Natural history of pessary use in women aged 65-74 versus 75years and older with pelvic organ prolapse: a 12-year study.

Abstract

The feasibility of use and long-term outcomes of vaginal pessaries for the management of pelvic organ prolapse (POP) in older women remains unknown. Our aim was to determine successful fit rates and outcomes among older women seeking care for POP. This was a retrospective cohort study of 304 consecutive women aged 65years and older with symptomatic POP undergoing a pessary trial at the outpatient urogynecology clinic in Québec, Canada. Women successfully fitted with a pessary were followed, and survival curves were used to ascertain the median time to pessary discontinuation for women aged 65 to 74years in comparison with women aged 75years and older. Long-term use was defined as longer than 1year. Predictors of a successful fitting and long-term discontinuation were ascertained using logistic and Cox regression analyses. Half of the women attempting a pessary trial were aged 75years and older, and 63% were fitted successfully regardless of age. Women with a history of hysterectomy or reconstructive pelvic surgery, or those with posterior vaginal wall prolapse were more likely to fail initial insertion. For women aged 65 to 74years and women aged 75years and older, the cumulative probabilities of continued pessary use were 87.5% and 80.8% at 1year, 80.6% and 70.9% at 2years, and 62.1% versus 37.8% at 5years. Erosions occurred in 19.3% of long-term users, with women aged 75years and older more likely to experience vaginal erosions (HR 3.2, 95% CI 1.6-6.3) and discontinue pessary use. Pessary use is a feasible and acceptable treatment option for the long-term management of symptomatic prolapse in over 60% of all women aged 65years and older.