Factors associated with long-term pessary use in women with symptomatic pelvic organ prolapse

Abstract

Objectives: This study aimed to evaluate the continuation rate and identify the factors associated with long-term pessary use, which are essential for counseling women with symptomatic pelvic organ prolapse (POP) seeking long-term pessary treatment.

Methods: This prospective observational study included 277 patients who had successful pessary fittings between April 2015 and November 2016. All patients were followed until April 2018. Data analysis was performed with independent-samples t-tests, non-parametric tests, chi-square tests, and logistic regression.

Results: The median (range) follow-up time was 26 (17–36) months; 76.5% of patients continued to use pessaries at the study endpoint. Sixty-one patients discontinued pessary use, and almost all of them (55/61, 90.2%) discontinued pessary use within the first 12 months after successful pessary fitting. A total vaginal length (TVL) < 7.5 cm (odds ratio [OR], 0.181; 95% confidence interval [CI], 0.062–0.524; p = 0.002) and a lower baseline Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) score (OR, 0.974; 95% CI, 0.954–0.994; p = 0.013) were independent factors associated with pessary discontinuation.

Conclusion: TVL ≥ 7.5 cm and a higher baseline POPDI-6 score were independent factors associated with long-term pessary use after successful fitting in women with symptomatic POP.

Chinese abstract

目的：本研究旨在评估长期使用子宫托的持续率以及相关影响因素, 这对于有症状的盆腔器官脱垂（POP）患者寻求长期子宫托的治疗至关重要。

方法：本项前瞻性观察研究纳入了在2015年4月至2016年11月期间成功使用子宫托的277例患者。所有患者随访至2018年4月。采用独立样本t检验、非参数检验、卡方检验和logistic回归进行数据分析。

结果：随访时间的中位数为26（17-36）个月；76.5%的患者在研究终点时仍在使用子宫托。61例患者停止使用, 这些患者中有55例患者（55/61, 90.2%）是在使用子宫托的12个月内停止使用的。总阴道长度（TVL）<7.5cm（OR值, 0.181；95%可信区间, 0.062- 0.524；P < 0.002）和基线盆腔器官脱垂6（POPDI-6）评分低（OR, 0.974；95%可信区间, 0.954-0.994；P < 0.013）是与影响子宫托不能持续使用的独立危险因素。

结论：TVL ≥ 7.5cm和较高的基线POPDI-6评分是合并症状的盆腔器官脱垂女性长期持续使用子宫托的独立相关因素。

Keywords:

• Symptomatic pelvic organ prolapse
• vaginal pessary
• long-term use
• factor

Acknowledgements

The authors thank all who participated in the interviews to help us better understand symptomatic POP and long-term vaginal pessary use.

Conflict of interest

The authors report no conflicts of interest.

Source of funding

This work was supported by the CAMS Initiative for Innovative Medicine (CAMS-I2M) [Grant number 2017-12M-1-002].