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International Urogynecology Consultation Chapter 3 Committee 1 - Pessary Management.

Angie Rantell1, Zeelha Abdool2, Morgan E Fullerton3

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International Urogynecology Journal
|January 28, 2025
PubMed
Summary

Pessaries effectively manage pelvic organ prolapse (POP) symptoms for many women, but success depends on individual factors. More research is needed on pessary selection, training, and patient education for optimal outcomes.

Keywords:
Pelvic organ prolapsePessaryVaginal device

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Area of Science:

  • Urogynecology
  • Pelvic Health
  • Medical Device Management

Background:

  • Pelvic Organ Prolapse (POP) is a common condition affecting women's quality of life.
  • Pessary management is a primary conservative treatment option for POP.
  • International guidelines emphasize the need for standardized pessary care.

Purpose of the Study:

  • To review the current literature on pessary management for Pelvic Organ Prolapse (POP).
  • To identify factors influencing pessary fitting success, continuation rates, and associated complications.
  • To highlight gaps in knowledge regarding pessary selection, training, and patient education.

Main Methods:

  • A comprehensive narrative review of 540 articles was conducted.
  • 313 relevant studies on POP and pessary use were included.
  • Literature search utilized MeSH terms related to POP and pessary devices.

Main Results:

  • Pessary fitting success rates range from 41% to 96.6%, with continuation rates varying widely.
  • Successful pessary use significantly improves symptoms like vaginal bulge, pressure, and obstructive voiding.
  • Predictors of failure include prior surgery and posterior compartment involvement; older age and self-management support aid continuation.
  • Serious complications are rare but linked to neglected maintenance.
  • Significant gaps exist in evidence for pessary selection, preventative measures, and standardized training/education.

Conclusions:

  • Pessary use is effective for managing POP symptoms, with varied success and continuation rates.
  • While effectiveness is established, critical knowledge gaps remain in provider training, patient education, and evidence-based selection criteria for pessaries.
  • Further research is essential to optimize pessary provision and management, ensuring better patient outcomes and reducing complications.