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At least 91 records · Page 5Linked to original sources
PubMed1992

Cervical and vaginal cancer associated with pessary use.

From 1967 to 1990, 96 previously untreated patients with cervicovaginal cancer associated with a history of vaginal pessary use to control uterovaginal prolapse were referred to eight radiation therapy departments in France. Sixty-eight patients had cervical cancer, and 28 had vaginal cancer. The mean interval between pessary insertion and cancer diagnosis was 18 years, with a range of 1 to 41 years. Most patients received radiation therapy and brachytherapy. Few (5%) had Grade 3 treatment side effects. The overall 5-year relative survival rate was 54%; nonsurvival was related to locoregional recurrence. Because almost all tumors occurred at the site of pessary insertion, foreign body chronic inflammation in association with viral infection may be the cause of the tumors.

Aged↗
PubMed2006

Management of the neglected vaginal ring pessary.

We present two cases of vaginal pessaries left in situ for prolonged periods and subsequent impaction that were managed differently. One was partially epithelialized and removed in the outpatient clinic by a new technique whereby the ring pessary was divided by a bone-cutter and passed through the epithelial tunnel without anesthesia. The second, which was a completely epithelialized metal ring pessary, was removed under anesthesia. Resulting fibrosis can cure the prolapse.

Aged↗
PubMed1990

A vesicovaginal fistula and intravesical foreign body. A rare case of the neglected pessary.

A case of neglected pessary is presented. After erosion through the anterior vaginal and bladder walls the device came to rest entirely within the bladder. Surgical management of removal of the pessary and repair of the resulting vesicovaginal fistula are described. Appropriate use of supportive pessaries as well as complications of misuse and neglect are discussed.

Aged↗
PubMed1991

Mid-trimester termination of pregnancy with 16,16-dimethyl-trans-delta 2 PGE1 vaginal pessaries: a comparison with intra- and extra-amniotic prostaglandin E2 administration.

PGE1 analogue (gemeprost) vaginal pessaries administered three hourly for three doses has been compared with a single extra- or intra-amniotic injection of PGE2 for mid-trimester termination of pregnancy in 450 women between 13 and 20 weeks gestation. The mean (SD) induction-abortion interval (IAI) in the vaginal pessary group of 19.5 (8.4) h was significantly longer than the respective intervals of 14.4 (9.3) and 16.1 (6.8) h in the patients treated extra- or intra-amniotically (P less than 0.001). Seventy-three percent treated with gemeprost aborted within 24 h of initial treatment compared with 84% and 87%, respectively in the extra- and intra-amniotic groups (P less than 0.05). Patients treated with gemeprost were more likely to need further prostaglandin treatment and had an increased incidence of gastrointestinal side effects. Despite these differences vaginal gemeprost pessaries provide a safe, effective, easy to administer method for midtrimester termination of pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1987

Treatment of clue cell-positive discharge with 200 mg povidone-iodine pessaries. A double-blind and placebo-controlled trial.

In a double-blind randomized study we evaluated the efficacy of povidone-iodine in the treatment of clue cell-positive discharge (CCPD). Vaginal pessaries (200 mg povidone-iodine or placebo) were taken twice daily for five consecutive days. Although the regimen was reasonably well accepted, 'messiness' was reported by 13 of 33 women (39%). Of 44 women enrolled, treatment efficacy was evaluated in 28 women who had both follow-up visits. There was no significant difference in the efficacy of povidone-iodine and placebo pessaries, at either the first or the second follow-up visit (p values 0.46 and 1 respectively). It is concluded that the use of povidone-iodine pessaries, at least in the regimen described, cannot be regarded as an effective therapy for CCPD.

Adult↗
PubMed1984

Pessary test: simple prognostic test in women with stress urinary incontinence.

To overcome urethral obstruction and other shortcomings associated with previously described tests such as the Bonney test and the Marshall test, the pessary test was employed during preoperative evaluation of women with stress urinary incontinence. The similarity of changes seen in the resting and stress urethral closure pressure profiles with the pessary test and post-incontinence surgery, provided an objective evaluation of the pessary test as a simple and reliable clinical tool to predict successful outcome of anticipated incontinence surgery.

Female↗
PubMed1987

Prostaglandin-induced pregnancy termination: further studies using gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries in the early second trimester.

The use of gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries for the termination of pregnancy in the early second trimester has been further investigated. Of 113 women between 12 and 16 weeks gestation, 93 (82%) aborted within 24 hours of the administration of 4.4 +/- 0.1 1 mg gemeprost pessaries. The mean induction-abortion interval was 881 +/- 31 minutes. Successful abortion was achieved in 16 of the remaining 20 women after a second course of gemeprost pessaries without the need for oxytocin supplementation. There were no serious complications. Crampy abdominal pain and vaginal bleeding started after 275 and 756 minutes respectively. Twenty-two (19%) patients did not require pain relief during treatment, but 90 (80%) required parenteral opiates. Vomiting and diarrhoea occurred in 16 (14%) and 23 (20%) cases respectively. The safe induction of therapeutic abortion in 96% of women using vaginal prostaglandin alone offers an acceptable alternative to surgical evacuation in the early second trimester.

