Vaginal Pessary in Women With Symptomatic Pelvic Organ Prolapse: A Randomized Controlled Trial.
OBJECTIVE
To compare pelvic floor symptoms, quality of life, and complications in women with symptomatic pelvic organ prolapse (POP) with or without vaginal pessaries in addition to those who do pelvic floor exercises for 12 months.


METHODS
This was a parallel-group, single-blind, randomized controlled trial with 12 months of follow-up. Women with symptomatic stage I to stage III POP were randomized to either pelvic floor exercises training (control group) or pelvic floor exercises training and insertion of a vaginal pessary (pessary group). The primary outcome was the change of prolapse symptoms and quality of life by using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaires. Secondary outcomes included bothersome of prolapse symptoms, desired treatment, and any complications.


RESULTS
From December 2011 through November 2014, 311 women were screened and 276 were randomized as follows: 137 to the control and 139 to the pessary group. One hundred thirty-two (95.0%) women in the pessary group and 128 (93.4%) in the control group completed the study. The Pelvic Organ Prolapse Distress Inventory of Pelvic Floor Distress Inventory and the Pelvic Organ Prolapse Impact Questionnaire of Pelvic Floor Impact Questionnaire scores decreased in both groups after 12 months, but the mean score differences were higher in the pessary group (Pelvic Organ Prolapse Distress Inventory: -29.7 compared with -4.7, P<.01; Pelvic Organ Prolapse Impact Questionnaire: -29.0 compared with 3.5, P<.01). Complication rates were low and similar in both groups.


CONCLUSIONS
We provided further evidence in nonsurgical treatment for POP. Prolapse symptoms and quality of life were improved in women using a vaginal pessary in addition to pelvic floor exercises.


BACKGROUND
Centre for Clinical Research and Biostatistics-Clinical Trials Registry, https://www2.ccrb.cuhk.edu.hk/web/?page_id=746, ChiCTR-TRC-11001796.
Department of Obstetrics & Gynaecology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR.
Rachel Y K
RY
Cheung
Jacqueline H S
JH
Lee
L L
LL
Lee
Tony K H
TK
Chung
Symphorosa S C
SS
Chan
D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D010570:Pessaries / Q000009:adverse effects*; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods; D016896:Treatment Outcome