Vaginal pessaries in managing women with pelvic organ prolapse and urinary incontinence: patient characteristics and factors contributing to success.
OBJECTIVE
An aging population has resulted in higher prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP). This study examines a nurse-run clinic and analyzes the factors contributing to successful pessary use.


METHODS
A retrospective chart review of 1,216 patients was completed. History, pelvic examination and pessary fitting was done. Data was analyzed utilizing a categorical model of maximum-likelihood estimation to investigate relationships.


RESULTS
Median patient age was 63 years. Median number of pessaries tried was two. Eighty-five percent of post-menopausal women were on hormone replacement therapy (HRT) prior to fitting. Highest success rate of 78% was in the group on both systemic and local HRT. Success rates ranged from 58% for urge incontinence to 83% for uterine prolapse. Prior vaginal surgery was a factor impacting success. In our series highest success rates for fitting were obtained with ring pessaries, ring with support, and gellhorns.


CONCLUSIONS
This model is a viable, option for the conservative management of UI and POP. Local HRT plays an important role in successful pessary fitting. Complications are rare.
Hanson
Lesley-Ann M
LA
Department of Obstetrics and Gynecology, Urogynecology Clinic, Royal Alexandra Hospital, Women's Health Clinics, University of Alberta, 10240, Kingsway Ave, Edmonton, Alberta, Canada, T5H 3V9. lhanson@cha.ab.ca
Schulz
Jane A
JA
Flood
Catherine G
CG
Cooley
Bonita
B
Tam
Florence
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D020047:Rectocele / Q000628:therapy; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000628:therapy; D014549:Urinary Incontinence / Q000628:therapy*; D014596:Uterine Prolapse / Q000628:therapy*; D014782:Visceral Prolapse / Q000628:therapy