Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse

Int Urogynecol J. 2018 Aug;29(8):1123-1128. doi: 10.1007/s00192-017-3445-x. Epub 2017 Aug 16.

Abstract

Introduction and hypothesis: To ascertain the rate of discontinuation after vaginal pessary use among pelvic organ prolapse patients.

Methods: We enrolled women suffering from pelvic organ prolapse who opted to use vaginal pessary as the first line of treatment and were fitted with a pessary at the urogynecological clinic in Khon Kaen University's Srinagarind Hospital (Thailand) during the period between 2010 and 2016. Patients' medical records were retrospectively reviewed. Patients were contacted by telephone if there were missing data or if more information was required.

Results: One hundred and forty women were included. The median age was 71.5 years (interquartile = 65.0, 77.0) and normal vaginal parity was 4.0 (interquartile =3.0, 6.0). The mean ± SD of BMI was 23.5± 3.6 kg/m2. Most of the women enrolled in the study (97.9%) were postmenopausal and many were at an advanced stage of prolapse (73.6%). Support pessaries were the most common treatment (95.0%). The discontinuation rate of pessary use after 1 year was 16.1%. The most common reason for discontinuing the vaginal pessary was frequent expulsion (26.3%). Abnormal vaginal discharge was the most common adverse effect after pessary insertion (17.1%). Lower BMI and history of hysterectomy were the significant risk factors for discontinuation of pessary use (0.76 [95%CI 0.62-0.93] and 15.89 [95%CI 1.67-151.02] respectively).

Conclusions: The discontinuation rate of pessary use in the case of pelvic organ prolapse was low after 1 year. Abnormal vaginal discharge was the most common adverse side effect. Lower BMI and history of hysterectomy were factors significantly associated with the discontinuation.

Keywords: Adverse effects; Discontinuation rate; Pelvic organ prolapse; Vaginal pessary.

MeSH terms

  • Aged
  • Female
  • Humans
  • Patient Compliance*
  • Pelvic Organ Prolapse / complications
  • Pelvic Organ Prolapse / therapy*
  • Pessaries / adverse effects*
  • Pessaries / statistics & numerical data
  • Retrospective Studies
  • Thailand
  • Time Factors
  • Treatment Outcome