SUFU 2021: The Role of Pessaries in the Treatment of Women with Stress Urinary Incontinence: A Systematic Review

( Vaginal pessaries are a viable non-surgical treatment option especially as complications associated with mesh used in the surgical treatment of stress urinary incontinence (SUI) are of concern to providers and women.

This is a systematic review and meta-analysis to synthesize existing evidence to determine the short-term efficacy of pessaries for SUI using patient-reported outcomes (PROs) and objective measures. The search yielded 612 unique articles, of which 14 studies were included in the analysis. Primary outcomes were PROs, such as feeling continent, the Urogenital Distress Inventory (UDI), and the Incontinent Impact Questionnaire (IIQ). Secondary outcomes included objective measures such as the pad test, post-void residual (PVR), urethral closure pressure, and pessary continuation rates. Participants were aged 51.4±4.1yr (n = 915, mean±SD) and primarily Caucasian (67%). At baseline, parity was 2.1±0.5 (n=615), 46.36% were postmenopausal (n=732), 8.04% had undergone prior UI surgery was (n=734), and 25.34% had undergone prior nonsurgical UI treatment (n=592).

After pessary treatment, 76% of women reported feeling continent (compared to 0% at baseline, n=154 at follow-up, p< 0.0001). Pessary use resulted in significant improvements in pad weight test and urethral closure pressure. Continuation rates were impressive (at short-term [78%], long-term [51%] follow up). As expected, pain and discomfort were significant side effects of pessary use, however, the severity and if they affected continuation of pessary use is not clear. Pessaries were also associated with a low incidence of pain and discomfort. Pessaries offer an effective alternative for patients who desire conservative treatment of SUI. 

Presented by: Julia Klein, Michelina Stoddard, Bills Chughtai, Weill Cornell Medicine, Department of Urology, Weill Medical College of Cornell University

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting