Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PESSARIES”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed1992

An intravaginal controlled-release prostaglandin E2 pessary for cervical ripening and initiation of labor at term.

The purpose of this randomized, double-blind study was to evaluate the efficacy and safety of a new controlled-release hydrogel pessary for ripening the cervix and initiating labor. Subjects had an entry Bishop score of 4 or less and gestational age of 37 or more weeks. One hundred fourteen women received a placebo pessary and 101 received the hydrogel pessary, containing 10 mg of prostaglandin (PG) E2. Compared with the placebo group, those given the PGE2 pessary were more likely to have an increase in Bishop score of 3 or more (60 or 59% versus 21 or 18%; P less than .0001), change to a Bishop score of 6 or higher (59 or 58% versus 18 or 16%; P less than .0001), and active labor (68 or 67% versus 15 or 13%; P less than .0001). Including the crossover study, uterine hyperstimulation (28 of 182, 15%) and fetal heart rate abnormalities (18 of 182, 10%) in PGE2-treated subjects were reversed on removal of the pessary with no apparent harm to the mother or fetus. These temporary adverse effects appeared while the pessary was in place and after the onset of active labor. Oxytocin was unnecessary in 89 of 182 (49%) of the PGE2-treated cases and was used more often to augment than to induce labor. We conclude that the described controlled-release PGE2 vaginal pessary induces appreciable cervical ripening and frequently initiates active labor with little or no need for oxytocin. The pessary may cause uterine hyperstimulation or fetal heart rate abnormalities, but these would be expected to reverse on removal of the pessary.

Delayed-Action Preparations↗
PubMed2004

Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse.

OBJECTIVE: We sought to demonstrate that a positive pessary test could predict postsurgical stress urinary incontinence in women with severe pelvic organ prolapse and that performing tension-free vaginal taping (TVT) could effectively prevent its occurrence. METHODS: Among the 79 patients evaluated for severe pelvic organ prolapse without symptoms of stress urinary incontinence, all underwent meticulous urogynecologic evaluations and pessary testing. In group 1, 32 patients had positive pessary tests and underwent vaginal hysterectomy, anterior and posterior colporrhaphy, and TVT. In group 2, 47 patients (17 of whom had positive pessary tests and 30 of whom had negative pessary tests) underwent vaginal hysterectomy and anterior and posterior colporrhaphy alone. A comparison in terms of surgical outcome and clinical manifestations was made between these 2 groups of patients. RESULTS: After surgery, a small proportion of patients had de novo idiopathic detrusor overactivity (7.6%, n = 6), urinary tract infections (7.6%, n = 6), mild recurrent prolapse (5.1%, n = 4), and urinary retention (3.8%, n = 3). Eleven (64.7%) of 17 patients with positive pessary tests who did not undergo TVT had urine leakage after their hysterectomies in contrast with the 30 patients who had negative pessary test, none of whom developed symptomatic stress urinary incontinence after vaginal hysterectomy. Among the 32 patients with positive pessary tests who had TVT with their hysterectomies, 3 developed urine leakage later; the cure rate was 90.6%. CONCLUSION: Continent patients suffering from severe pelvic organ prolapse but with a positive pessary test are considered to be at high risk of developing postoperative symptomatic stress urinary incontinence. Among the patients in our medium-range study, TVT effectively prevented postsurgical urinary incontinence. LEVEL OF EVIDENCE: II-1

Female↗
PubMed2003

Entrapped vaginal pessary presented with frequency and urge incontinence.

Pessaries remain helpful for patients with genital prolapse who refuse or are not able to have surgery due to medical complications. It is generally considered both conservative and safe to wear a vaginal pessary. Only a few cases of severe complications have been reported whereby most result from a neglected pessary. We present a patient with extreme frequency and urge incontinence with recovery following the removal of the entrapped pessary. An 82-year-old oriental female carrying a vaginal pessary for more than 10 years had suffered from intractable frequency and urge incontinence for 6 months. The urinary analysis and urodynamic studies showed no sign of lower urinary infection or outlet obstruction. Physical examination found a black ring pessary in the vagina which could not be mobilized due to its deep embedment. The lower urinary tract symptoms were recovered after surgical removal of the pessary. Complication of a vaginal pessary may be caused by an ignorant patient or doctor. Frequency and urge incontinence could be an early sign of a severe complication due to a neglected pessary.

Aged↗
PubMed2000

Bacterial vaginosis increases in pessary users.

