INTRODUCTION AND OBJECTIVE:
Pessaries have resurfaced as a viable non-surgical treatment option in recent years in light of complications associated with mesh for surgical treatment of SUI. While the efficacy of pessaries in SUI has been studied, few high-quality studies with large cohorts exist. The purpose of this systematic review and meta-analysis is to synthesize existing evidence to determine short-term efficacy of pessaries for SUI using patient reported outcomes (PROs) and objective measures.
This review was approved by the PROSPERO database (CRD42020191677). PubMed, EMBASE and CINAHL were searched using the MeSH terms “stress urinary incontinence” and “pessary, pessaries or pessarium”. Studies were either randomized control trials, prospective cohort studies, prospective observational studies, retrospective cohort studies that included PROs or objective urodynamic data. Studies on pregnant women, pediatric populations, electronic pessaries and women using pessaries for indications other than SUI were excluded. The search yielded 612 unique articles, of which 14 studies were included in the analysis. Primary outcomes were PROs, such as feeling continent, the Urogenital Distress Inventory (UDI), and the Incontinent Impact Questionnaire (IIQ). Secondary outcomes included objective measures such as the pad test, post-void residual (PVR), urethral closure pressure, and pessary continuation rates.
Participants were aged 51.4±4.1yr (n=915, mean±SD) and primarily Caucasian (67%). At baseline, parity was 2.1±0.5 (n=615), 46.36% were postmenopausal (n=732), 8.04% had undergone prior UI surgery was (n=734), and 25.34% had undergone prior nonsurgical UI treatment (n=592). After pessary treatment, 76% (n=72) of women reported feeling continent compared to 0% at baseline (n=86) (p<0.0001). Furthermore, UDI scores decreased by 46.7% (n=160, p<0.0001), and IIQ scores decreased by 67.8% (n=118, p < 0.0001). At 1.5-6 months follow-up, 78% of women continued to use the pessary (n=124, p<0.0001), pad weight decreased by 57.6% (n=68, p<0.0001), and urethral closure pressure increased by 33.8% (n=122, p<0.0001). PVR increased by 17.1%, although not significantly (n=125, p=0.0550). Meta analysis demonstrated an overall medium effect size for increase in UCP from baseline to follow up (N=122) of Hedges’ g=0.56 [95% confidence interval (CI) -0.66-1.77, z=1.97, p=0.049.
Pessaries offer an effective alternative for patients who desire conservative treatment of SUI. This systematic review and meta-analysis demonstrates that pessaries are effective in the non-surgical treatment of SUI.
Source of Funding: