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Associate Editor for Contemporary OB/GYN
With ongoing aging of the population, incidence of pelvic organ prolapse (POP) is on the increase, and with it the need to increased education for ob/gyns and their patient about proper use of pessaries.
A new study underscores the need for careful counseling of patients prior to pessary insertion to avoid dislodgement.
Published in Female Pelvic Medicine and Reconstructive Surgery, the research evaluated factors associated with pessary dislodgment in women with advanced POP.
The prospective study was conducted in a tertiary urogynecology center from December 2017 and 2018.
The study authors found that presence of advanced apical POP and previous POP surgery are risk factors for ring pessary dislodgment. They advised that physicians guide and counsel patients before pessary insertion.
Women with symptomatic advanced POP—defined as anterior, posterior, or apical stage 3 or 4 in the Pelvic Organ Prolapse Quantification system [POP-Q]—were recruited. Demographic data and history of POP surgery and associated urinary and bowel symptoms were collected.
Prolapse was staged according to the POP-Q, and a ring pessary without support was the only type of pessary in this study.
After vaginal pessary insertion, patients were asked to walk and perform Valsalva maneuvers. If the pessary became displaced, reinsertion of the same or next size device was performed, up to three times.
An outpatient visit was scheduled for each patient 3 and 6 months after pessary insertion to assess for symptoms. They were vaginal discharge, bleeding, pain, discomfort, new-onset symptoms—urinary or bowel— and any pessary dislodgement.
To evaluate factors associated with dislodgment, women who had their pessaries dislodged within 6 months were compared with those who retained their pessary.
Of 93 women, 78 (83.9%) were able to retain the ring pessary during the 6-month follow-up, and 15 (16.1%) from the pessary dislodgement group failed to retain the device.
Results showed no difference regarding age, body mass index, parity, schooling, race, menopausal status, comorbidities, or sexual activity in women with a dislodged versus a retained VP.
However, women with a dislodged VP had significantly more previous reconstructive surgery—specifically anterior colporrhaphy—and more advanced POP-Q C points (apical prolapse) than women who retained the device.
The authors concluded that presence of advanced apical POP and previous POP surgery were risk factors for ring VP dislodgment.