The purpose of this study was to examine the association between pessary use, smoking and changes in the vaginal flora. Patients using pessaries were age matched with non-pessary using controls. All candidates examined were women attending the Mount Sinai Hospital, Toronto, for genitourinary problems. Vaginal cultures were routinely performed on all women attending the unit, irrespective of symptoms. Forty-four pessary users were age matched with 176 controls (4 controls per case). The mean age was 60.1 +/- 12.6 years, and 15% of these were premenopausal. The duration of pessary use ranged from 0.5 to 8 years (mean 3.3 +/- 1.7). Weight, parity, smoking status, diabetes mellitus, thyroid disease, UTI and postvoid residual urine volume were not significantly different between pessary users and controls. Bacterial vaginosis (BV) was noted in 32% of pessary users, versus 10% of controls. The relative risk of developing BV in pessary users was 3.3 (OR, 4.37; 95% CI, 2.15-9.32), P = 0.0002. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9 (OR, 3.78; 95% CI, 2.05-8.25), P = 0.0013. It was concluded that pessary use is a very effective and conservative method for the treatment of genital prolapse. However, we found that the presence of a foreign body was associated with changes in the vaginal flora, thereby increasing the odds of developing bacterial vaginosis to 4.37; this was further compounded by smoking.

Cohort Studies↗
PubMed2005

Pessary use in advanced pelvic organ prolapse.

The objective of this study was to review our experience with pessary use for advanced pelvic organ prolapse. Charts of patients treated for Stage III and IV prolapse were reviewed. Comparisons were made between patients who tried or refused pessary use. A successful trial of pessary was defined by continued use; a failed trial was defined by a patient's discontinued use. Thirty-two patients tried a pessary; 45 refused. Patients who refused a pessary were younger, had lesser degree of prolapse, and more often had urinary incontinence. Most patients (62.5%) continued pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery included four patients (33%) with unwillingness to maintain, three patients (25%) with inability to retain and two patients (17%) with vaginal erosion and/or discharge. Our findings suggest that pessary use is an acceptable first-line option for treatment of advanced pelvic organ prolapse.

Aged↗
PubMed2004

Pessary reduction and postoperative cure of retention in women with anterior vaginal wall prolapse.

This study aimed to determine whether preoperative pessary reduction of anterior vaginal wall prolapse in patients with elevated postvoid residual (PVR) volumes relieves urinary retention, and if reconstructive pelvic surgery in these patients cures urinary retention. The records of all women with symptomatic anterior vaginal wall and urinary retention (PVR >or=100 cc) who underwent evaluation and surgical repair of the anterior vaginal wall at our institution between 1996 and 1999 were retrospectively reviewed. All patients underwent a detailed urogynecologic and urodynamic evaluation and had a pessary trial prior to surgery. Cure of urinary retention was defined as PVR <100 cc at 3 months postoperatively. Sensitivity, specificity, positive and negative predictive values for pessary reduction testing were calculated. Twenty-four patients met the inclusion criteria. Two patients (8%) had stage 2, eleven (46%) stage 3, and eleven (46%) stage 4 anterior vaginal wall prolapse. Preoperatively, the use of pessary was associated with relief of urinary retention in 75% patients. In predicting postoperative cure of urinary retention, pessary testing had a sensitivity of 89%, specificity of 80%, positive predictive value of 94%, and negative predictive value of 67%. Nineteen of 24 patients had a PVR <100 cc postoperatively, indicating a 79% cure rate for urinary retention. In women with symptomatic anterior vaginal wall prolapse and urinary retention, use of a pessary is associated with relief of retention in the majority of patients. Furthermore, pessary reduction testing has good sensitivity, specificity, and positive predictive value for postoperative voiding function.

Adult↗
PubMed2000

Review of vaginal pessaries.

Pessaries have been used to treat pelvic organ prolapse throughout history, although with advances in the field of anesthesia and in surgical technique during the past century, pessary use declined. Current indications for pessary use include women awaiting definitive surgical repair, treatment for an unsuccessful surgical repair, treatment for women who are not surgical candidates, and for those who prefer medical management. In addition pessary use is gaining popularity among women with stress urinary incontinence, as well as in younger women interested in maintaining child bearing capabilities. Neonatal pelvic organ prolapse has also been treated successfully with pessaries. Many physicians have limited experience with pessary selection and fitting. This review article attempts to provide a basic overview of pessary selection and management.

Female↗
PubMed2006

Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse.

