25: Pessary use and severity of pelvic organ prolapse over time: a retrospective study

Abstract

To evaluate if long-term pessary use is associated with a change in pelvic organ prolapse (POP) severity and genital hiatus (GH) size. This is a retrospective study of women using pessaries for treatment of symptomatic POP and/or incontinence from January 2014 to April 2017 at a single urogynecology practice. Baseline and most recent pelvic organ prolapse quantification (POPQ) measurements and stages were recorded. The primary outcome was change in POPQ point GH. Secondary outcomes included change in POPQ stage, type of pessary (e.g., space-filling or support), size of pessary, number of pessary changes over time (e.g., size and/or type of pessary), and duration of use. Demographic characteristics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used to compare categorical data as appropriate. Pearson’s and Spearman’s correlation coefficients were used where appropriate for evaluation of change over time. A total of 132 patients were included in the analysis. The cohort was predominantly non-Hispanic white (75%) women using pessaries for symptomatic POP greater than stage 2 (70.5%). All patients were post-menopausal. Median duration of pessary use was 39.5 months (IQR 17-64.5 months). POPQ point GH (r = -0.215, p = 0.014) and POPQ stage (r = -0.276, p = 0.001) decreased significantly as duration of pessary use increased. Compared to patients with baseline POPQ stage <3, those with baseline POPQ stages ≥3 had a significant decrease in GH as duration of pessary use increased (-0.5 cm vs. 0 cm, p <0.001). This relationship was not seen when comparing baseline GH <3 cm to those with baseline GH ≥3 cm. Patients underwent a significant number of changes in pessary type over time (p < 0.001); however, there was no significant change in the size of pessary over time (p = 0.191). Pessary use by women with pelvic organ prolapse causes a change in vaginal anatomy over time as seen by decreasing POPQ stage and point GH. Prospective studies are needed to further characterize and confirm these findings.