Role of pessaries in management of women with pelvic organ prolapse and stress urinary incontinence at a University Hospital in Oman

Abstract

Introduction: Millions of women have been diagnosed with pelvic floor dysfunction worldwide which covers a range of conditions, most significantly pelvic organ prolapse (POP), urinary incontinence (UI) and faecal incontinence. About 40% of patients with POP could present with SUI and affects the quality of life of women, which is a social and hygienic problem. The extent and consequences of the burden of disease due to pelvic floor dysfunction is poorly understood. Over the past three decades efforts have been made to develop devices with evidence-based designs to control urinary incontinence. We aim to address the role of mechanical intravaginal devices in the management of urinary incontinence coexisting with uterovaginal prolapse at a tertiary academic institute in Oman. Materials and methods: This is a retrospective cohort study of women presenting with SUI with or without POP and managed with pessary at urogynecology clinic, Sultan Qaboos University Hospital, Muscat, Oman. The electronic patient records were reviewed from January 1, 2008 to December 31, 2014. Women with other form of UI other than SUI or who opted for surgical management were excluded. The demographic data (age, parity, BMI, menopausal status, etc.) and clinical data (type and degree of prolapse, type and size of pessary used, presence of other medical conditions, etc.) were collected and analyzed for outcome with SPSS v21. Results: During the study period of 6 years 52 women were managed with pessary for SUI. The mean age of women was 58.9 years, mean parity was six, and mean BMI 29.1 kg/m2. Forty-four patients (84.6%) presented with both SUI and prolapse and eight with SUI only (15.4%). The most common type of prolapse was cystocele seen in 43(82.7%) patients. The main types of pessaries used were incontinence ring pessary (23%) or ring without cover 42.3%. In 44 (84.6%) women, pessary use significantly relieved symptoms and patients were complaint with its use for a long time. The majority of patients experienced no side effects (75%). The most common side effect was spontaneous expulsion of pessary (11.5%) and excessive vaginal discharge (5.8%). Conclusion: Results of this study show that pessary use is an effective conservative treatment for prolapse and SUI in our population. Further follow up will be done to assess the effectiveness of long term pessary use in women having concomitant SUI and POP.