Objectives: To identify clinical characteristics and quality of life/symptom questionnaire scores associated with unsuccessful vaginal pessary trials in the treatment of pelvic organ prolapse (POP).
Methods: This was a retrospective study of pessary fittings between 2006 and 2012 at our tertiary care urogynecology unit. One hundred one patients with symptomatic POP filled out detailed history and validated pelvic floor quality-of-life and symptom questionnaires at baseline. They were examined and POP was staged. After discussion of treatment options, they agreed to attempt a trial of pessary (TOP). Unsuccessful TOP was defined as an inability to continue pessary use beyond 4 weeks from initial fitting. Stepwise logistic regression analysis was performed to build a prediction model for the odds of unsuccessful TOP.
Results: The main reason for unsuccessful TOP was patient discomfort. Multivariate stepwise logistic regression showed that age 65 or younger (odds ratio [OR], 3.13; P = 0.042), smoking history (OR, 3.42; P = 0.049), genital hiatus/total vaginal length ratio greater than 0.8 (OR, 6.70; P = 0.042), and lower POP Quantification overall stage (OR, 2.84; P = 0.017) were associated with increased likelihood of unsuccessful TOP. Other variables such as sexual activity and concurrent urinary or POP symptoms did not affect the outcome.
Conclusions: Several clinical characteristics influenced the likelihood of unsuccessful TOP. These may be taken into account for clinical counseling. Pessaries remain a good treatment option, as many clinical variables did not seem to influence the success of fittings.
Younger age, smoking history, vaginal dimensions and decreasing magnitude of prolapse predicted an unsuccessful trial of pessary. Pessaries remain a good option for treatment of prolapse, as many variables did not influence the success of fitting.
From the University of British Columbia, Vancouver, Canada.
Reprints: Roxana Geoffrion, MD, Urogynecologist, Department of Obstetrics and Gynecology, University of British Columbia, St. Paul’s Hospital, 1190, 4th Floor, Hornby St, Vancouver, BC V6Z 2K5, Canada. E-mail: firstname.lastname@example.org.
The University of British Columbia Summer Student Research Program/Providence Health Care Research Institute provided grant for medical student Tina Zhang.
The authors have declared they have no conflicts of interest.