Discontinuation rate and adverse events after 1year of vaginal pessary use in women with pelvic organ prolapse.

Abstract

To ascertain the rate of discontinuation after vaginal pessary use among pelvic organ prolapse patients. We enrolled women suffering from pelvic organ prolapse who opted to use vaginal pessary as the first line of treatment and were fitted with a pessary at the urogynecological clinic in Khon Kaen University's Srinagarind Hospital (Thailand) during the period between 2010 and 2016. Patients' medical records were retrospectively reviewed. Patients were contacted by telephone if there were missing data or if more information was required. One hundred and forty women were included. The median age was 71.5years (interquartile=65.0, 77.0) and normal vaginal parity was 4.0 (interquartile =3.0, 6.0). The mean±SD of BMI was 23.5± 3.6kg/m2. Most of the women enrolled in the study (97.9%) were postmenopausal and many were at an advanced stage of prolapse (73.6%). Support pessaries were the most common treatment (95.0%). The discontinuation rate of pessary use after 1year was 16.1%. The most common reason for discontinuing the vaginal pessary was frequent expulsion (26.3%). Abnormal vaginal discharge was the most common adverse effect after pessary insertion (17.1%). Lower BMI and history of hysterectomy were the significant risk factors for discontinuation of pessary use (0.76 [95%CI 0.62-0.93] and 15.89 [95%CI 1.67-151.02] respectively). The discontinuation rate of pessary use in the case of pelvic organ prolapse was low after 1year. Abnormal vaginal discharge was the most common adverse side effect. Lower BMI and history of hysterectomy were factors significantly associated with the discontinuation.