OBJECTIVE: To prospectively evaluate the effects of vaginal pessaries on symptoms associated with pelvic organ prolapse and identify the risk factors for failure. METHODS: All women referred to a specialist urogynecology unit with symptomatic pelvic organ prolapse who elected to use a pessary were included in this study. All completed the Sheffield pelvic organ prolapse symptom questionnaire before use and after 4 months of use. The primary outcome measure was change of symptoms from baseline to 4 months. RESULTS: Of 203 consecutive women fitted with a pessary, 153 (75%) successfully retained the pessary at 2 weeks, and 97 completed the questionnaires at 4 months. Multivariate logistic regression analysis showed that failure to retain the pessary was significantly associated with increasing parity (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14-2.02, P = .004) and hysterectomy (OR 4.57, 95% CI 1.71-12.25, P = .002). In the success group at 4 months (n = 97), a significant improvement in voiding was reported by 39 participants (40%, P = .001), in urinary urgency by 37 (38%, P = .001), in urge urinary incontinence by 28 (29%, P = .015), in bowel evacuation by 27 (28%, P = .045), in fecal urgency by 22 (23%, P = .018), and in urge fecal incontinence by 19 (20%, P = .027), but there was no significant improvement in stress urinary incontinence in 22 participants (23% P = .275). Of the 26 (27%) who were sexually active, 16 (17%, P = .001) reported an increase in frequency of sexual activity, and 11 (11%, P = .041) had improved in sexual satisfaction. CONCLUSION: A vaginal pessary is an effective and simple method of alleviating symptoms of pelvic organ prolapse and associated pelvic floor dysfunction. Failure to retain the pessary is associated with increasing parity and previous hysterectomy. LEVEL OF EVIDENCE: II-3.

Aged↗
PubMed1984

Induction of labour using prostaglandin E2 pessaries.

199 patients were used in a double blind placebo controlled trial testing the efficacy of prostaglandin E2 3 mg pessaries in the induction of labour. The trial showed that prostaglandin E2 pessaries were effective in the induction of labour but that with only a 55% success rate the results were less than that quoted by others. It was felt that the success rate could be increased by either reducing the time interval between insertion of the pessaries or by using a slow release vehicle for the prostaglandin. Surprisingly no significant shortening in the duration of labour was found between the prostaglandin group and the placebo group, despite a significant increase in the favourability of the cervix in the prostaglandin pessary group. Also no factors were found which definitely distinguished between the success or failure of induction of labour using prostaglandin pessaries. It was felt that prostaglandin pessaries were a safe and reasonably effective method of induction of labour and that, with reduction in the time interval between insertion of pessaries or the use of a slow release vehicle for the prostaglandin, the efficacy would be greatly increased.

Adolescent↗
PubMed1993

Vaginal pessaries and their use in pelvic relaxation.

To evaluate the therapeutic usefulness of pessaries in patients with pelvic relaxation, a retrospective study was performed identifying 107 patients who had been fitted with a pessary for symptomatic pelvic relaxation. Of this group, 101 returned or were available for follow-up. Ninety-one had at least one pelvic organ protruding to or beyond the hymen. Specific reasons for using the pessary are cited. Group 1 included 19 patients who were thought to be medically unfit for surgery. Twenty-one percent of this group died within one year of their evaluation for pelvic relaxation. Group 2 was composed of 24 patients who chose to use the pessary only temporarily while awaiting a suitable time for surgery. Group 3 consisted of 58 patients who were offered the option of definitive surgical repair but initially declined. Fifty of the 101 patients have continued to use the pessary. Twenty-six had repairs, and four have died. Only 21 patients have discontinued the pessary, had no surgical repair and thus continue without treatment of their pelvic relaxation. No major complications were associated with use of the pessary.

Adult↗
PubMed1989

Clinical use of Norgestomet ear implants or intravaginal pessaries for synchronization of estrus in anestrous dairy goats.

Ear implants that contained 3 mg Norgestomet or vaginal pessaries that contained 40 or 45 mg fluorogestone acetate were used to induce estrus in dairy goats in three herds in May. Ear implants or vaginal pessaries were left in place for 11 d. Cloprostenol (50 mug) and PMSG (500 IU) were administered i.m. 24 h prior to removal of ear implants or vaginal pessaries. After removal of vaginal pessaries, onset of standing estrus occurred in 22 23 goats (96%) at 20 +/- 4.7 h, in 19 20 goats (95%) at 22 +/- 6.3 h, and in 16 16 goats (100%) at 19 +/- 1.2 h in Herds A, B and C, respectively. After removal of ear implants, onset of standing estrus occurred in 25 25 goats (100%) at 19 +/- 4.9 h, in 20 22 goats (91%) at 22 +/- 7.0 h, and in 15 15 goats (100%) at 18 +/- 2.2 h in Herds A, B and C, respectively. Does were bred by natural service in Herds A and B, and by artificial insemination 28 h after vaginal pessary or ear implant removal in Herd C. Pregnancy rates were determined 39 to 53 d post breeding by real-time ultrasound. Pregnancy rates in goats with vaginal pessaries were 32, 55 and 6%; and in goats with ear implants they were 56, 67 and 27% in Herds A, B and C, respectively. Problems encountered included poor libido in some bucks, abortions in undersized yearling does, and loss of ear implants by three does (not included in the data). Statistically there was no difference in pregnancy rates between goats receiving vaginal pessaries or ear implants (P>0.10).

