Use of vaginal pessary in women with symptomatic pelvic organ prolapse: Risk factors for failure one year after...

Vaginal pessaries are offered as a first-line treatment for symptoms associated with pelvic organ prolapse (POP). The objective of our study was to identify risk factors for failure of pessary use within 1 year of insertion.

We prospectively included women who accepted a pessary fitting for symptomatic POP. Symptoms and quality of life were assessed at inclusion, 1 month, 6 months, and 1 year after insertion using validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12, USP and PFIQ-7). Patient satisfaction was assessed by the PGII score. Pessary failure was defined as stopping pessary use during the period.

Of the 206 women included, 175 had available results at 1 year. Of these, 70 (40.0 %) had pessary failure and 105 (60.0 %) were still wearing the pessary. The overall PFDI-20 symptom score and its subscores were significantly improved as early as 1 month after pessary insertion. Factors associated with pessary failure at 1 year were: a younger age at insertion (RR_{5 years increase} = 0.93, 95 %CI = 0.86-0.99; p = 0.047); history of prolapse surgery (RR = 1.92, 95 %CI = 1.34-2.75; p < 0.001); and higher PFDI-20 score before insertion (RR = 1.04, 95 %CI = 1.01-1.07); p = 0.015). Clinical factors associated with failure were: a wide genital hiatus (GH) (RR = 1.25, 95 %CI = 1.06-1.48; p = 0.0077); short total vaginal length (TVL) (RR = 1.30, 95 %CI = 1.04-1.62; p = 0.019); high GH/TVL ratio (RR = 1.27, 95 %CI = 1.15-1.41; p < 0.001); and presence of a POP-Q stage ≥ 2 rectocele (RR = 1.51, 95 %CI = 1.05-2.18; p = 0.025). The 1-year satisfaction rate of users was high with 89.9 % reporting being improved or very improved, and 85.7 % planning to continue pessary use for 5 years or more.

The vaginal pessary is an effective treatment for women with symptomatic POP and improves their quality of life. Risk factors for pessary failure are diverse but clinical characteristics such as a large GH or short TVL seem to be associated with pessary failure due to higher expulsion rates. Satisfaction at 1 year is high among pessary users.