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Pessaries are moderately effective for the treatment of female pelvic organ prolapse
Clinical Question
Is use of a pessary an effective treatment for female pelvic organ prolapse?
Bottom line
The use of a pessary to treat female POP results in a clinically meaningful and statistically significant reduction in symptoms. These findings are limited by the observational nature of the majority of studies included in the meta-analysis, a limited success rate in pessary fitting, and substantial abandonment of pessary use over time. 2a-
Reference
Study design: Meta-analysis (other)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These authors conducted a meta-analysis of studies that addressed the treatment of female pelvic organ prolapse (POP) using pessaries. The authors included 6 prospective observational studies and 2 randomized controlled trials, for a total of 627 participants, most with stage III POP. Studies were included if they assessed commonly used patient-reported metrics both before and after treatment, using 1 (or more) of 6 validated questionnaires to measure symptoms related specifically to POP. Exclusion criteria were the inclusion of patients younger than 18 years or pregnant patients, and the use of pessaries for treatment of conditions other than POP. Meta-analyses were performed for each of the questionnaires and showed statistically significant improvement that was also clinically relevant. For example, at the first follow-up visit, usually at 3 months of treatment, the Pelvic Floor Distress Inventory — Short Form 20 (scale 0–300) showed a mean change in symptom severity of -46 (CI -65 to -27). Studies varied in length and showed abandonment rates that were usually higher with longer follow-up. Of note, adverse events were common, including vaginal discharge (in 24% of participants), development of urinary incontinence (27%), and vaginal irritation or bleeding (15%). Another caveat is that in studies that reported success in fitting, the rates of unsuccessful fitting varied (42%, 15%, and 28%).
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Historical from mid 70's when rings(pessaries) were first li
As a retired practioner, and one with a pure science background in statistics as well as all of the undergrad medical disciplines - and entering practice in the late 70's - we railed against observational studies too.
Pessaries, though we called them rings, were amongst our first line treatments. Maybe THE first.
There is a potential bias in that those success rates are abnormally GOOD, even for practitioners performing the placement as a first line. The drop out rate for practitioners continuing to perform placement was much higher, let alone successful placement. These are abnormally efficient practitioners.
The side effects were obvious to everyone of my genre.
Curious, and unbelieved by many, we haven't actually advanced very far in over 5 decades!
A simple comment. I still have a set of fitting rings sitting on the top shelf of my office. Over decades of practice I have shown these to my colleagues and students, and asked if anyone knew what they were. So far, they haven't been recognised by a single person! Qualified or not. (I'm excluding specialists - and they find the original rings fascinating)
fpop common
pessaries helpfull