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.
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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