Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse.
OBJECTIVE
Our purpose was to estimate, in women after 2 months of pessary use, patient satisfaction and the percentage of prolapse and urinary symptoms that improve or worsen.


METHODS
In a prospective study, 100 consecutive women with symptomatic pelvic organ prolapse were fitted with a pessary, and 73 women had a successful 2-week pessary fitting trial. Prolapse and urinary symptoms were assessed at baseline and at 2 months. Patient satisfaction was assessed at 2 months. Risk factors for patient dissatisfaction were assessed.


RESULTS
Nearly all prolapse symptoms resolved from baseline to 2 months, respectively: bulge (90% to 3%; P<.001), pressure (49% to 3%; P<.001), discharge (12% to 0%; P=.003), and splinting (14% to 0%; P=.001). Among women with concurrent urinary symptoms at baseline, stress incontinence improved in 45%, urge incontinence improved in 46%, and voiding difficulty improved in 53%, after 2 months. However, among women without urinary symptoms at baseline, occult (de novo) stress incontinence occurred in 21%, de novo urge incontinence occurred in 6%, and de novo voiding difficulty occurred in 4%. At 2 months, 92% of the women were satisfied with their pessary. Six women (8%) were dissatisfied and discontinued use of the pessary. Dissatisfaction was associated with occult stress incontinence (odds ratio, 17.1; 95% CI, 1.9, 206; P=.004).


CONCLUSIONS
After 2 months, 92% of women with a successful pessary fitting trial were satisfied. Nearly all prolapse symptoms resolved after 2 months; 50% of urinary symptoms improved, but occult stress incontinence was a common side effect.
Clemons
Jeffrey L
JL
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA. Jeffrey.Clemons@nw.amedd.army.mil
Aguilar
Vivian C
VC
Tillinghast
Tara A
TA
Jackson
Neil D
ND
Myers
Deborah L
DL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010570:Pessaries; D011446:Prospective Studies; D012237:Rhode Island; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000628:therapy*; D014596:Uterine Prolapse / Q000150:complications / Q000628:therapy*