Evaluation of vaginal pessary management: a UK-based survey

The use of intravaginal pessaries has been proven integral in the conservative treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). Although there is no shortage of studies supporting the efficacy of intravaginal devices for conservative management of POP and UI and a large variety of pessaries are widely used in the UK, data on the clinical practice and recommended changing intervals are lacking. To evaluate the current clinical practice and management of patients with vaginal pessaries, self-administered questionnaires were mailed to all UK-based consultant obstetricians and gynaecologists. A total of 640 out of 1,173 (54.6%) clinicians approached returned the questionnaire, out of which 555 (86.7%) used vaginal pessaries. A total of 129 out of 555 (23.3%) clinicians claimed to change their patients pessaries every 3-6 months; 372 (67.0%) every 6 months and 54 (9.7%) reported a frequency of 6-12 months before changing the device. Complication rates of 40.3%, 35.2% and 18.5% were observed by clinicians performing 3-6 monthly, 6-monthly and up to 12-monthly changing intervals. Discontinuation of pessary use was related to recurrent involuntary expulsion in 54.0% (268/496), discomfort (27.4%, 136/49), vaginal bleeding and infection (7.8%, 39/496 clinicians) and dislike of the changing procedure (10.7%, 53/496). Changing intervals greatly vary between clinicians all over the country. The lack of differences in proportions of complications observed in 3-monthly and even up to 12-monthly observation periods suggest that 6-monthly and probably up to 12-monthly intervals represent a safe and cost-effective regimen to follow-up patients with vaginal pessaries.