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Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting
Author(s) -
Vasconcelos Camila Teixeira Moreira,
Gomes Maria Laura Silva,
Geoffrion Roxana,
Saboia Dayana Maia,
Bezerra Karine de Castro,
Vasconcelos Neto José Ananias
Publication year - 2020
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24493
Subject(s) - pessary , medicine , sex organ , odds ratio , logistic regression , confidence interval , obstetrics , body mass index , gynecology , prospective cohort study , surgery , genetics , biology
Aims To determine the percentage of women with symptomatic pelvic organ prolapse who opted for pessary and had a successful pessary fitting trial; to identify the most commonly used size of pessary for stage of prolapse; and to identify risk factors associated with unsuccessful fitting. Methods We conducted a prospective cohort study of women with symptoms of genital prolapse referred to a public hospital tertiary care clinic (2013‐2019). We used ring and ring with support pessaries for fittings. We collected patient demographics, pelvic organ prolapse quantification, size of pessary used and evaluated factors associated with pessary fittings. We defined unsuccessful fit as failure to continue pessary use at 4 weeks post fitting trial. We used Mann‐Whitney and χ 2 tests to compare variables between groups of successfully and unsuccessfully fitted. Using logistic regression, we built a prediction model for unsuccessful fit. Results All 170 women with symptomatic prolapse referred to our clinic accepted to undergo a pessary fitting. More than 70% (n = 124/72.9%) were successfully at 4 weeks. We used an average of 1.7 pessaries (range: 1‐6) per patient to identify the best‐fitting pessary and #2, 5, 3, 7, and 4 were the sizes commonly used (78.2%). Women with body mass index ≥30 kg/m 2 (odds ratio [OR]: 4.74; 95% confidence interval [CI], 1.98‐11.32; P < .001), total vaginal length <7.5 cm (OR: 3.78; 95% CI, 1.98‐11.32; P < .001), and sexually active women (OR: 2.26; 95% CI, 1.04‐4.91; P = .035) were associated with increased unsuccessful fitting. Conclusion The vaginal pessary proved to be an excellent choice, with high acceptance and successful fitting rates.