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pessary

Pessaries are devices made of rubber or silicone materials, or both, designed to reduce pelvic prolapse temporarily & alleviate symptoms of pelvic organ prolapse in females with & without incontinence. Pessaries are available in various sizes & shapes depending on the type & severity of prolapse & the integrity of the perivaginal muscles. Classification: Types of pessaries 1) ring pessary for mild to moderate prolapse 2) Gellhorn pessary for moderate to severe prolapse 3) cube pessary a) insufficient vaginal tone to support other pessaries b) must be removed daily to prevent infections & erosions 4) Smith Hodge vaginal pessary Indications: Pessaries are recommended for women with symptomatic pelvic organ prolapse in two circumstances: 1) as a temporary measure for women awaiting surgical correction & 2) for treatment of women who are either unable, for medical reasons, or are unwilling to undergo correction of the prolapse. Contraindications: - vaginal prolapse - vaginitis - women without routine access to a health care provider who cannot remove or insert the device - does not lower rates of preterm delivery [7] Procedure: 1) must be fitted 2) examine patient after 1 week 3) pessaries may be left in place for 2 weeks* 4) concurrent use of topical estrogens may prevent complications (see below) 5) frequent & regular monitoring * except cube pessary (must be removed daily) Complications: can result when the pessary is misused or neglected 1) ulceration of vagina 2) vaginal infection 3) rectovaginal &/or vesicovaginal fistula Notes: - longer vaginal length predicts successful fitting [8]

General

device (medical device)

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Eslami M, Urinary Incontinence in Older Adults, UCLA School of Medicine, Syllabus, 2001
  3. Zetlin & Lehhez J Am Geriatr Soc 140:635, 1992
  4. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  5. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006 Jul;108(1):93-9. PMID: 16816061
  6. Trowbridge ER, Fenner DE. Practicalities and pitfalls of pessaries in older women. Clin Obstet Gynecol. 2007 Sep;50(3):709-19. Review. PMID: 17762419
  7. Nicolaides KH et al A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth N Engl J Med 2016; 374:1044-1052. March 17, 2016 PMID: 26981934 http://www.nejm.org/doi/full/10.1056/NEJMoa1511014
  8. Mao M et al. Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: A prospective study. BJOG 2018 Oct; 125:1434 PMID: 29700950 https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15260