Long-term vaginal ring pessary use: discontinuation rates and adverse events

Objective To evaluate, at a minimum of 6 years, the long-term discontinuation rates and incidence of adverse events associated with vaginal ring pessary use. Design Retrospective case identification. Setting Tertiary urogynaecology unit. Sample All women fitted with either a Portex ring pessary or Introl bladder neck support device during the index period (1992-2002). Methods Retrospective chart review. Main outcome measures Length of use and complications of pessary use, including bleeding, extrusion, malodorous vaginal discharge, constipation and incontinence. Results Of the 273 women fitted with a ring pessary, 167 were successfully using it at 4 weeks; subsequently, 93 (56%) experienced complications comprising bleeding, extrusion, severe vaginal discharge, pain and constipation, in that order, although 38 women (23%) had more than one type of complication and most had more than one episode. Only 23 of 167 (14%) continued with pessary use at the study endpoint (November 2008). The median duration of use was 7 years (interquartile range, 6-9 years; range, 2.25-13.9 years). Of those who discontinued, the median duration was 1.4 years (range, 0.1-11 years; interquartile range, 0.5-3.6 years). After cessation, 73 (44%) chose conservative treatment and 50 (30%) chose surgery. Twelve women died during the time frame; nine returned to their GP. Conclusions We were surprised to find a 56% complication rate in pessary users. Our study shows that, over time, the majority of women chose to discontinue using pessaries. Women should be informed of these data when deciding on the management of their pelvic organ prolapse.