Self-care Pessary Management and Factors Associated With Long-Term Pessary Use

Lucy Olson; Heather Winn; Irene Morcuende; Rene R Genadry; Joseph T Kowalski; Catherine S Bradley

doi:10.1097/SPV.0000000000001839

There is limited evidence on predictors and complications of long-term pessary use and how outcomes vary by management strategy.IMPORTANCEThere is limited evidence on predictors and complications of long-term pessary use and how outcomes vary by management strategy.The objectives of this study were to compare outcomes of pessary self-care (SC) versus office-based care (OC) and identify factors associated with long-term pessary use in patients with pelvic organ prolapse (POP).OBJECTIVESThe objectives of this study were to compare outcomes of pessary self-care (SC) versus office-based care (OC) and identify factors associated with long-term pessary use in patients with pelvic organ prolapse (POP).We conducted a retrospective cohort study of patients fitted with a pessary for POP and with >3 months of use between 2008 and 2017. Patients were classified by pessary management strategy (SC vs. OC) and duration of use. Patient characteristics, complications, and reasons for discontinuation were compared between groups using bivariable and multivariable analyses.STUDY DESIGNWe conducted a retrospective cohort study of patients fitted with a pessary for POP and with >3 months of use between 2008 and 2017. Patients were classified by pessary management strategy (SC vs. OC) and duration of use. Patient characteristics, complications, and reasons for discontinuation were compared between groups using bivariable and multivariable analyses.The study included 275 patients who used a pessary for a median of 17.1 (range: 3-110) months. Of 268 with follow-up, 89 (33%), 107 (40%), and 72 (27%) used the pessary for <1 year, 1-<3 years, and ≥3 years, respectively. Most (77%) performed SC. SC users were healthier, younger, more sexually active, and had less advanced POP than OC users (all P≤0.01). SC users had fewer space-occupying pessaries (61 (28.6%) vs 40 (64.5%), P<0.001), though many self-managed Gellhorn (n=50), cube (n=10) and donut (n=1) pessaries. SC users had a similar duration of use to OC users but fewer vaginal erosions and office visits (both P<0.001). Duration of use was not associated with management. In multivariable models, increasing age predicted longer use, and pulmonary disease predicted shorter use.RESULTSThe study included 275 patients who used a pessary for a median of 17.1 (range: 3-110) months. Of 268 with follow-up, 89 (33%), 107 (40%), and 72 (27%) used the pessary for <1 year, 1-<3 years, and ≥3 years, respectively. Most (77%) performed SC. SC users were healthier, younger, more sexually active, and had less advanced POP than OC users (all P≤0.01). SC users had fewer space-occupying pessaries (61 (28.6%) vs 40 (64.5%), P<0.001), though many self-managed Gellhorn (n=50), cube (n=10) and donut (n=1) pessaries. SC users had a similar duration of use to OC users but fewer vaginal erosions and office visits (both P<0.001). Duration of use was not associated with management. In multivariable models, increasing age predicted longer use, and pulmonary disease predicted shorter use.In this cohort, the majority of patients were able to self-manage a pessary. Duration of use was associated with patient characteristics but not with management type.CONCLUSIONSIn this cohort, the majority of patients were able to self-manage a pessary. Duration of use was associated with patient characteristics but not with management type.

Self-care Pessary Management and Factors Associated With Long-Term Pessary Use

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