Unsuccessful Pessary Fitting Research Articles

Outcomes of pessary fitting trials for patients with stage IV pelvic organ prolapse: a prospective study

Introduction and hypothesisThe objective was to evaluate the efficacy of pessaries in the treatment of stage IV pelvic organ prolapse (POP) and identify the influencing factors.MethodsOne hundred and fifty-seven patients with stage IV symptomatic POP were admitted to the hospital for pessary fitting. A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting in whom use continued 2 weeks later. The rates of successful pessary fitting, patient satisfaction, remission of prolapse and urinary symptoms, and the occurrence of factors associated with successful pessary fitting were calculated and predictors of appropriate pessary type selection were analyzed.ResultsA total of 130 patients with stage IV POP had a successful pessary fitting (82.8%). The satisfaction rate associated with the two types of pessaries was more than 90%. The success rate among patients undergoing a ring pessary fitting trial was 44.6%, and 84.3% of the patients were self-managed. Prolapse symptoms significantly improved in 90% of cases, and urinary symptoms improved in 58–93% of cases from baseline. The number of vaginal deliveries, history of hysterectomy and vaginal introitus/total vaginal length (TVL) ratio were independent risk factors associated with unsuccessful pessary fitting.ConclusionFor patients with stage IV POP, the successful fitting rate is as high as 80% or more. More vaginal deliveries, a history of hysterectomy, and a larger vaginal introitus/TVL ratio (ratio >0.6) were predictors of unsuccessful pessary fitting.

Pessary fitting for pelvic organ prolapse: parameters associated with specific reasons for failure.

The objective was to assess if specific reasons for unsuccessful pessary fitting have different predictive parameters. This is a prospective observational case-control study of women with symptomatic pelvic organ prolapse (POP) choosing pessary treatment. All women underwent an interview, clinical examination, and 3D/4D transperineal ultrasound (TPUS). Groups were defined based on fitting outcome: successful, pessary dislodgment, failure to relieve POP symptoms, pain/discomfort, increased/de novo urinary incontinence, or other reasons. Clinical, demographic, and TPUS parameters were assessed in the prediction of different reasons for unsuccessful fitting and receiver operating characteristic (ROC) curves were constructed. A total of 162 women were assessed and 130 were included. Levator hiatal area (HA) on maximum Valsalva divided by ring pessary size ("Valsalva HARP ratio") was a predictor of unsuccessful fitting (OR 3.00, 95% CI 1.15-7.81, p= 0.025) with an area under the ROC curve (AUC) of 0.62 (95% CI 0.50-0.74, p= 0.04). Predictors of pessary dislodgment were: complete avulsion (OR 24.20, 95% CI 2.46-237.84, p value 0.01) and Valsalva HARP ratio (OR 2.94, 95% CI 1.32-6.55, p value 0.01) with an area under the ROC curve (AUC) of 0.92 (95% CI 0.84-0.99, p= 0.00). No significant parameter was identified in the prediction of pain/discomfort. Solitary predominant posterior compartment POP was a predictor of failure to relieve POP symptoms (OR 20.00, 95% CI 3.48-115.02, p value 0.00; AUC 0.75, 95% CI 0.53-0.98, p= 0.03). Complete avulsion and a small ring pessary with respect to the levator HA in Valsalva are predictors of pessary dislodgment, whereas solitary predominant posterior compartment POP is a predictor of failure to relieve POP symptoms.

Factors associated with unsuccessful pessary fitting and reasons for discontinuation in Korean women with pelvic organ prolapse.