Journal Article↗
PubMed1984

A comparison of three dosages of prostaglandin E2 pessaries for ripening the unfavourable cervix prior to induction of labor.

A study was planned to evaluate the effect of Prostaglandin E2 pessaries in three different dosages in ripening the unfavourable cervix prior to the induction of labor. A single dose of PGE2 as pessary in the three different dosages was administered into the posterior vaginal fornix to ripen an unfavourable cervix with a Bishop score less than or equal to 4 in 101 primigravid and 79 multigravid patients. The pessary containing 2 mgm was as effective as 3 mgm and 5 mgm PGE2 pessary in ripening the cervix, and the outcome of labor and fetal status were similar with the different dosages of PGE2. However, two multigravid patients who received 5 mg of PGEs pessary and one multigravid patient who received 3 mg of PGE2 pessary developed hypertonic uterine activity. None of the patients who received 2 mg PGE2 pessary developed any adverse effect on uterine activity.

Adolescent↗
PubMed2001

Preexisting stress urinary incontinence: a predictor of discontinuation with pessary management.

OBJECTIVE: To identify variables predictive of pessary discontinuation in the treatment of pelvic organ prolapse. METHODS AND MATERIALS: Forty-two women with symptomatic pelvic organ prolapse presenting at a hospital-based urogynecology practice without a prior history of pessary use who opted for this form of management were included in the study. Data collected included vaginal paritye, presence or absence of symptomatic urinary incontinence, and previous pelvic surgery. RESULTS: Of the 42 patients, 24 (57%) were successfully managed with a pessary while 18 (43%) discontinued pessary use and were categorized as failures. Patients with preexisting urinary incontinence were more likely to discontinue pessary usage (OR 10.2 [1.06-240.96]). Logistic regression analysis indicated that stress urinary incontinence was the only significant type of incontinence predictive of discontinuation of pessary usage (p = .04). CONCLUSIONS: Preexisting stress urinary incontinence may be an independent predictor of pessary failure in the management of pelvic organ prolapse.

Journal Article↗
PubMed1997

Vaginal lever pessary in patients with multiple gestation, preterm labor and low fetal station. A report of three cases.

BACKGROUND: The vaginal pessary has been utilized previously in patients with cervical incompetence, resulting in improvement in pregnancy outcome. The mechanical advantages generated by the vaginal lever pessary could theoretically be applied to patients in preterm labor with low station of the presenting part to prevent cervical dilatation. CASES: One patient with twins and two with triplet pregnancies presented in preterm labor with advanced cervical dilatation and low fetal station. They were treated with tocolytic drugs, and a vaginal lever pessary was placed. The gestational age at delivery was delayed with the addition of the vaginal pessary. Based on previous experience with these difficult cases, it was judged that the use of the pessary achieved a delay in delivery that would not have occurred without the device. CONCLUSION: Vaginal pessaries can be used as mechanical adjuvants in the treatment of preterm labor. These devices work by altering the pressure dynamics on the cervix and lower uterine segment. They may also help limit cervical change by preventing engagement of the presenting part into the maternal pelvis. In these cases, a vaginal pessary appears to be beneficial in delaying delivery in multiple gestations presenting with advanced cervical dilatation and low station of the presenting part.

Adult↗
PubMed2004

Vaginal pessaries for the management of stress and mixed urinary incontinence.

The aim of this retrospective cohort study was to describe the use of incontinence pessaries in 239 women presenting to a tertiary referral center with symptoms of stress or mixed urinary incontinence. The mean age of the group was 57.4 years and mean body mass index 31.1 kg/m(2). We offered pessaries to 190 of 239 women, of whom 119 (62.6%) chose to undergo fitting. Most women (89.1%) achieved a successful fit. Of 106 women who took a pessary home to manage their incontinence, we were unable to contact six for follow-up. Fifty-five women used the pessary for at least 6 months (median duration 13.0 months, range 6-30), but 45 discontinued use before 6 months (median duration 1.0, range 0.03-4). Women with pulmonary disease and those who used diuretic medications were more likely to use pessaries for longer than 6 months, but no other differences between these groups were found. Pessaries appear to be an acceptable treatment option for stress and mixed urinary incontinence in that most women are willing to consider the option, and half of those successfully fitted continue use for at least 6 months.

