Effectiveness of a continuous-use ring-shaped vaginal pessary without support for advanced pelvic organ prolapse in postmenopausal women

Introduction and hypothesis

There is considerable variation in the clinical management of pessaries. This study was aimed at exploring the efficacy of the continuous use of ring pessaries without support for the treatment of advanced pelvic organ prolapse (POP) in nonhysterectomized postmenopausal women.

Methods

We conducted this prospective study of fitted pessaries between January 2013 and June 2015 in the Department of Obstetrics and Gynecology at Macarena Hospital, Seville University, Spain. A total of 171 nonhysterectomized postmenopausal patients with symptomatic POP (stages III and IV) were counseled for two treatment options: either surgery or vaginal pessary. A total of 94 patients who agreed to use the vaginal ring pessary were included. A successful fitting was defined as the continued use of the device until the end of the study (a median 27-month follow-up). The data were analyzed with continuity correction tests, Mann–Whitney U tests, and Fisher’s exact test.

Results

Pessary use was continued by 80.8% of the patients. Most discontinuations (50.0%) occurred within the first week after device insertion. The adverse events rate was 31.6%, and all adverse events were Clavien–Dindo grade I. The complications were extrusion of the pessary (18.4%), bleeding or excoriation (10.5%), and pain or vaginal discharge (2.6%). No major complications occurred.

Conclusions

The ring pessary without support was successfully fitted in patients with advanced POP, resulting in a high success rate. There were few side effects and complications associated with continuous use of this pessary without periodic removal or replacement.