ObjectiveTo identify the factors associated with unsuccessful pessary fitting and reasons for pessary discontinuation in Korean women with pelvic organ prolapse (POP).MethodsThe medical records of 234 patients who underwent pessary fitting for the management of symptomatic POP were retrospectively reviewed. A ring pessary with or without support was used. Successful pessary fitting was defined as the ability to wear a pessary for 2 weeks without any discomfort. Factors associated with unsuccessful pessary fitting were determined using a multivariable logistic regression analysis. A Kaplan-Meier survival curve was obtained to examine the probability of continuing pessary use over the follow-up period. The reasons for the discontinuation of pessary were identified.ResultsTwo-hundred-and-twenty-five women were included in the analysis. The rate of unsuccessful pessary fitting was 40%. Prior hysterectomy (odds ratio [OR], 4.13; 95% confidence interval [CI], 1.81–9.42) and POP quantification stage III–IV (OR, 2.49; 95% CI, 1.28–4.85) were independent risk factors for unsuccessful pessary fitting. Among the patients with successful pessary fitting, the median time to discontinuation of pessary use was 4 years. The most common causes of discontinued use were vaginal erosion (45.3%) and urinary incontinence (26.5%).ConclusionPatients with a history of hysterectomy and advanced-stage POP are at risk for an unsuccessful fitting of the ring pessary. Vaginal erosion is the main reason for discontinued use among patients with successful pessary fitting.

Vaginal pessary continuation in symptomatic pelvic organ prolapse patients with prior hysterectomy.

To evaluate the success rate of pessary fitting and continuation rate for symptomatic pelvic organ prolapse (POP) patients with a hysterectomy and to explore potential predictors. In this prospective observational study, 119 symptomatic POP patients with a prior hysterectomy received pessary treatment between April 2015 and February 2019. A successful pessary fitting was defined as a patient who was fitted with a pessary and continued to use it 2 weeks later. Patients with successful pessary fitting were followed until February 2020. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression. The success rate of pessary fitting was 63.2%. A history of POP reconstructive surgery (OR = 2.6, 95% CI 1.0-6.7, P = 0.043) and a short total vaginal length <7.3 cm, (OR = 0.5, 95% CI 0.3-0.9, P = 0.014) were potential risk factors for unsuccessful pessary fitting. A total of 78.1% of the patients continued pessary use for a median duration of 26 months. Among patients who discontinued, 75% ceased within 1 year. Older age (OR = 1.1, 95% CI 1.0-1.2, P = 0.038) and prolapse score improvement at 3 months less than 50% (OR = 2.8, 95% CI 1.1-7.2, P = 0.035) were potential risk factors for discontinuation. Pessaries remain a useful approach to treat prolapse in women who had a hysterectomy. Patients with POP reconstructive surgery and total vaginal length<7.3 cm should be informed that they might have lower success rate of pessary fitting. Age and prolapse score improvement at 3 months were potential predictors for continuation.

Factors associated with pessary fitting in women with symptomatic pelvic organ prolapse: A large prospective cohort study.

To identify factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP). This prospective observational study included 611 consecutive women with symptomatic POP in a tertiary-care hospital. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted or refitted with a pessary and continued to use it 2 weeks later. Parametric and nonparametric tests were used for the data analysis. A total of 524 patients had successful pessary fittings (85.8% success rate). The success rate of the ring pessary with support was 57.9%, of the Gellhorn pessary was 69.1%. Stage IV prolapse (odds ratio [OR], 2.12), posterior compartment prolapse (OR, 1.92), genital hiatus (OR, 1.41), and vaginal introitus (OR, 1.40) were independent predictors of unsuccessful ring with support pessary fitting. Vaginal length (OR, 0.74/0.60 for ring with support/Gellhorn) and history of POP reconstructive surgery (OR, 2.50/2.58 for ring with support/Gellhorn) were independent predictors of both ring with support and Gellhorn pessary fitting. Stage IV prolapse, posterior compartment prolapse, large genital hiatus, and wide vaginal introitus were risk factors for unsuccessful fitting of ring pessary with support. Short vaginal length and a history of POP reconstructive surgery were risk factors for unsuccessful fitting of both pessaries.

Factors associated with unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: Systematic review and metanalysis.

