title: Changes in Prolapse and Urinary Symptoms After Successful Fitting of a Ring Pessary With Support in Women With Advanced Pelvic Organ Prolapse: A Prospective Study.
abstract: OBJECTIVE
  To estimate the percentage of improvement in prolapse and urinary symptoms and adverse effects in women with advanced pelvic organ prolapse (POP) after 3 months of use of a ring pessary with support.
  
  
  METHODS
  In this prospective study, 109 consecutive women with advanced POP were fitted with a ring pessary with support; 73 (73/109, 67.0%) of the women had a successful 3-month pessary fitting trial. Prolapse symptoms, urinary symptoms, and urinary flow parameters were assessed at baseline and at 3 months. Adverse effects were assessed within 3 months. McNemar's test and paired-sample t tests were performed.
  
  
  RESULTS
  Prolapse and urinary symptoms improved from baseline to 3 months, including bulging (90.4% to 23.3%; P <.001) and pressure (64.4% to 13.7%; P <.001). Voiding difficulty improved in 97.8% of the women (45/46; P <.001), splinting improved in 100% (19/19; P <.001), urge urinary incontinence improved in 76.9% (30/39; P <.001), and stress urinary incontinence improved in 58.1% (18/31; P = .025) after 3 months. After pessary treatment, the differences in maximum flow rate, mean flow rate, void volume, and postvoid residual at baseline and 3 months were statistically significant (P <.05). Vaginal discharge (32/73, 43.8%) was the most common adverse event. Vaginal ulcers developed in 7 (7/73, 9.6%) of the women.
  
  
  CONCLUSIONS
  The ring pessary with support was successfully fitted in patients with advanced POP with a high success rate and few complications. The pessary could resolve more than half of the prolapse and urinary symptoms. Therefore, initial conservative treatment with a ring pessary with support in advanced POP is worthwhile.
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: dingdingdangdang11@126.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Ding
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xiao-Chen
authors.initials: XC
authors.lastname: Song
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Mou
authors.initials: M
authors.lastname: Deng
authors.affiliation: Departments of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: zhu_julie@vip.sina.com.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhu
mesh_terms: D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010570:Pessaries; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D014554:Urination; D013519:Urogenital Surgical Procedures / Q000379:methods*