Urogynecology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Arch Gynecol Obstet. 2011 Aug;284(2):391-5. doi: 10.1007/s00404-010-1675-y. Epub 2010 Sep 17.
To evaluate the risk factors of unsuccessful fitting of ring pessary in pelvic organ prolapse (POP), continuation rate, and adverse events.
The ring pessary was offered to 100 symptomatic POP patients. POP was staged according to Pelvic Organ Prolapse Quantification (POP-Q) system. A successful fitting was defined as when patients continued pessary use for more than 2 weeks. Adverse events were evaluated in patients who had a successful fitting.
Most patients (71%) were in POP-Q stage III-IV and 77 patients were fitted at the initial visit. Successful fitting was reported in 62 patients (62%). However, 52 patients (52%) continued to use the pessary at 13 months median follow-up. The most common reason for discontinuation was frequent pessary expulsion. Short vaginal length ≤ 6 cm and wide introitus > 4 fingerbreadths were the significant risk factors for unsuccessful fitting. New onset of stress urinary incontinence (SUI) developed in 28.2% of patients. One third and 21% of patients had vaginal discharge and vaginal erosion, respectively. Only half of the patients could manage the pessary either by themselves or with their caregivers.
The ring pessary fitting can be attempted in all POP cases irrespective of stage. Short vaginal length <6 cm and wide introitus >4 fingerbreadths were the risk factors for unsuccessful fitting. It has an acceptable continuation rate and manageable adverse events. The self-care of pessary is an important strategy to minimize adverse events.
评估环形子宫托治疗盆腔器官脱垂（POP）失败的风险因素、续用率和不良事件。
向 100 名有症状的 POP 患者提供环形子宫托。POP 根据盆腔器官脱垂定量（POP-Q）系统进行分期。成功适配定义为患者继续使用子宫托超过 2 周。对适配成功的患者评估不良事件。
大多数患者（71%）POP-Q 分期为 III-IV 期，77 名患者在初次就诊时进行了适配。62 名患者（62%）报告适配成功。然而，52 名患者（52%）在中位随访 13 个月时仍继续使用子宫托。最常见的停用原因是子宫托频繁脱落。阴道短于 6cm 和入口宽于 4 指宽是适配失败的显著风险因素。28.2%的患者新发压力性尿失禁（SUI）。三分之一和 21%的患者分别出现阴道分泌物和阴道侵蚀。只有一半的患者可以自己或在照顾者的帮助下管理子宫托。
环形子宫托适配可以尝试用于所有 POP 病例，无论分期如何。阴道短于 6cm 和入口宽于 4 指宽是适配失败的风险因素。它具有可接受的续用率和可管理的不良事件。子宫托的自我护理是减少不良事件的重要策略。
