development of a national guideline. We present a clear rationale and need for a UK guideline on pessary management of vaginal prolapse and a standardised pessary training model for multi-professional use.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Quality of Life; Surveys and Questionnaires; United Kingdom; Uterine Prolapse
PubMed: 33034677
DOI: 10.1007/s00192-020-04537-5 -
European Review For Medical and... Feb 2023To evaluate whether cervical pessary effectively reduces the preterm birth < 37 weeks rate in patients who have not delivered after an episode of arrested preterm labor.
Cervical pessary for preterm birth prevention after an episode of arrested preterm labor: a retrospective cohort study with targeted maximum likelihood estimation of the average treatment effect.
OBJECTIVE
To evaluate whether cervical pessary effectively reduces the preterm birth < 37 weeks rate in patients who have not delivered after an episode of arrested preterm labor.
PATIENTS AND METHODS
Retrospective cohort study was conducted on singleton pregnant patients admitted to our institution between January 2016 and June 2021 for threatened preterm labor and who had a cervical length < 25 mm. Women in whom a cervical pessary was placed were considered as exposed, while women in whom expectant management was preferred were considered as unexposed. The primary outcome was the rate of preterm birth before 37 weeks. A targeted maximum likelihood estimation was used to estimate the average treatment effect of cervical pessary by adjusting for a-priori-defined confounders.
RESULTS
A cervical pessary was placed in 152 (36.6%) patients (exposed), while the remaining 263 (63.4%) were managed expectantly (unexposed). The adjusted average treatment effect was -14% (-18 to -11%), -17% (-20 to -13%), and -16% (-20 to -12%) for preterm birth < 37 weeks, < 34 weeks, and < 32 weeks, respectively. The average treatment effect for adverse neonatal outcomes was -7% (-8 to -5%). No difference in gestational weeks at delivery between exposed and unexposed emerged when gestational age at first admission was > 30.1 gestational weeks.
CONCLUSIONS
The positioning of a cervical pessary placement may be evaluated to reduce the risk of a subsequent preterm birth after an episode of arrested preterm labor in pregnant patients with onset of symptoms before 30 gestational weeks.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Infant; Premature Birth; Pessaries; Likelihood Functions; Retrospective Studies; Obstetric Labor, Premature; Cervix Uteri
PubMed: 36808353
DOI: 10.26355/eurrev_202302_31202 -
The Journal of Obstetrics and... Sep 2017This study was conducted to investigate attitudes toward pessary use in Thai women with pelvic organ prolapse (POP).
AIM
This study was conducted to investigate attitudes toward pessary use in Thai women with pelvic organ prolapse (POP).
METHODS
Ninety Thai women with symptomatic POP without any history of previous prolapse treatment were recruited. Participants completed a questionnaire about attitudes toward pessary use in Thai language. Patient characteristics and decision-making factors were identified.
RESULTS
Forty eight women (53.3%) decided to use a pessary. Most respondents felt that pessary use would improve emotional status (56.2%), pain (52.0%) and quality of life (75%). The opinions of family members and post-application bleeding, discharge, irritation and pain were important factors in decision-making.
CONCLUSION
Many Thai women with POP prefer a pessary. Their decision is influenced by opinions of family members and complications of pessary use. Counseling about the advantages and uncommon complications of pessary use should be provided to both patients and family members to improve higher pessary acceptance.
Topics: Aged; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Pelvic Organ Prolapse; Pessaries; Thailand
PubMed: 28833951
DOI: 10.1111/jog.13374 -
Female Pelvic Medicine & Reconstructive... Feb 2022The 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...
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.
Topics: COVID-19; Female; Humans; Pandemics; Pelvic Organ Prolapse; Pessaries; Retrospective Studies; SARS-CoV-2; Urban Population
PubMed: 34171881
DOI: 10.1097/SPV.0000000000001085 -
International Urogynecology Journal Jan 2023
Topics: Humans; Pessaries; Pelvic Organ Prolapse
PubMed: 36462059
DOI: 10.1007/s00192-022-05415-y -
The Medical Journal of Malaysia Nov 2023Pelvic organ prolapse (POP) is a condition involving weakened pelvic floor muscles causing organs to protrude. Conservative POP treatment comprises pelvic floor...
INTRODUCTION
Pelvic organ prolapse (POP) is a condition involving weakened pelvic floor muscles causing organs to protrude. Conservative POP treatment comprises pelvic floor exercises and vaginal pessaries. Besides conservative care, surgery is offered. However, surgery is invasive, risky and unsuitable for those with serious medical conditions. This study aims to assess the acceptance, success and outcomes of the Gellhorn pessary for POP treatment, especially in advanced cases.
MATERIALS AND METHODS
The present study is a retrospective cohort study using hospital medical records (patient files) from October 2019 to November 2021 (for 2 years). This study was performed in Malaysian women (n=53) suffering from advanced stages of POP, in which Gellhorn pessaries of diameter (44-76mm) were inserted by trained personnel. Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were used to measure patients' symptoms and quality of life before and after Gellhorn pessary fitting. Patients were reassessed every three months for two years and their satisfaction scores were recorded.
RESULTS
We observed a significant difference in pre-test (pre-fitting) and post-test (three months post-fitting) scores on all three subscales and the PFIQ-7 total score. Twentyeight (52.83%) patients continued the use of Gellhorn pessary for at least 24 months, whereas 25 (47.20%) patients discontinued during this period. A retrospective analysis of the patients who discontinued Gellhorn pessary showed that 13 (24.52%) patients gave up the use of pessary for definitive surgery. It is noteworthy to mention here that only one out of the 13 patients who were awaiting surgery, chose surgery and the remaining 12 changed their mind after being fitted with the Gellhorn pessary. Seven (13.20%) patients declined reinsertion due to discomfort and voiding difficulties and refused further intervention, whereas three (5.66%) patients requested a ring pessary. Two (3.77%) patients, requested the removal of pessary due to vesicovaginal fistula and rectovaginal fistula (caused by an impacted pessary). The rate of continued use was 79.24% (42 patients) after 1st year and 52.83% (28 patients) at the end of two years.
CONCLUSION
In the current study, the Gellhorn pessary was used to treat stage 3 and 4 POP with significant symptom reduction post-fitting. More than half of the patients continued to use the pessary after 24 months of fitting. Therefore, the Gellhorn pessary can be used as a treatment strategy for stage 3 and 4 POP with reasonable acceptance in the Malaysian population.
Topics: Humans; Female; Retrospective Studies; Pessaries; Quality of Life; Pelvic Organ Prolapse; Pelvic Floor
PubMed: 38031210
DOI: No ID Found