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VOLUME 7 , ISSUE 2 ( July-December, 2019 ) > List of Articles

Original Article

Pessary Expulsion Rate and Risk Factors for Expulsion in Southern Thai Women with Pelvic Organ Prolapse

Pukavut Withayajiakkhajorn, Wongsakorn Limbutara, Chatchawan Gorsagun

Keywords : Discontinuation, Expulsion, Pelvic organ prolapse, Vaginal pessary

Citation Information : Withayajiakkhajorn P, Limbutara W, Gorsagun C. Pessary Expulsion Rate and Risk Factors for Expulsion in Southern Thai Women with Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2019; 7 (2):59-61.

DOI: 10.5005/jp-journals-10032-1184

License: CC BY-NC 4.0

Published Online: 18-07-2020

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To investigate and ascertain the rate of and risk factors for vaginal pessary expulsion after vaginal pessary use among pelvic organ prolapse (POP) patients in Southern Thailand. Materials and methods: The retrospective medical records’ review and telephone interview were conducted in 140 patients with POP managed by vaginal pessary insertion as the first-line treatment during the period between March 2015 and January 2018. Factors influencing pessary expulsion, pessary discontinuation, and adverse event after pessary use were investigated. Results: Of the 482 POP patients, vaginal pessaries were offered to 140 patients. The prolapse was in advanced stage (stage III–IV) in most of the patients (77.1%), according to POP quantification (POP-Q) system. All of the pessaries offered were of ring type, without support in any prolapse stage. After vaginal pessary insertion, the expulsion rate was 22.1%. The mean of the pessary continuation period in all patients were 20.5 ± 8.2 months. During the study period, the discontinuation rate was 22.8%. Factors associated with pessary expulsion from logistic regression analysis were high body mass index [(BMI; relative risk (RR) 3.491, 95% confidence interval (CI) 1.302–9.356; p = 0.013]; history of previous hysterectomy (RR 37.68, 95% CI 4.508–315.098; p = 0.001); age more than 65 years (RR 3.71, 95% CI 0.078–0.929; p = 0.038); advanced degree of prolapse (RR 4.842, 95% CI 4.842–1.008; p = 0.049); and adverse effects related to pessary insertion were vaginal discharge (5%), vaginal discomfort (13.5%), vaginal erosion (7.1%), vaginal bleeding (1.4%), and constipation (0.7%). Conclusion: The expulsion and discontinuation rates of vaginal ring pessary in POP patients in any degree of prolapse were acceptable based on our experience from Southern Thailand. Factors associated with expulsion in this population were high BMI, history of previous hysterectomy, advanced age, and advanced degree of prolapse.


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  1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300(11):1311–1316. DOI: 10.1001/jama.300.11.1311.
  2. Subak LL, Waetjen LE, Van den Eaden S, et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001;98(4):646–651. DOI: 10.1016/s0029-7844(01)01472-7.
  3. Chuenchompoonut V, Bunyavejchevin S, Wisawasukmongchol W, et al. Prevalence of genital prolapse in thai menopausal women (using new standardization classification). J Med Assoc Thai 2005;88(1):1–4.
  4. Cundiff GW, Weidner AC, Visco AG, et al. A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol 2000;95(6, Part 1):931–935. DOI: 10.1097/00006250-200006000-00029.
  5. Jones KA, Harmanli OZ. Pessary use in pelvic organ prolapse and urinary incontinence. Rev Obstet Gynecol 2010;3(1):3–9. DOI: 10.3909/riog0110.
  6. Ding J, Chen C, Song XC, et al. Successful use of ring pessary with support for advanced pelvic organ prolapse. Int Urogynecol J 2015;26(10):1517–1523. DOI: 10.1007/s00192-015-2738-1.
  7. Manchana T. Ring pessary for all pelvic organ prolapse. Arch Gynecol Obstet 2011;284(2):391–395. DOI: 10.1007/s00404-010-1675-y.
  8. Yimphong T, Temtanakitpaisan T, Buppasiri P, et al. Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse. Int Urogynecol J 2017;;29(8):1123–1128. DOI: 10.1007/s00192-017-3445-x.
  9. Wolff B, Williams K, Winkler A, et al. Pessary typesand discontinuation rates in patients with advanced pelvic organ prolapse. Int Urogynecol J 2017;8(7):993–997. DOI: 10.1007/s00192-016-3228-9.
  10. Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG 2009;116(13): 1715–1721. DOI: 10.1111/j.1471-0528.2009.02380.x.
  11. MacLennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: Int J Obstet Gynaecol 2000;107(12):1460–1470. DOI: 10.1111/j.1471-0528.2000.tb11669.x.
  12. Swift S, Woodman P, O'Boyle A, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiological condition of pelvic organ support defects. Am J Obstet Gynecol 2005;192(3):795–806. DOI: 10.1016/j.ajog.2004.10.602.
  13. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89(4):501–506. DOI: 10.1016/S0029-7844(97)00058-6.
  14. Price N, Slack A, Jwarah E, et al. The incidence of reoperation for surgically treated pelvic organ prolapse: an 11-year experience. Menopause Int 2008;14(4):145–148. DOI: 10.1258/mi.2008. 008029.
  15. Fernando RJ, Thakar R, Sultan AH, et al. Effect of vaginal pessaries on symptoms associated with pelvic organ pro-lapse. Obstet Gynecol 2006;108(1):93–99. DOI: 10.1097/01.AOG. 0000222903.38684.cc.
  16. Wang Y, Yang J, Han J, et al. Factors influencing therapy decision in patients with severe pelvic organ prolapse. Zhonghua Fu Chan Ke Za Zhi 2015;50(2):112–115.
  17. Cheung RY, Lee JH, Lee LL, et al. Vaginal pessary in women with symptomatic pelvic organ prolapse: a randomized controlled trial. Obstet Gynecol 2016;128(1):73–80. DOI: https://doi.org/10.1097/AOG.0000000000001489.
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