title: A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands: identifying needs for further research.
abstract: OBJECTIVE
  To identify practice variation in management of patients with a vaginal pessary for pelvic organ prolapse (POP).
  
  
  METHODS
  A nationwide survey was sent to all Dutch gynecologists with a special interest in urogynecology.
  
  
  RESULTS
  The response rate was 59 %. Of the respondents, 13 % had a written protocol for pessary treatment in their department. Pessary treatment was proposed by 69 % of respondents as a treatment option. Counseling about side effects varied. All respondents provided information concerning the possibility of serious vaginal discharge. Concerning this side effect, 15 % of the respondents stated that it occurs in 5 - 20 % of patients, 27 % that it occurs in 20 - 40 % of patients, and 57 % that it occurs in more than 40 % of patients. Another item concerned counseling for the likelihood of vaginal blood loss. All respondents provided information concerning the possibility of vaginal blood loss. Concerning this side effect, 53 % of the respondents stated that it occurs in 5 - 20 % of patients, 33 % that it occurs in 20 - 40 %, and 14 % that it occurs in more than 40 % of patients. Follow-up after initial placement was done by 69 % of the respondents at 2 - 6 weeks, by 2 % at 8 weeks, and by 29 % at 12 weeks or more. Most (98 %) of the respondents extended the interval between visits when the patient had no complaints, and 96 % of the respondents reported that they routinely instruct patients about self-management.
  
  
  CONCLUSIONS
  Pessaries are suggested as a treatment option by a majority of gynecologists, but practice varies widely. We consider that the variation in practice is due to a lack of available protocols and lack of evidence.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.velzel@amc.nl.|Department of Obstetrics and Gynecology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands. j.velzel@amc.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Velzel
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Roovers
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Van der Vaart
authors.affiliation: Department of Obstetrics and Gynecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Broekman
authors.affiliation: Department of Obstetrics and Gynecology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Vollebregt
authors.affiliation: Department of Obstetrics and Gynecology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Hakvoort
mesh_terms: D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: Pessary; Prolapse; Prolapse management; Survey