Le pessaire gynécologique: est-ce vraiment un dispositif d’un autre âge, un cache-misère?

Abstract

ObjectivesThe use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device’ size, insertion, removal, follow-up visits and care. MethodsA review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed. ResultsThis device appears to be as effective as surgical management to relieve symptoms related to urogenital prolapse and restore body image. It can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. However, despite its moderate cost and its harmlessness, this device remains somewhat little known as regards the practical modalities of its use, which, moreover, appear not consensual. ConclusionA guide intended for the attention of the patients as well as a film relating to the practical modalities of the device’ use were elaborated to improve the knowledge of both professionals and users in order to optimize and secure the care pathway.