Vaginal pessary Viable alternative to surgery for a weak pelvic floor

Most women underwent pessary treatment for symptomatic pelvic organ prolapse (POP), according to a long-term study.

In a prospective study of 312 Chinese women with symptomatic POP, 75% continued pessary treatment – either with a ring or Gellhorn pessary – 5 years after the initial fitting, reported Lan Zhu, MD, of the Peking Union Medical College Hospital in Beijing, and colleagues.

Appearing in Menopause, the journal of the North American Menopause Society (NAMS), researchers identified certain factors that were linked to a higher likelihood for women to stop pessary treatment.

These included a vaginal length less than 7.5 cm (OR 2.7, 95% CI 1.3-5.7, P= 0.007) and unable to take care of themselves (OR 2.6, 95% CI 1.3-5.1, P= 0.008). In addition, a less than 50% improvement in Urinary Impact Questionnaire-7 scores at month 3 after initial fitting was also associated with a significantly higher chance of discontinuation (OR 2.1, 95% CI 1.1-4.2, P= 0.025).

“The current guidelines and recommendations suggesting that women with symptoms of POP should be offered a vaginal pessary as an alternative to surgery are based on its effectiveness in short- and medium-term studies,” Zhu’s group pointed out, adding that the prevalence of POP is expected. increase by 46% by 2050 in the United States due to rising obesity rates among the aging population.

The group said that if healthcare providers are aware of specific predictors of long-term pessary discontinuation, they can help determine which patients are best suited for surgery.

“This study highlights the efficacy and long-term acceptability of pessaries for women with symptomatic pelvic organ prolapse, positioning them as a simple and safe solution that can avoid the need for pelvic reconstructive surgery.” NAMS Medical Director Stephanie Faubion, MD, MBA, of the Mayo Clinic in Rochester, Minnesota, said in a statement.

This review included women with symptomatic primary or recurrent POP who were offered one of three treatment options: pelvic floor muscle training, pessary, or surgery. Women with stage II POPs were usually offered strength training, while those with stage III or IV POPs were advised to opt for pessary treatment.

The final analysis included a total of 265 postmenopausal women with successful pessary fitting from November 2013 to July 2015. They were first fitted with a ring (77%), but were replaced with a Gellhorn pessary if the ring was uncomfortable (23%). Almost no participant was using systemic estrogen or topical vaginal hormone therapy prior to pessary treatment.

Each year, dropout rates have declined – from 8.7% in the first year to 2.7% in the fifth year. The majority of patients who stopped using the pessary within the first 2 years then opted for surgery.

Vaginal erosion was the most common complication of pessary treatment, although it only occurred in 16% of women and usually resolved within a week or two. There have been no reports of fistulas or other serious complications.