Abortifacient Agents↗
PubMed1990

The concurrent in vitro and in vivo release of PGE2 from a controlled-release hydrogel polymer pessary for cervical ripening.

Twenty five patients booked for induction of labour, at 38 weeks or more gestation, were administered a controlled release vaginal polymer pessary containing 10 mg prostaglandin E2 (PGE2), designed to release 0.6 mg per hour in vivo. The release profile from the polymer was linear throughout the eight hour observation period with a correlation coefficient of 0.81, and regression slope of 0.93 mg/hr. with 95% confidence intervals of 0.63 mg/hr. to 1.23 mg/hr. This compared with a concomitant release profile in vitro which was uniform with time for the first five hours, but then continued at a decreasing rate with a correlation coefficient of 0.98. The relationship between PGE2 release and cervical score change was linear, with a correlation coefficient of 0.65. The results show that PGE2 release from the pessary in vivo is predictable, and suggest that the controlled release pessary offers the advantages of greater control of cervical ripening than alternative vehicles currently available.

Cervix Uteri↗
PubMed2004

The use of pessaries in vaginal prolapse.

Pessaries are frequently used in cases of vaginal prolapse. Many different type of pessaries have been used in the past and are still in use today. In general it is considered to be a safe and simple form of therapy but little is known on the success rate, the indications and the optimal management. We give an overview of the history, type, indications and complications of pessaries, and give guidelines for daily practice.

Clinical Trials as Topic↗
PubMed2006

A polyherbal vaginal pessary with spermicidal and antimicrobial action: evaluation of its safety.

A polyherbal vaginal pessary (Praneem) has been formulated that has antimicrobial properties against genital pathogens in addition to spermicidal action. Thus, it has dual potential as a barrier method for contraception and for providing protection against some sexually transmitted infections. The present study reports the findings of a multicentre trial that was conducted to evaluate the safety of this product. Trials were carried out in 23 women in three centres in India: the Postgraduate Institute of Medical Education and Research, Chandigarh; Safdarjang Hospital, New Delhi; and Kamla Nehru Memorial Hospital, Allahabad. Thorough clinical and pelvic examinations were carried out as well as cervical cytology, blood biochemistry and haematology before and after use of the polyherbal pessary intravaginally once daily for 7 consecutive days. No toxicity was observed on clinical examination or by laboratory investigations. Daily intravaginal use of this pessary for 7 days had no adverse effects on cervical cytology or on metabolic and organ functions.

Administration, Intravaginal↗
PubMed1997

Combination of pessary and periurethral collagen injections for nonsurgical treatment of uterovaginal prolapse and genuine stress urinary incontinence.

BACKGROUND: The combination of severe uterovaginal prolapse and stress urinary incontinence in medically compromised patients in whom surgery is contraindicated is a difficult treatment dilemma. CASE: A 75-year-old woman with severe cardiac compromise and a history of pulmonary embolus presented with severe uterovaginal prolapse and stress urinary incontinence. The combination of a vaginal pessary and three periurethral collagen injections resulted in successful management of her prolapse and resolution of her stress urinary incontinence. CONCLUSION: Although pessaries are frequently a satisfactory treatment option for women with severe uterovaginal prolapse, the appearance or worsening of urinary incontinence may make the option of pessary use less attractive. The addition of periurethral collagen injections will improve or cure urinary incontinence symptoms.

Aged↗
PubMed1985

A comparison of prostaglandin E2 pessaries and laminaria tents for ripening the cervix before termination of pregnancy.

Forty primigravid women aged 15-45 years were randomly allocated to receive either an intravaginal pessary of 3 mg prostaglandin E2 (PGE2) or an intracervical 5-mm laminaria tent (LT) 12-16 h before termination of pregnancy at 6-14 weeks gestation. The degree of dilatation of the cervix at operation and its resistance to further dilatation during the procedure were assessed by a 'blind' operator. Laminaria tents were more effective in achieving dilatation and softening of the cervix than were PGE2 pessaries and in 40% of women no further dilatation was necessary. There were no associated side-effects or complications. A cervical tear occurred in two of 20 patients treated with PGE2 pessaries and all 20 required further dilatation of the cervix. Laminaria tents provide a simple, safe, acceptable and effective means of 'ripening' the cervix prior to termination of early pregnancy.

Abortion, Therapeutic↗
PubMed1981

Management of incarcerated vaginal pessaries.

