Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study

To evaluate the success rate of vaginal pessary fitting and identify the risk factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP).

Prospective observational study.

The Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China.

Women with symptomatic POP between May 2015 and December 2016 (n = 343).

A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting and continued use 2 weeks later. The independent samples t-test, non-parametric test, Chi-square test, Fisher's exact test, logistic regression and receiver operating characteristic curves were used for the data analysis.

The success rate of vaginal pessary fitting and the risk factors associated with unsuccessful pessary fitting.

302 patients had successful pessary fitting (88.0% success rate). A higher body mass index [BMI; 24.7 ± 3.1 kg/m² in the successful group versus 25.7 ± 3.8 kg/m² in the unsuccessful group, odds ratio (OR) 1.174, 95% CI 1.055-1.307, P = 0.003] and a shorter TVL [8.0 (8-9) cm in the successful group versus 7.0 (6.8-8) cm in the unsuccessful group, OR 0.338, 95% CI 0.223-0.513, P < 0.001) were independent predictors of an unsuccessful pessary fitting. The receiver operating characteristic curve showed that patients with a total vaginal length (TVL) less than 7.3 cm had a higher unsuccessful pessary fitting rate (sensitivity = 0.82, specificity = 0.64).

A higher BMI and shorter TVL were independent predictors of an unsuccessful pessary fitting. Patients with a TVL <7.3 cm are not appropriate candidates for a vaginal pessary.

A higher BMI and shorter TVL (<7.3 cm) were independent predictors of an unsuccessful pessary fitting.