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. 2024 Sep;35(9):1797-1805.
doi: 10.1007/s00192-024-05864-7. Epub 2024 Jul 24.

The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse-A retrospective cohort study

Evy Paulussen  1   2 , Renée Börger  3   4   5 , Hugo van Eijndhoven  6 , Marian Engberts  6 , Pieternel Steures  7 , Mirjam Weemhoff  2
Affiliations

The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse-A retrospective cohort study

Evy Paulussen et al. Int Urogynecol J. 2024 Sep.

Abstract

Introduction and hypothesis: This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM).

Methods: A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation.

Results: A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01).

Conclusions: Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.

Keywords: Conservative treatment; Pelvic organ prolapse; Pessary; Self-management; Urogynaecology.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Patient flow. *Successful fitting was stated when the pessary remained properly in place and the patient wished to continue pessary therapy. PSM pessary self-management
See this image and copyright information in PMC

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