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A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women.
J Am Geriatr Soc. 2021 09; 69(9):2518-2523.JA

Abstract

OBJECTIVES

To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP).

DESIGN

A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week.

SETTING

The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center.

PARTICIPANTS

The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries.

MAIN OUTCOME

Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery.

RESULTS

The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion.

CONCLUSIONS

Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.

Authors+Show Affiliations

Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33979457

Citation

Gold, Ronen S., et al. "A Tailored Flexible Vaginal Pessary Treatment for Pelvic Organ Prolapse in Older Women." Journal of the American Geriatrics Society, vol. 69, no. 9, 2021, pp. 2518-2523.
Gold RS, Baruch Y, Amir H, et al. A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women. J Am Geriatr Soc. 2021;69(9):2518-2523.
Gold, R. S., Baruch, Y., Amir, H., Gordon, D., & Groutz, A. (2021). A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women. Journal of the American Geriatrics Society, 69(9), 2518-2523. https://doi.org/10.1111/jgs.17223
Gold RS, et al. A Tailored Flexible Vaginal Pessary Treatment for Pelvic Organ Prolapse in Older Women. J Am Geriatr Soc. 2021;69(9):2518-2523. PubMed PMID: 33979457.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women. AU - Gold,Ronen S, AU - Baruch,Yoav, AU - Amir,Hadar, AU - Gordon,David, AU - Groutz,Asnat, Y1 - 2021/05/12/ PY - 2021/04/24/revised PY - 2021/03/23/received PY - 2021/04/27/accepted PY - 2021/5/13/pubmed PY - 2021/11/25/medline PY - 2021/5/12/entrez KW - complications KW - efficacy KW - older women KW - patient's satisfaction KW - pelvic organ prolapse KW - vaginal pessary SP - 2518 EP - 2523 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 69 IS - 9 N2 - OBJECTIVES: To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). DESIGN: A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. SETTING: The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. PARTICIPANTS: The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. MAIN OUTCOME: Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. RESULTS: The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. CONCLUSIONS: Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/33979457/A_tailored_flexible_vaginal_pessary_treatment_for_pelvic_organ_prolapse_in_older_women_ L2 - https://doi.org/10.1111/jgs.17223 DB - PRIME DP - Unbound Medicine ER -