Changes in Prolapse and Urinary Symptoms after Successful Fitting of a Ring Pessary with Support in Women with Advanced Pelvic Organ Prolapse: A Prospective Study

To estimate the percentage of improvement in prolapse and urinary symptoms and adverse effects in women with advanced pelvic organ prolapse (POP) after 3 months of use of a ring pessary with support.

In this prospective study, 109 consecutive women with advanced POP were fitted with a ring pessary with support; 73 (73/109, 67. 0%) of the women had a successful 3-month pessary fitting trial. Prolapse symptoms, urinary symptoms and urinary flow parameters were assessed at baseline and at 3 months. Adverse effects were assessed with 3 months. McNemar's test and paired-sample t-tests were performed.

Prolapse and urinary symptoms improved from baseline to 3 months, including bulging (90.4% to 23.3%; P<0.001) and pressure (64.4% to 13.7%; P<0.001). Voiding difficulty improved in 97.8% of the women (45/46; P<0.001), splinting improved in 100% (19/19; P<0.001), urge urinary incontinence improved in 76.9% (30/39; P<0.001), and stress urinary incontinence improved in 58.1% (18/31; P=0.025) after 3 months. After pessary treatment, the differences in maximum flow rate, mean flow rate, void volume and post-void residual at baseline and 3 months were statistically significant (p<0.05). Vaginal discharge (32/73, 43.8%) was the most common adverse event. Vaginal ulcers developed in 7 (7/73, 9.6%) of the women.

The ring pessary with support was successfully fitted in patients with advanced POP with a high success rate and few complications. The pessary could resolve more than half of the prolapse and urinary symptoms. Therefore, initial conservative treatment with a ring pessary with support in advanced POP is worthwhile.

Urology. 2015 Sep 12 [Epub ahead of print]

Jing Ding, Chun Chen, Xiao-Chen Song, Lei Zhang, Mou Deng, Lan Zhu

Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.  Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. , Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. , Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. , Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. , Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

PubMed

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