To identify the factors associated with unsuccessful pessary fitting and reasons for discontinuation for women with symptomatic pelvic organ prolapse (POP). This systematic review is registered at the PROSPERO database. We have included all studies, regardless of the study design whose primary outcomes were factors associated with unsuccessful pessary fitting and discontinuation for symptomatic POP women. Exclusion criteria were case series, literature reviews, other forms of conservative treatment. Data selection/extraction was performed by two investigators. For pessary fitting, a meta-analysis was performed for at least two studies pooled in a forest plot. The risk of bias was classified by the ROBINS-I and ROB-2 classification. From 409 studies retrieved after data search, only twenty-one articles remained for final analysis (18 cohort studies, 1 cross-sectional study, and 2 RCTs). Meta-analysis was performed in nine studies for pessary fitting and the associated factors were: higher body mass index (BMI) (MD = 0.688 [0.233-1.143]; P = .03; i2 = 0%), previous reconstructive surgery (OR = 1.705 [1.016-2.860]; P = .043; i2 = 69%) and advanced POP (OR = 4.2 [2.9-6.1]; P < .05; i2 = 92%). Older age, larger total vaginal length (TVL), and genital hiatus and previous hysterectomy were not associated factors. Regarding discontinuation, thirteen reasons were quoted, and the most frequent were: the desire for surgical treatment (111/3.601), pessary extrusion (385/3.601), and pain/discomfort (163/3.601). Obese, previously reconstructive pelvic surgery, advanced prolapse are at risk for unsuccessful pessary fitting. Pain is the most quoted reason for discontinuation. These pooled data may help clinicians to identify patients that may not succeed in their attempt for pessary treatment.

Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study

To evaluate the success rate of vaginal pessary fitting and identify the risk factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP). Prospective observational study. The Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China. Women with symptomatic POP between May 2015 and December 2016 (n=343). A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting and continued use 2weeks later. The independent samples t-test, non-parametric test, Chi-square test, Fisher's exact test, logistic regression and receiver operating characteristic curves were used for the data analysis. The success rate of vaginal pessary fitting and the risk factors associated with unsuccessful pessary fitting. 302 patients had successful pessary fitting (88.0% success rate). A higher body mass index [BMI; 24.7±3.1kg/m2 in the successful group versus 25.7±3.8kg/m2 in the unsuccessful group, odds ratio (OR) 1.174, 95% CI 1.055-1.307, P=0.003] and a shorter TVL [8.0 (8-9) cm in the successful group versus 7.0 (6.8-8) cm in the unsuccessful group, OR 0.338, 95% CI 0.223-0.513, P<0.001) were independent predictors of an unsuccessful pessary fitting. The receiver operating characteristic curve showed that patients with a total vaginal length (TVL) less than 7.3cm had a higher unsuccessful pessary fitting rate (sensitivity=0.82, specificity=0.64). A higher BMI and shorter TVL were independent predictors of an unsuccessful pessary fitting. Patients with a TVL <7.3cm are not appropriate candidates for a vaginal pessary. A higher BMI and shorter TVL (<7.3cm) were independent predictors of an unsuccessful pessary fitting.

Levator Ani Muscle Avulsion Is a Risk Factor for Vaginal Pessary Expulsion

Pelvic organ prolapse (POP) is a highly prevalent condition; vaginal pessary is a common treatment for this condition. A recent randomized controlled trial and prospective studies have confirmed the efficacy of vaginal pessary as treatment for this condition. However, expulsion of vaginal pessary remains a major issue. The reported rate of pessary expulsion has been around 30-60%. Several risk factors were known to be associated with unsuccessful pessary fitting namely short vaginal length and wide vaginal introitus. Levator ani muscle (LAM) avulsion is known to be associated with POP. It is also related to symptoms of prolapse and surgical outcome of prolapse repair. The association between successful vaginal pessary use and pelvic floor muscle and hiatal dimensions were examined. LAM avulsion was associated with 3 times higher risk of pessary expulsion in one year. More severe staging of prolapse also increased the risk of expulsion. Pessary expulsion is usually occurs within 2 weeks after insertion, but it can also happen within 6 months.

Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice

Introduction and hypothesisPelvic organ prolapse is a common condition. There is inconsistency between predictors of unsuccessful pessary fitting in urological/gynaecological clinics. Research in general practice is scarce. The aim was to estimate the proportion of women in general practice with a symptomatic pelvic organ prolapse and unsuccessful pessary fitting, and to identify characteristics associated with unsuccessful pessary fitting.MethodsA cross-sectional study in general practice (n = 20) was carried out among women (≥55 years) with symptomatic prolapse (n = 78). Multivariate logistic regression analysis was used to identify predictors of unsuccessful pessary fitting.ResultsIn total, 33 women (42 %) had unsuccessful pessary fitting. Factors associated with unsuccessful pessary fitting were age (per year, OR 0.93 [95 % CI 0.87–1.00]), body mass index (per kg/m2, OR 1.14 [95 % CI 1.00–1.30]), and having underactive pelvic floor muscles (OR 2.60 [95 % CI 0.81–8.36]).ConclusionsPessary fitting was successful in 58 %, indicating that pessary treatment may be suitable for many, but not for all women in general practice with symptomatic prolapse. The condition of the pelvic floor probably plays a role in the success of pessary fitting, as demonstrated by the association with underactive pelvic floor muscles, and body mass index. The association with age may reflect the higher acceptance of conservative treatments for prolapse in older women. This is the first study on predictive factors for unsuccessful pessary fitting in general practice. Therefore, further research should seek to confirm these associations before we can recommend the use of this information in patient counselling.

Clinical Characteristics Associated With Unsuccessful Pessary Fitting Outcomes

Options for patients with pelvic organ prolapse (POP) include surgery and conservative management using a pessary. Two thirds of patients with POP offered a choice between surgery and pessary initially opt for the pessary. Success rates for pessary fittings vary widely. Previous studies have investigated possible clinical predictors of unsuccessful pessary fitting. However, lack of clear definitions for an unsuccessful fitting hinders research, and studies attempting to identify clinical predictors for unsuccessful fitting are inconsistent. It has been hypothesized that certain individual patient characteristics may predict unsuccessful fitting. When identified, the presence of these factors could be used to counsel patients faced with the treatment choice between pessary and surgery for POP. The aim of this retrospective study was to identify clinical characteristics and quality-of-life/symptom scores associated with an unsuccessful trial of pessary (TOP) in women with POP. Data were collected for 101 women with POP who underwent pessary fittings between 2006 and 2012 at a tertiary urogynecology unit. Treatment options were explained to all participants. Baseline standard POP quantification staging was performed. At baseline, patients completed detailed history and validated pelvic floor quality-of-life and symptom questionnaires. An unsuccessful TOP was defined as an inability to continue use of the pessary beyond 4 weeks from initial fitting. Multivariate stepwise logistic regression analysis was used to build a prediction model for odds of unsuccessful TOP. Patient discomfort was the primary reason for unsuccessful TOP. Multivariate analysis showed that the following clinical characteristics were significantly associated with the likelihood of unsuccessful TOP: age 65 years or younger (odds ratio [OR], 3.13; P = 0.042), smoking history (OR, 3.42; P = 0.049), genital hiatus/total vaginal length ratio greater than 0.8 (OR, 6.70; P = 0.042), and lower POP quantification overall stage (OR, 2.84; P = 0.017). Variables not associated with the likelihood of unsuccessful TOP included sexual activity and concurrent urinary or POP symptoms. These findings show that pessaries remain a good treatment option for women with POP. The data show a number of clinical characteristics that influence the likelihood of unsuccessful TOP. Clinicians can use these results to counsel women with POP faced with a choice between conservative and surgical management.

Patient Characteristics Associated With a Successful Pessary Fitting

: The objective of the study was to assess if patient characteristics, including Pelvic Organ Prolapse Quantification measurements, are predictive of successful pessary fitting in women with pelvic organ prolapse (POP) and/or incontinence. : This was a retrospective chart review of patients who underwent a pessary fitting for POP and/or incontinence. Multiple demographic parameters, pessary fitting data, and Pelvic Organ Prolapse Quantification measurements were examined. : Complete data were available on 158 patients, and 59% were successfully fit. Shorter total vaginal length (TVL), less than 8 cm, was associated with an unsuccessful pessary fitting (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.02-0.46). A genital hiatus (GH)/TVL ratio of less than 0.9 was predictive of successful fitting (OR, 12.5; 95% CI, 1.5-102). Patients with a prior hysterectomy were more likely to have an unsuccessful pessary fitting (OR, 0.41; 95% CI, 0.22-0.8). The GH/TVL ratio and TVL were predictors only in patients with a previous hysterectomy. : Patients with a previous hysterectomy and a TVL of less than 8 cm or a GH/TVL ratio of 0.9 or greater can be counseled that successful pessary fitting is unlikely.

