title: Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse.
abstract: OBJECTIVE
  The aim of this study was to investigate factors associated with long-term pessary use in patients with advanced pelvic organ prolapse (POP).
  
  
  METHODS
  This was a retrospective chart review of patients with POP of stage ≥2 managed with a pessary. Patients were excluded if the date of fitting or follow-up was unavailable. Long-term use was defined as more than 1 year. Patient demographics, pessary fitting, and follow-up visit dates were collected. The primary end point was the duration of use and the prognostic impact of pessary type. Secondary objectives addressed other influencing factors including age, estrogen use, and prolapse stage. The data were analyzed using SPSS version 21.
  
  
  RESULTS
  The final analysis included 311 patients. The mean (± standard deviation, SD) duration of pessary use was 7.0 ± 0.72 years (median 5.7 years). Long-term use was found in 76 % (164) of these patients. Factors associated with longer use were age >65 years (p = 0.004) and estrogen use (p = 0.048). The estimated mean (± SD) durations of use of the Gellhorn, open ring, ring with support, cube and donut pessaries were 10.5 ± 0.7 years, 3.4 ± 0.6 years, 1.8 ± 0.2 years, 1.8 ± 0.3 years and 1.7 ± 0.5 years, respectively. The Gellhorn pessary was associated with significantly longer use than other pessary types (10.5 ± 0.7, p < 0.0000001); this finding was independent of age, prolapse stage, hysterectomy, and vaginal estrogen use.
  
  
  CONCLUSIONS
  In this retrospective analysis, the duration of use was longest with the Gellhorn pessary. Older age and vaginal estrogen use were associated with longer pessary use.
authors.affiliation: Department of Obstetrics & Gynecology and Urology, Loyola University Medical Center, Maywood, IL, USA. birtewolff@gmail.com.|Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA. birtewolff@gmail.com.
authors.forename: Birte
authors.identifier: http://orcid.org/0000-0001-8882-0684
authors.initials: B
authors.lastname: Wolff
authors.affiliation: Division of Urogynecology, Northwell Health System, Manhasset, NY, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Williams
authors.affiliation: Division of Urogynecology, Northwell Health System, Manhasset, NY, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Winkler
authors.affiliation: Division of Urogynecology, Northwell Health System, Manhasset, NY, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lind
authors.affiliation: Division of Urogynecology, Northwell Health System, Manhasset, NY, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Shalom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Estrogen; Gellhorn pessary; Pelvic organ prolapse; Pessary