title: Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial.
abstract: OBJECTIVE
  The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP).
  
  
  METHODS
  This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1 cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3 weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher's exact test.
  
  
  RESULTS
  Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3-37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77 days (interquartile range 49-99 days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p = 0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p = 0.003).
  
  
  CONCLUSIONS
  Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 510, Los Angeles, CA, 90033, USA. dancz@usc.edu.|, 621 N. Curtis Ave., Alhambra, CA, 91801, USA. dancz@usc.edu.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Dancz
authors.affiliation: Division of Ultrasound, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Daphne
authors.initials: D
authors.lastname: Walker
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 510, Los Angeles, CA, 90033, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 510, Los Angeles, CA, 90033, USA.
authors.forename: Nuzhath
authors.initials: N
authors.lastname: Hussain
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1200 N State St IRD 510, Los Angeles, CA, 90033, USA.
authors.forename: Begüm
authors.initials: B
authors.lastname: Özel
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000628:therapy*; D010570:Pessaries; D011446:Prospective Studies
keywords: Epidemiology; Obstructive uropathy; Screening