Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse.
OBJECTIVE
Our purpose was to estimate the percentage of women with symptomatic pelvic organ prolapse who had a successful pessary fitting trial, to identify pelvic examination parameters that are associated with an unsuccessful pessary fitting trial, and to identify the most commonly used pessary for each stage of prolapse.


METHODS
In a prospective, observational study, 100 consecutive women with symptomatic pelvic organ prolapse were examined, staged, and fitted with either a ring or Gellhorn pessary. A successful pessary fitting trial occurred if a woman continued to use a pessary 1 week after being fitted. Women were then divided into two groups on the basis of whether they had a successful pessary fitting trial: group 1 was successful, and group 2 was unsuccessful. Pelvic examination parameters were evaluated as risk factors for an unsuccessful pessary fitting trial.


RESULTS
Group 1 had 73 women, and group 2 had 27 women. A short vaginal length (< or =6 cm) and a wide vaginal introitus (4 fingerbreadths accommodated) were associated with group 2 (11% vs 0%, P=.02, and 22% vs 7%, P=.04, respectively). Ring pessaries were used more with stage II and III prolapse (100% and 71%, respectively), whereas Gellhorn pessaries were used more with stage IV prolapse (64%, P<.001).


CONCLUSIONS
Seventy-three women (73%) with symptomatic pelvic organ prolapse had a successful pessary fitting trial. A short vaginal length and a wide vaginal introitus were risk factors for an unsuccessful pessary fitting trial. Gellhorn pessaries are more often needed with stage IV prolapse.
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, RI, USA. Jeffrey.Clemons@nw.amedd.army.mil
Jeffrey L
JL
Clemons
Vivian C
VC
Aguilar
Tara A
TA
Tillinghast
Neil D
ND
Jackson
Deborah L
DL
Myers
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D012307:Risk Factors; D017211:Treatment Failure; D014596:Uterine Prolapse / Q000628:therapy*; D014621:Vagina / Q000033:anatomy & histology