A 5-year prospective study of vaginal pessary use for pelvic organ prolapse

Objective: To evaluate prospectively the use of vaginal pessaries for pelvic organ prolapse (POP) and to identify complications and reasons for discontinuing pessary use over a 5-year period. Methods: A prospective observational study was conducted among all women with POP referred to the urogynecology clinic of a UK hospital between June 2002 and June 2005 who opted to use a vaginal pessary. Patients were followed-up for 5 years. Results: Of the 246 women who chose to use a vaginal pessary, 187 successfully retained the pessary 4 weeks after insertion. Over a 5-year period, 36 (19.3%) of the 187 women were lost to follow-up. Of the 151 women included in the analysis, 21 (13.9%) discontinued use at some point after 4 weeks, whereas 130 (86.1%) used the pessary successfully over 5 years. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% disimpaction or constipation). Most failures (73.8%) occurred within 4 weeks of pessary insertion. After cessation of pessary use, 70(28.5%) of the 246 women chose surgery and 10(4.1%) chose no further treatment. Conclusion: If treatment of POP with a vaginal pessary is successful at 4 weeks, most women will continue to use the pessary over 5 years without a concomitant increase in complications. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.