Prospective Evaluation of Outcomes of Mechanical Devices in Women with Symptomatic Pelvic Organ Prolapse in Ogbomoso, South-Western Nigeria

Akintunde Olusegun Fehintola,Sunday Adekunle Oladeji,Lawrence Olujire Olujide,Olurotimi Idowu Aaron,Olumuyiwa Ayotunde Ogunlaja,Olufemi Timothy Awotunde,Babatola Bakare,Samuel Eniola Akinola

doi:10.4236/ojog.2021.114044

Abstract

Background: Symptomatic pelvic organ prolapse (POP) impacts the sufferers’ quality of life negatively. There is a preference for a mechanical device in certain conditions though the definitive management of POP is surgical. Objectives: We conducted the study to evaluate the outcome of management of POP using mechanical devices. Methods: It was a prospective study. It took place in the gynecology unit of the Bowen University Teaching Hospital Ogbomoso between May 2014 and April 2019. We followed up with eligible patients who opted for pessary use for a median duration of 18 months (Range 12 - 84 months). We excluded those who refuse to participate in the study. Results: Of the 127 patients with symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion. We lost Six (9.2%) patients to follow up. Of the 64 women included in the analysis, 16 (25%) discontinued use at some point after four weeks, whereas 36 (56.3%) used the pessary successfully throughout the follow-up period. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% dis-impaction or constipation). After cessation of pessary use, 12 (25%) of the 48 women chose surgery, and 10 (20.8%) chose no further treatment. Conclusion: This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings. Therefore, it is justifiable to offer pessaries in the initial management of uterovaginal prolapse to all patients who opt for conservative management and those awaiting surgery.

Highlights

Pessaries have been in existence in one form or another since biblical times [1], and currently, many different kinds of pessaries are available to treat the various types of pelvic descent
This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings
There is a lack of data on pessary’s use as a viable alternative to surgery in women with POP in Nigeria, the need for this study. This present study evaluated the use of vaginal pessaries for pelvic organ prolapse (POP) and identified complications and reasons for discontinuing pessary use over the follow-up period prospectively

Summary

Introduction

Pessaries have been in existence in one form or another since biblical times [1], and currently, many different kinds of pessaries are available to treat the various types of pelvic descent. Patients who are not fit for surgery, those who refuse surgery and women with U-V prolapse in pregnancy can use pessary. Other forms of treatment modalities for U-V prolapse include general measures in the forms of estrogen use by menopausal women, physiotherapy, and electrical stimulation. These forms of treatment, are only used for mild conditions of U-V prolapse [3]. We followed up with eligible patients who opted for pessary use for a median duration of 18 months (Range 12 - 84 months) We excluded those who refuse to participate in the study. Results: Of the 127 patients with symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion.

Objectives

Results

Conclusion