Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

Suelene Albuquerque Coelho,Luiz Gustavo O Brito,Camila Carvalho De Araújo,Luiza Borges Aguiar,Jorge M Haddad,Paulo C Giraldo,Cássia R T Juliato

doi:10.6061/clinics/2019/e934

Suelene Albuquerque Coelho, Luiz Gustavo O Brito + Show 5 more

Open Access

https://doi.org/10.6061/clinics/2019/e934

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Abstract

OBJECTIVE:To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP).METHODS:A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries.RESULTS:Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries.CONCLUSIONS:Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.

Highlights

Pelvic organ prolapse (POP) is a common and increasingly prevalent disease in adult and elderly women [1]
Surgical treatment is the definitive treatment for this disease; for patients who do not want to undergo surgery, life-style adjustment, physical therapy and the use of vaginal pessaries (VPs) are possibilities that should be offered as initial treatment options [2]
250 (73.52%) physicians had concluded a medical residency in obstetrics and gynecology, and 60.88% had participated in a clinical fellowship in urogynecology

Summary

Introduction

Pelvic organ prolapse (POP) is a common and increasingly prevalent disease in adult and elderly women [1]. Surgical treatment is the definitive treatment for this disease; for patients who do not want to undergo surgery (or have a high anesthetic risk), life-style adjustment, physical therapy and the use of vaginal pessaries (VPs) are possibilities that should be offered as initial treatment options [2]. Among the three latter conservative treatments, VPs provide high subjective cure rates (60-80%) [3]. Received for publication on August 31, 2018. Accepted for publication on May 7, 2019

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