Factors which influence the short-term success of pessary management of pelvic organ prolapse

Abstract

Objective: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial.

Study design: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chi-square test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05.

Results: One hundred sixty-eight patients (41%) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P<.001) or known reconstructive surgery for prolapse (P=.010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit.

Conclusion: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.