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

Abstract

Objective: 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).

Design: Prospective observational study.

Setting: The Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China.

Population: Women with symptomatic POP between May 2015 and December 2016 (n = 343).

Methods: A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting and continued use 2 weeks 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.

Main outcome measures: The success rate of vaginal pessary fitting and the risk factors associated with unsuccessful pessary fitting.

Results: 302 patients had successful pessary fitting (88.0% success rate). A higher body mass index [BMI; 24.7 ± 3.1 kg/m² in the successful group versus 25.7 ± 3.8 kg/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 7.3 cm had a higher unsuccessful pessary fitting rate (sensitivity = 0.82, specificity = 0.64).

Conclusions: A higher BMI and shorter TVL were independent predictors of an unsuccessful pessary fitting. Patients with a TVL <7.3 cm are not appropriate candidates for a vaginal pessary.

Tweetable abstract: A higher BMI and shorter TVL (<7.3 cm) were independent predictors of an unsuccessful pessary fitting.

Keywords: Predictor; symptomatic pelvic organ prolapse; unsuccessful pessary fitting.