Adolescent↗
PubMed2004

Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse.

OBJECTIVE: Our purpose was to estimate, in women after 2 months of pessary use, patient satisfaction and the percentage of prolapse and urinary symptoms that improve or worsen. STUDY DESIGN: In a prospective study, 100 consecutive women with symptomatic pelvic organ prolapse were fitted with a pessary, and 73 women had a successful 2-week pessary fitting trial. Prolapse and urinary symptoms were assessed at baseline and at 2 months. Patient satisfaction was assessed at 2 months. Risk factors for patient dissatisfaction were assessed. RESULTS: Nearly all prolapse symptoms resolved from baseline to 2 months, respectively: bulge (90% to 3%; P<.001), pressure (49% to 3%; P<.001), discharge (12% to 0%; P=.003), and splinting (14% to 0%; P=.001). Among women with concurrent urinary symptoms at baseline, stress incontinence improved in 45%, urge incontinence improved in 46%, and voiding difficulty improved in 53%, after 2 months. However, among women without urinary symptoms at baseline, occult (de novo) stress incontinence occurred in 21%, de novo urge incontinence occurred in 6%, and de novo voiding difficulty occurred in 4%. At 2 months, 92% of the women were satisfied with their pessary. Six women (8%) were dissatisfied and discontinued use of the pessary. Dissatisfaction was associated with occult stress incontinence (odds ratio, 17.1; 95% CI, 1.9, 206; P=.004). CONCLUSION: After 2 months, 92% of women with a successful pessary fitting trial were satisfied. Nearly all prolapse symptoms resolved after 2 months; 50% of urinary symptoms improved, but occult stress incontinence was a common side effect.

Adult↗
PubMed2006

Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse.

OBJECTIVE: This study was undertaken to evaluate the responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse undergoing surgical and nonsurgical management. STUDY DESIGN: The responsiveness of the prolapse, urinary and colorectal scales of the PFDI and PFIQ were assessed in 2 independent populations: (1) 42 women with stage II or greater prolapse enrolled in an ongoing multicenter randomized trial comparing 2 different pessaries (Pessary group) and (2) 64 women with stage III or greater prolapse who underwent vaginal reconstructive surgery (Surgery group). All subjects completed the PFDI and PFIQ at baseline and again either 3 months (Pessary group) or 6 months (Surgery group) after initiation of treatment. Responsiveness was assessed with standardized response mean (SRM), effect size (ES), and the paired t test. RESULTS: In the Pessary group, there was a significant improvement in the prolapse and urinary scales of the PFDI, with each demonstrating moderate responsiveness (prolapse: SRM 0.69, ES 0.68; urinary: SRM 0.57, ES: 0.50, P < .001 for each). The colorectal scale of the PFDI and each of the 3 scales of the PFIQ demonstrated no significant change in scores with pessary use. In the Surgery group, there was a significant improvement in the prolapse, urinary, and colorectal scales of both the PFDI and PFIQ (P < .01 for each). The prolapse and urinary scales of the PFDI demonstrated excellent responsiveness with SRM and ES 1.20 or greater for the prolapse scale and equal to1.05 for the urinary scales. The colorectal scale of the PFDI and the urinary and prolapse scales of the PFIQ demonstrated moderate responsiveness (SRM 0.61-0.70 and ES 0.56-0.60) after surgery. Subjects who had a recurrence of their prolapse develop after surgery (6%) had significantly less improvement in the prolapse scale of the PFDI than those who did not. After controlling for preoperative prolapse stage and baseline quality of life scores, subjects in the Surgery group had significantly greater improvement in each of the scales of the PFDI and the prolapse and urinary scales of the PFIQ than did the Pessary group (P < .05 for each). CONCLUSION: The PFDI and PFIQ are responsive to change in women undergoing surgical and nonsurgical treatment for pelvic organ prolapse. The PFDI is more responsive than the PFIQ.

Aged↗
PubMed1998

Double pessary use in grade 4 uterine and vaginal prolapse.

BACKGROUND: Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition. TECHNIQUE: With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first. EXPERIENCE: We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief. CONCLUSION: In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.

Aged↗