title: How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists.
abstract: OBJECTIVE
  Gellhorn and shelf pessaries can be effective management for women with pelvic organ prolapse (POP). This study aimed to investigate the opinion of IUGA members about shelf/Gellhorn pessary use, and in particular, how often to change them in patients with POP. There are no evidence-based guidelines available on this subject.
  
  
  METHODS
  Members of the International Urogynaecology Association (IUGA) and the British Society of Urogynaecology (BSUG) were sent a single electronic mailing of semi-structured questionnaires containing closed and open questions and free text response boxes. The internet-based survey consisted of 13 questions. Free text responses were analysed using a thematic qualitative analysis.
  
  
  RESULTS
  A total of 322 respondents from the IUGA membership participated in the survey. Most consider shelf/Gellhorn pessaries an effective first-line treatment for their patients with POP. Self care is usually acceptable with ring pessaries, but with shelf/Gellhorn, 35 % would like to change them every 3 months, 31 % every 6 months and the rest varied. The routine use of oestrogens along with shelf/Gellhorn pessaries is a common practice. The risk of urogenital fistulae is well documented, but overall clinicians felt that shelf/Gellhorn pessaries are a safe and effective treatment for POP.
  
  
  CONCLUSIONS
  This study highlights the wide variation in global practice of the management of shelf/Gellhorn pessaries for POP. In order to inform our practice, evidence-based guidelines are required. A randomised control trial may help to decide whether or not it is appropriate to change the shelf/Gellhorn pessaries at all.
authors: Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, Derriford Hospital, Plymouth, PL6 8DH, UK, Afshan.khaja@nhs.net.
authors: A
authors: A
authors: Khaja
authors: R M
authors: RM
authors: Freeman
mesh_terms: D001291:Attitude of Health Personnel; D020878:Device Removal; D005260:Female; D006176:Gynecology; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries / Q000009:adverse effects / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014572:Urology