Objectives: To (1) determine the proportion of hysterectomy cases with documentation of pessary counseling prior to prolapse surgery and (2) identify variables associated with women offered a pessary.
Study Design: The Michigan Surgical Quality Collaborative (MSQC) is a hysterectomy improvement initiative. Hysterectomies from 2013 to 2015 in which prolapse was the principal diagnosis were included. "Pessary offer" was defined as documentation showing the patient declined, could not tolerate, or failed a pessary trial. Bivariate analyses were used to compare demographics, medical history, surgical route, concomitant procedures (colpopexy or colporrhaphy), and intra- and postoperative complications between women with and without pessary offer. Hierarchical logistic regression was used to determine factors independently associated with pessary offer. Risk-adjusted pessary offer rates by hospital were calculated.
Results: The adjusted rate of pessary offer was 25.2%, ranging from 3 to 76% per hospital. Bivariate comparisons showed differences between women with and without pessary offer in age, tobacco use, prior pelvic surgery, insurance status, surgical approach, secondary indication for surgery, concomitant prolapse procedure, teaching hospital status and hospital bed size. In logistic regression, odds of pessary offer increased with age > 55 years (OR 1.45, 95% CI 1.12-1.88, p = 0.006), Medicare insurance (OR 1.65, 95% CI 1.30-2.10, p < 0.0001), and a concomitant procedure (OR 1.5, 95% CI 1.16-1.93, p = 0.002). Postoperative urinary tract infections were more common in patients offered a pessary (6.4% vs. 2.5%, p < 0.0001), but other complications were similar.
Conclusions: Overall, only one-quarter of hysterectomies for prolapse in MSQC hospitals had documentation of pessary counseling-suggesting an opportunity to improve documentation, counseling regarding pessary use, or both.
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http://dx.doi.org/10.1007/s00192-018-3696-1 | DOI Listing |
Urogynecology (Phila)
January 2025
Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern Medicine, Chicago, IL.
Importance: Literature surrounding conservative management of voiding dysfunction (VD) due to pelvic organ prolapse (POP) is limited.
Objective: The objective of this study was to evaluate the effect of pessaries on VD in women with symptomatic POP.
Study Design: This was a retrospective case series of adult women who underwent a pessary fitting for POP and VD between January 2010 to December 2022 at 2 tertiary care centers.
Eur J Obstet Gynecol Reprod Biol
December 2024
Department of Obstetrics and Gynaecology, Caen University Hospital, Caen, France; Inserm U1086 "ANTICIPE", Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Caen, France.
Introduction: Vaginal pessaries are offered as a first-line treatment for symptoms associated with pelvic organ prolapse (POP). The objective of our study was to identify risk factors for failure of pessary use within 1 year of insertion.
Materials And Methods: We prospectively included women who accepted a pessary fitting for symptomatic POP.
Arch Gynecol Obstet
October 2024
Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany.
Naunyn Schmiedebergs Arch Pharmacol
September 2024
SCES's Indira College of Pharmacy, New Mumbai Pune Highway, Tathawade, Pune, India.
J Clin Med
August 2024
Department of Obstetrics and Gynaecology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Pelvic organ prolapse (POP) affects many women and is often managed with pessary treatment, yet predicting the success of fitting remains challenging. This study aims to identify anatomical parameters associated with successful and unsuccessful pessary treatment using dynamic magnetic resonance imaging (dMRI). A cross-sectional study in Maastricht University Medical Centre (MUMC+), the Netherlands.
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