AI Article Synopsis
- Vaginal pessaries are commonly used for pelvic organ prolapse in women who cannot undergo surgery or choose not to, but they require proper care to avoid severe complications.
- An 89-year-old woman developed a large vesicovaginal fistula after neglecting her Gellhorn pessary for 3 years, which had fully migrated into her bladder.
- The pessary was surgically removed, and after a course of vaginal estrogen, the fistula was successfully repaired; this case highlights the importance of patient education and proper follow-up care to prevent such issues.
Article Abstract
Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.
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