Uterine procidentia is relatively common among white multiparous women. The incidence increases with age in association with other predisposing factors. Conservative management of uterine prolapse is rare today, perhaps due to definitive results with surgical therapy and the high incidence of earlier hysterectomy. Still, physicians should become familiar with pessary use and its complications. Three conservatively managed cases of pessary incarceration are reported. Applications of estrogen cream improved the condition of the vagina, permitting removal of the incarcerated pessary a few day later. Careful instruction of patients and relatives about follow-up care can prevent such complications.

Aged↗
PubMed1982

Treatment of vaginal candidosis with a single 500-mg clotrimazole pessary.

In a double-blind study the therapeutic efficacy of a single 500-mg clotrimazole pessary was compared with that of a 200-mg clotrimazole pessary inserted once daily for three days in 72 patients with vaginal candidosis confirmed by culture. On clinical assessment four weeks after completion of treatment with the single-dose pessary the cure rate was 86% compared with 92% after the three-day regimen. There was no significant difference in the eradication rate between the single-dose (94%) and three-day regimens (89%). Four weeks after completion of treatment the recurrence rates by culture were 18% with the single-dose and 24% with the three-day regimen. The former treatment was well tolerated and as effective as the three-day clotrimazole regimen.

Adult↗
PubMedDate not supplied

Neotran--a new double-active pessary for the treatment of vaginitis.

The common causes of vaginitis have changed in recent years. Infection with Trichomonas vaginalis is much less frequent than it used to be. The most common causes of vaginitis are candidiasis and bacterial vaginosis due to infection with mixed bacterial flora. In general practice, treatment of vaginitis is often begun before microbiological confirmation of the diagnosis is available. A vaginal pessary has been formulated to provide an effective therapy in all three forms of vaginitis mentioned above. This formulation, Neotran, is believed to be the first pessary to contain both metronidazole and miconazole. In vivo and in vitro studies showed Neotran to be effective against Candida albicans and mixed bacterial flora. Neotran was shown, in vitro, to be active against Trichomonas but, because of the current rarity of trichomonal infection in the UK, it was not possible to show its effectiveness against Trichomonas in vivo. In a general-practice clinical trial of the treatment of vaginitis in 80 patients, Neotran pessaries achieved a microbiological resolution rate of 83% in those patients who were bacteriologically evaluable and was well tolerated. Overall clinical evaluation of the patients showed the condition to be resolved in 73% of patients, improved in 21% and unchanged in 6%.

Adolescent↗
PubMed1981

FSH or FSH plus LH superovulation in ewes following estrus synchronization with medoxyprogesterone acetate pessaries.

The estrous cycles of 28 ewes 9 to 10 months of age were synchronized with Medoxyprogesterone (MAP) pessaries. Superovulation was attempted by injecting either (follicle stimulating hormone) FSH or FSH plus Luteinizing Hormone (LH). MAP pessaries were in place for 12 days. FSH was administered (IM) to all ewes at 12-hr intervals over a 3-day period, 5 mg injected twice on day 11 after pessary insertion, followed by 4 and 3 mg twice daily on days 12 and 13, respectively. LH (25 mg injected IV) was given to 14 ewes within 8 hr after the onset of behavioral estrus. All ewes were hand mated with several rams at 12-hr intervals from the onset to the end of behavioral estrus. Ovulation, embryo recovery and fertilization rates were recorded for each ewe. Of 14 ewes injected with only FSH, 13 ovulated, with a mean ovulation rate of 8.2 +/- 5.6; embryo recovery rate averaged 62%, and fertilization rate was 97%. All 14 ewes given both FSH + LH ovulated, with an ovulation rate of 8.9 +/- 5.8 per ewe; embryo recovery averaged 70%, and 91% of all embryos recovered were fertilized. No statistical differences in ovulation, embryo recovery or fertilization rates were found between the FSH and FSH + LH superovulation treatment groups. In addition, no difference in the number of ewes showing estrus or duration of behavioral estrus was noted between FSH and FSH + LH treatments.

Animals↗
PubMed1992

The use of vaginal pessaries for uterine prolapse.

Vaginal pessaries are useful for treating uterine prolapse when surgical intervention is not a safe option. This article covers recommendations for selection, insertion and care of the appliance. Careful follow-up is necessary to minimize possible complications, which can include infection, ulceration of the mucosa, incarceration of the pessary, and an increased incidence of vaginal and cervical malignancy. Disagreement within the literature about the proper schedule for follow-up, and inadequate documentation of the risks of pessary usage underscore the need for clinical research in this area.

Aftercare↗
PubMedDate not supplied

[Effectiveness of cervical cerclage and pessary in the treatment of isthmo-cervical insufficiency].

The aim of this study was comparison of gestation, labour, puerperium and condition of newborns in women with cervical incompetence treated with cerclage or pessary. The interval from treatment to delivery was longer in women with pessary. In women who had cervical cerclage tocolysis was applied more frequently. Among patients with pessary kolpitis was found more often. Gestational age at delivery, the way of a labour, condition of newborns and complications during puerperium didn't differ significantly between both groups.

Adolescent↗