Is pelvic-floor morphology a predictor of successful pessary retention? Original research and review of the literature

Abstract

Background. Vaginal pessaries are known to be an effective treatment modality for pelvic organ prolapse (POP). Pessaries form an important part of the physician’s armamentarium in the treatment of POP, but currently many of the factors affecting their successful use are poorly understood. Objectives. To determine the association between pessary retention (PR) at 1 year, and functional pelvic floor morphology, i.e. levator hiatal distance and area, and levator avulsion. Methods. This retrospective study reviewed the records of 73 patients with symptomatic POP at a tertiary urogynaecological centre. This multi-ethnic cohort had previously been studied for pelvic-floor morphology, had had 4D transperineal pelvic-floor ultrasound, and had opted for a vaginal pessary as a treatment option. Results. Our population had a mean age of 59.4 (range 32 - 91) years, and mean body mass index of 29.4 (range 20 - 42) kg/m2 , with a mean assessment of stage 3 in the Pelvic Organ Prolapse Quantifications System (POP-Q). The level of prolapse was found to be related to PR (p=0.077). We further explored this concept using symmetric measures of association (γ=–0.353), indicating that PR decreases with increasing prolapse severity. PR was also found to be inversely associated with prior pelvic reconstructive surgery (n=63; p=0.055; γ=–0.417). There was a strong correlation that failed, however, to achieve significance by a small margin (p=0.052) between hiatal distance on contraction and PR. Conclusion. This study found an inverse relationship between PR and hiatal distance on contraction, prior pelvic surgery and the severity of prolapse. This was a pilot study with a limited number of participants, and the authors plan a prospective study to further clarify the association between long-term PR and functional pelvic floor morphology