Pessaries effective option for management of Pelvic Organ Prolapse, finds study

New research revealed that pessaries are an effective treatment option for Pelvic organ prolapse (POP). The study was published in the journal Obstetrics & Gynecology. Improvement in the questionnaire scores pre and post-usage of the pessaries was the main basis of the study result. 

Pessaries have been used for a long time for pelvic organ prolapse. As recurrence is expected with surgery, mechanical devices like pessaries offer a better solution. Literature also shows the usage and effectiveness of pessaries for pelvic organ prolapse. Researchers from USA and Canada conducted a systematic review and meta-analysis to evaluate the existing evidence on the efficacy of pessaries in improving the quality of life when used for the treatment of pelvic organ prolapse (POP). 

Using keywords like "pelvic organ prolapse" and "pessar/y/ies/ium or vaginal support device," and "safety or safe or outcome or complication or efficacy or effective or effectiveness, the search strategy was carried out in databases like PubMed, EMBASE, CINAHL, and clinical trials.gov. Three reviewers independently screened studies and included only studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. 

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for data abstraction. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was a change in mean pretreatment and posttreatment questionnaire scores. The questionnaires that were included were those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire - Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I2 statistic.

Result:

• Eight studies including 627 patients were included for systematic review.
• The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%).
• The majority of studies conducted 3-month follow-ups with slight variability.
• A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use:  

• No significant heterogeneity was found. 

Thus, the researchers concluded that pessaries are effective treatment options for pelvic organ prolapse. 

For full reading, click here: 10.1097/AOG.0000000000004931 

Sansone S, Sze C, Eidelberg A, et al. Role of Pessaries in the Treatment of Pelvic Organ Prolapse: A Systematic Review and Meta-analysis [published online ahead of print, 2022 Sep 8]. Obstet Gynecol. 2022;10.1097/AOG.0000000000004931.