title: Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice.
abstract: OBJECTIVE
  Pelvic organ prolapse is a common condition. There is inconsistency between predictors of unsuccessful pessary fitting in urological/gynaecological clinics. Research in general practice is scarce. The aim was to estimate the proportion of women in general practice with a symptomatic pelvic organ prolapse and unsuccessful pessary fitting, and to identify characteristics associated with unsuccessful pessary fitting.
  
  
  METHODS
  A cross-sectional study in general practice (n = 20) was carried out among women (≥55 years) with symptomatic prolapse (n = 78). Multivariate logistic regression analysis was used to identify predictors of unsuccessful pessary fitting.
  
  
  RESULTS
  In total, 33 women (42 %) had unsuccessful pessary fitting. Factors associated with unsuccessful pessary fitting were age (per year, OR 0.93 [95 % CI 0.87-1.00]), body mass index (per kg/m2, OR 1.14 [95 % CI 1.00-1.30]), and having underactive pelvic floor muscles (OR 2.60 [95 % CI 0.81-8.36]).
  
  
  CONCLUSIONS
  Pessary fitting was successful in 58 %, indicating that pessary treatment may be suitable for many, but not for all women in general practice with symptomatic prolapse. The condition of the pelvic floor probably plays a role in the success of pessary fitting, as demonstrated by the association with underactive pelvic floor muscles, and body mass index. The association with age may reflect the higher acceptance of conservative treatments for prolapse in older women. This is the first study on predictive factors for unsuccessful pessary fitting in general practice. Therefore, further research should seek to confirm these associations before we can recommend the use of this information in patient counselling.
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: Chantal M C R
authors.initials: CM
authors.lastname: Panman
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Wiegersma
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands. j.h.dekker@umcg.nl.
authors.forename: Janny H
authors.initials: JH
authors.lastname: Dekker
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000502:physiology; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome
keywords: General practice; Pelvic organ prolapse; Pessaries; Prediction; Risk factors