References

Bodner-Adler B, Bodner K, Stinglmeier A Prolapse surgery versus vaginal pessary in women with symptomatic pelvic organ prolapse: which factors influence the choice of treatment?. Arch Gynecol Obstet.. 2019; 299:(3)773-777 https://doi.org/10.1007/s00404-019-05046-7

Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev.. 2013; 2013:(2) https://doi.org/10.1002/14651858.CD004010.pub3

Chan MC, Hyakutake M, Yaskina M, Schulz JA. What are the clinical factors that are predictive of persistent pessary use at 12 months?. J Obstet Gynaecol Can.. 2019; 41:(9)1276-1281 https://doi.org/10.1016/j.jogc.2018.11.015

Gerjevic KA, Erekson E, Strohbehn K, Jacobs KA, Hanissian PD, Aarts JW. Information priorities for deciding on treatment of pelvic organ prolapse. Female Pelvic Med Reconstr Surg.. 2019; 25:(5)372-377 https://doi.org/10.1097/SPV.0000000000000572

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG.. 2013; 120:(2)152-160 https://doi.org/10.1111/1471-0528.12020

Haylen BT, Maher CF, Barber MD An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J.. 2016; 27:(2)165-194 https://doi.org/10.1007/s00192-015-2932-1

Lough K, Hagen S, McClurg D, Pollock A Shared research priorities for pessary use in women with prolapse: results from a James Lind Alliance Priority Setting Partnership. BMJ Open.. 2018; 8:(4) https://doi.org/10.1136/bmjopen-2017-021276

Manonai J, Sarit-Apirak S, Udomsubpayakul U. Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use. Menopause.. 2018; 26:(6)665-669 https://doi.org/10.1097/GME.0000000000001277

Mao M, Ai F, Zhang Y Changes in the symptoms and quality of life of women with symptomatic pelvic organ prolapse fitted with a ring with support pessary. Maturitas. 2018; 117:51-56 https://doi.org/10.1016/j.maturitas.2018.09.003

Miceli A, Dueñas-Diez JL. Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study. Int Urogynecol J.. 2019; 30:(12)2161-2169 https://doi.org/10.1007/s00192-019-03919-8

Pulliam SJ, Morgan DM, Guaderrama N, Guire K, Adam RA. Differences in patterns of preoperative assessment between high, intermediate, and low volume surgeons when performing hysterectomy for uterovaginal prolapse. Female Pelvic Med Reconstr Surg.. 2016; 22:(1)7-10 https://doi.org/10.1097/SPV.0000000000000204

Ramsay S, Tu le M, Tannenbaum C. Natural history of pessary use in women aged 65–74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J.. 2016; 27:(8)1201-1207 https://doi.org/10.1007/s00192-016-2970-3

Sammarco AG, Morgan DM, Kamdar NS, Swenson CW. Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse. Int Urogynecol J.. 2019; 30:(5)753-759 https://doi.org/10.1007/s00192-018-3696-1

Sung VW, Wohlrab KJ, Madsen A, Raker C. Patient-reported goal attainment and comprehensive functioning outcomes after surgery compared with pessary for pelvic organ prolapse. Am J Obstet Gynecol.. 2016; 215:(5)659.e1-659.e7 https://doi.org/10.1016/j.ajog.2016.06.013

Pessary offer documentation in women undergoing surgery for pelvic organ prolapse at a tertiary care hospital

13 August 2020
Professional
02 August 2020
Volume 29 · Issue 15

Abstract

Background:

Women report similar functional outcomes after pessary treatment or surgery for pelvic organ prolapse (POP).

Aims:

To assess the documentation of pessary counselling in women who underwent surgery for POP. Methods: This was a retrospective cohort study conducted on women who underwent hysterectomy for prolapse. The primary outcome measure was documentation regarding offer of pessary. ‘Pessary offer’ was defined as documentation that clearly stated that the care provider offered pessary to the patient.

Findings:

Over the study period, 81 hysterectomies took place for POP; pessary offer was documented for only 19 (23.5%) case records. Characteristics significantly associated with pessary offer were history of chronic cough (P=0.031), previous pelvic surgery (P<0.001), no secondary indication for surgery (P=0.012), concomitant surgery performed other than hysterectomy (P=0.046), age range (P<0.001) and BMI range (P<0.001).

Conclusion:

Pessary offer was documented in less than quarter of cases. This denotes a need to strengthen documentation of offer, counselling for pessary, or both of these.

Pelvic organ prolapse (POP) is a common condition and affects approximately 50% of women who deliver vaginally (Gyhagen et al, 2013). A feeling of a vaginal bulge is the most commonly reported symptom; however, difficulty in opening bowels, urinary incontinence, backache and sexual pain are also common presenting symptoms (Haylen et al, 2016).

Management options for POP consist of pelvic floor exercises, pessary insertion and surgery. It is customary to offer less invasive options first (Manonai et al, 2018).

A pessary is a device made of silicone or plastic that is placed in the vagina to achieve anatomical correction and reduction of prolapse for symptomatic relief. Once inserted, a pessary remains in situ for 4–6 months and is replaced at follow up provided the recipient has no complications (Lough et al, 2018). The use of a pessary for POP is extremely common, and according to a Cochrane database review, around 77% of physicians offer a pessary as first-line management (Bugge et al, 2013). A pessary is a safe and effective conservative treatment option, relieves almost half of all symptoms and has a beneficial effect on quality of life for affected women (Mao et al, 2018).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

Pelvic organ prolapse
Prolapse surgery
Pessary