Use of vaginal pessary in women with symptomatic pelvic organ prolapse: Risk factors for failure one year after insertion.

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. Symptoms and quality of life were assessed at inclusion, 1 month, 6 months, and 1 year after insertion using validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12, USP and PFIQ-7). Patient satisfaction was assessed by the PGII score. Pessary failure was defined as stopping pessary use during the period.

Results: Of the 206 women included, 175 had available results at 1 year. Of these, 70 (40.0 %) had pessary failure and 105 (60.0 %) were still wearing the pessary. The overall PFDI-20 symptom score and its subscores were significantly improved as early as 1 month after pessary insertion. Factors associated with pessary failure at 1 year were: a younger age at insertion (RR = 0.93, 95 %CI = 0.86-0.99; p = 0.047); history of prolapse surgery (RR = 1.92, 95 %CI = 1.34-2.75; p < 0.001); and higher PFDI-20 score before insertion (RR = 1.04, 95 %CI = 1.01-1.07); p = 0.015). Clinical factors associated with failure were: a wide genital hiatus (GH) (RR = 1.25, 95 %CI = 1.06-1.48; p = 0.0077); short total vaginal length (TVL) (RR = 1.30, 95 %CI = 1.04-1.62; p = 0.019); high GH/TVL ratio (RR = 1.27, 95 %CI = 1.15-1.41; p < 0.001); and presence of a POP-Q stage ≥ 2 rectocele (RR = 1.51, 95 %CI = 1.05-2.18; p = 0.025). The 1-year satisfaction rate of users was high with 89.9 % reporting being improved or very improved, and 85.7 % planning to continue pessary use for 5 years or more.

Conclusion: The vaginal pessary is an effective treatment for women with symptomatic POP and improves their quality of life. Risk factors for pessary failure are diverse but clinical characteristics such as a large GH or short TVL seem to be associated with pessary failure due to higher expulsion rates. Satisfaction at 1 year is high among pessary users.