Discontinuation of pessary therapy within 24 months: can it be predicted?

Introduction: Pelvic organ prolapse is a distressing condition affecting women. Pessary therapy is a conservative and effective treatment option. However, 20-60% of women discontinue pessary treatment within 24 months.

Objective: To identify patient characteristics associated with discontinuation of pessary treatment for symptomatic pelvic organ prolapse up to 24 months and to explore whether a prediction model can be developed.

Study Design: Prospective observational study in 22 Dutch hospitals with a follow-up duration of 24 months.

Method: Baseline patient characteristics from 6 different domains were compared between women who continued pessary therapy and women who discontinued pessary therapy within 24 months. Women with initial fitting failure were not included in analysis. Univariable and multivariable analysis were applied to identify predictors.

Results: Of the 251 women included in analysis, 102 stopped using a pessary at 24 months (40.6%). After multivariable analysis, age (OR 0.95, 95% CI 0.92-0.98, p < 0.001) and the presence of patient-reported allergies (OR 2.48, 95% CI 1.32-4.66, p = 0.005) were found to be predictive for pessary discontinuation within 24 months. These two factors explain 11% of the models' variance. However, in 49% of patient-reported allergies, the allergy was not specified.

Conclusion: Younger women and those who reported allergies at baseline were less likely to continue pessary use. However, the high number of unspecified reported allergies and the lack of a clear scientific explanation, suggests that a direct causal link is unlikely and warrants additional research.