Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study

• Published in: International Urogynecology Journal Vol. 30; no. 12; pp. 2161 - 2169
• Main Authors: Miceli, Alessio, Dueñas-Diez, José-Luis
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2019; Springer Nature B.V
• Subjects: Aged; Cohort analysis; Contraceptive Devices, Female; Female; Gynecology; Health risk assessment; Humans; Hypotheses; Hysterectomy, Vaginal; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Pessaries; Prospective Studies; Severity of Illness Index; Surgery; Treatment Outcome; Urology; Efficacy; Vaginal hysterectomy; Advanced pelvic organ prolapse; Adverse events; Ring pessary without support
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-019-03919-8

Introduction and hypothesis This study aimed to evaluate the efficacy of the ring pessary compared with surgery as a primary treatment for advanced pelvic organ prolapse (POP) in non-hysterectomized, postmenopausal women. Our starting hypothesis was that the pessary is as effective as and less risky than surgery. Methods This study was a prospective observational study, which recruited 171 women with symptomatic advanced POP in a tertiary hospital for 30 months. They were treated according their preference with either surgery [77/171 (45.0%)] or vaginal ring pessary without support [94/171 (55.0%)]. The primary outcomes included the discontinuation of pessary use and the incidence of recurrent prolapse throughout the study. Secondary outcomes included complications categorized according to Clavien-Dindo classification. Descriptive statistics were used for demographic data. The mean and standard deviation were calculated for continuous variables, and continuity correction tests, Mann-Whitney U tests, and Fisher’s exact tests were used for categorical variables. Results There was successful use of a pessary in 84.4% (76/90) of cases, and 89.6% (69/77) of patients did not have prolapse recurrence in the surgical group (>POP-Q 2). In the pessary group, the adverse event rate was 31.6%, and all were Clavien-Dindo grade I. Thirty patients [30/77 (39.0%)] had complications in the surgery group: 14.3% were Clavien-Dindo grade I (11/77), 10.4% were grade II (8/77), and 14.3% were grade III (11/77). Conclusions The pessary is effective and has mild adverse events in non-hysterectomized, postmenopausal women with advanced POP.