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Pessaries (mechanical devices) for pelvic organ prolapse in women.

Abstract

BACKGROUND

Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting, although many are asymptomatic. The use of pessaries (a passive mechanical device designed to support the vagina) to treat prolapse is very common, and up to 77% of clinicians use pessaries for the first line management of prolapse. A number of symptoms may be associated with prolapse and treatments include surgery, pessaries and conservative therapies. A variety of pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery.

OBJECTIVES

To determine the effectiveness of pessaries (mechanical devices) for pelvic organ prolapse.

SEARCH METHODS

We searched the Cochrane Incontinence Group Specialised Register of trials (searched 13 March 2012), which includes searches of CENTRAL, MEDLINE, PREMEDLINE and handsearching of conference proceedings, and handsearched the abstracts of two relevant conferences held in 2011. We also searched the reference lists of relevant articles.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in one arm of the study.

DATA COLLECTION AND ANALYSIS

Abstracts were assessed independently by two authors with arbitration from a third if necessary. Data extraction was completed independently for included studies by two review authors.

MAIN RESULTS

To date there is only one published randomised controlled trial assessing the use of pessaries in the treatment of pelvic organ prolapse.

AUTHORS' CONCLUSIONS

The review authors identified one randomised controlled trial comparing ring and Gellhorn pessaries. The results of the trial showed that both pessaries were effective for the approximately 60% of women who completed the study with no significant differences identified between the two types of pessary. However, methodological flaws were noted in the trial, as elaborated under risk of bias assessment. There is no consensus on the use of different types of device, the indications nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of pessaries in comparison with no treatment, surgery and conservative measures.

Authors+Show Affiliations

School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.carol.bugge@stir.ac.uk.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23450548

Citation

Bugge, Carol, et al. "Pessaries (mechanical Devices) for Pelvic Organ Prolapse in Women." The Cochrane Database of Systematic Reviews, 2013, p. CD004010.
Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013.
Bugge, C., Adams, E. J., Gopinath, D., & Reid, F. (2013). Pessaries (mechanical devices) for pelvic organ prolapse in women. The Cochrane Database of Systematic Reviews, (2), CD004010. https://doi.org/10.1002/14651858.CD004010.pub3
Bugge C, et al. Pessaries (mechanical Devices) for Pelvic Organ Prolapse in Women. Cochrane Database Syst Rev. 2013 Feb 28;(2)CD004010. PubMed PMID: 23450548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pessaries (mechanical devices) for pelvic organ prolapse in women. AU - Bugge,Carol, AU - Adams,Elisabeth J, AU - Gopinath,Deepa, AU - Reid,Fiona, Y1 - 2013/02/28/ PY - 2013/3/2/entrez PY - 2013/3/2/pubmed PY - 2013/3/30/medline SP - CD004010 EP - CD004010 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting, although many are asymptomatic. The use of pessaries (a passive mechanical device designed to support the vagina) to treat prolapse is very common, and up to 77% of clinicians use pessaries for the first line management of prolapse. A number of symptoms may be associated with prolapse and treatments include surgery, pessaries and conservative therapies. A variety of pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery. OBJECTIVES: To determine the effectiveness of pessaries (mechanical devices) for pelvic organ prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Register of trials (searched 13 March 2012), which includes searches of CENTRAL, MEDLINE, PREMEDLINE and handsearching of conference proceedings, and handsearched the abstracts of two relevant conferences held in 2011. We also searched the reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in one arm of the study. DATA COLLECTION AND ANALYSIS: Abstracts were assessed independently by two authors with arbitration from a third if necessary. Data extraction was completed independently for included studies by two review authors. MAIN RESULTS: To date there is only one published randomised controlled trial assessing the use of pessaries in the treatment of pelvic organ prolapse. AUTHORS' CONCLUSIONS: The review authors identified one randomised controlled trial comparing ring and Gellhorn pessaries. The results of the trial showed that both pessaries were effective for the approximately 60% of women who completed the study with no significant differences identified between the two types of pessary. However, methodological flaws were noted in the trial, as elaborated under risk of bias assessment. There is no consensus on the use of different types of device, the indications nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of pessaries in comparison with no treatment, surgery and conservative measures. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/23450548/Pessaries__mechanical_devices__for_pelvic_organ_prolapse_in_women_ L2 - https://doi.org/10.1002/14651858.CD004010.pub3 DB - PRIME DP - Unbound Medicine ER -