番茄社区

Most women stuck with 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 with pessary treatment -- either with a ring or Gellhorn pessary -- 5 years after initial fitting, reported Lan Zhu, MD, of Peking Union Medical College Hospital in Beijing, and colleagues.

Appearing in , the journal of the North American Menopause Society (NAMS), the researchers pinpointed certain factors that were tied to a higher chance of women discontinuing pessary treatment.

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

"Current guidelines and recommendations suggesting that women with symptomatic POP should be offered a vaginal pessary as an alternative to surgery are based on its effectiveness in short- and intermediate-term studies," Zhu's group pointed out, adding that the prevalence of POP is expected to due to rising obesity rates among the aging population.

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

"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 may obviate the need for pelvic reconstructive surgery," said NAMS medical director Stephanie Faubion, MD, MBA, of the Mayo Clinic in Rochester, Minnesota, in a statement.

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

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

Over each year, discontinuation rates decreased -- falling from 8.7% during the first year to 2.7% by the fifth year. The majority of patients who discontinued pessary use within the first 2 years subsequently opted for surgery.

Vaginal erosion was the most common complication of pessary treatment, although this only occurred in 16% of women and typically resolved within a week or two. There were no reports of fistulas or other severe complications.

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