Rectocoele, but not cystocoele, may predict unsuccessful pessary fitting

"Rectocoele, but not cystocoele, may predict unsuccessful pessary fitting." Journal of Obstetrics and Gynaecology, 31(5), pp. 441–442

Predictors of Successful Pessary Fitting and Continued Use in a Nurse-Midwifery Pessary Clinic

Women with incontinence and/or pelvic organ prolapse presenting to an urogynecology service were offered referral to a dedicated midwifery pessary clinic. Charts of these women were reviewed for demographic information, physical examination, pelvic floor disorders, and details of pessary-fitting sessions. Successful fitting was defined as a comfortable fit and retention of the pessary with valsalva and voiding. Continuation was defined as a successfully fit patient who returned at least once after the initial fitting with the pessary still in use. Spearman's correlations identified variables associated with successful fitting and continuation of use. Logistic regression identified variables that predicted continued use. Eighty-six percent of women were successfully fit, and 89% continued pessary use for a mean of 6 months. Predictors of unsuccessful fitting included a history of a prior prolapse procedure or hysterectomy (P < or = .001). Severe posterior prolapse was associated with pessary discontinuation after adjustment for patient's age (P < .04). Success rates for treatment of stress urinary incontinence, pelvic organ prolapse, or both were not significantly different (success rates of 94%, 89%, and 81%, respectively; P = .50). Predictors of unsuccessful pessary fitting include history of a prior prolapse procedure and hysterectomy. Severe posterior prolapse was the single predictor of pessary discontinuation.

Pessary Treatment of Pelvic Relaxation

The aims of this study were to determine predictors of successful pessary fitting and continued pessary use in patients with pelvic relaxation. Retrospective observational study. The medical records of 130 consecutive patients evaluated for pessary treatment of pelvic relaxation by a single specially trained nurse practitioner (CRJ) at Kaiser Foundation Hospital, Harbor City, Calif, between May 1, 1997, and June 30, 2002, were retrospectively reviewed. Voiding diaries, data collection sheet, and questionnaires. The medical records of the 130 patients were retrospectively reviewed, and data were recorded on data collection sheets. Patients using pessaries completed a questionnaire to assess treatment effectiveness. Coexisting stress urinary incontinence and previous prolapse and cystocele/rectocele repairs were each found to be independent predictors of unsuccessful pessary fitting. Fifty percent of successfully fitted patients had discontinued pessary use by 24 months. Current pessary users were more likely to have undergone prior pelvic reconstructive surgery (37% vs 13%, P = .02), less likely to require a space-filling pessary (13% vs 37%, P = .03), and more likely to recommend pessary to their friends or family (87% vs 50%, P = .007) compared to patients who discontinued pessary use. Prior pelvic reconstructive surgery is associated with an increased risk of unsuccessful pessary fitting; however, those patients who are successfully fitted tend to continue pessary use.

Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse

ObjectiveOur purpose was to estimate the percentage of women with symptomatic pelvic organ prolapse who had a successful pessary fitting trial, to identify pelvic examination parameters that are associated with an unsuccessful pessary fitting trial, and to identify the most commonly used pessary for each stage of prolapse. Study designIn a prospective, observational study, 100 consecutive women with symptomatic pelvic organ prolapse were examined, staged, and fitted with either a ring or Gellhorn pessary. A successful pessary fitting trial occurred if a woman continued to use a pessary 1 week after being fitted. Women were then divided into two groups on the basis of whether they had a successful pessary fitting trial: group 1 was successful, and group 2 was unsuccessful. Pelvic examination parameters were evaluated as risk factors for an unsuccessful pessary fitting trial. ResultsGroup 1 had 73 women, and group 2 had 27 women. A short vaginal length (≤6 cm) and a wide vaginal introitus (4 fingerbreadths accommodated) were associated with group 2 (11% vs 0%, P=.02, and 22% vs 7%, P=.04, respectively). Ring pessaries were used more with stage II and III prolapse (100% and 71%, respectively), whereas Gellhorn pessaries were used more with stage IV prolapse (64%, P<.001). ConclusionSeventy-three women (73%) with symptomatic pelvic organ prolapse had a successful pessary fitting trial. A short vaginal length and a wide vaginal introitus were risk factors for an unsuccessful pessary fitting trial. Gellhorn pessaries are more often needed with stage IV prolapse.