title: 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.
  
  
  OBJECTIVE
  To determine the effectiveness of pessaries (mechanical devices) for pelvic organ prolapse.
  
  
  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.
  
  
  METHODS
  Randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in one arm of the study.
  
  
  METHODS
  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.
  
  
  RESULTS
  To date there is only one published randomised controlled trial assessing the use of pessaries in the treatment of pelvic organ prolapse.
  
  
  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: School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.carol.bugge@stir.ac.uk.
authors: Carol
authors: C
authors: Bugge
authors: Elisabeth J
authors: EJ
authors: Adams
authors: Deepa
authors: D
authors: Gopinath
authors: Fiona
authors: F
authors: Reid
mesh_terms: D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries; D016032:Randomized Controlled Trials as Topic; D012005:Rectal Prolapse / Q000628:therapy*; D014522:Urethral Diseases / Q000628:therapy; D001745:Urinary Bladder Diseases / Q000628:therapy; D014596:Uterine Prolapse / Q000628:therapy