Bugge Carol, Adams Elisabeth J, Gopinath Deepa, Reid Fiona
School of Nursing, Midwifery and Health, University of Stirling, Stirling,
Cochrane Database Syst Rev. 2013 Feb 28;2013(2):CD004010. doi: 10.1002/14651858.CD004010.pub3.
Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting, although many are asymptomatic. The use of pessaries (a passive mechanical device designed to support the vagina) to treat prolapse is very common, and up to 77% of clinicians use pessaries for the first line management of prolapse. A number of symptoms may be associated with prolapse and treatments include surgery, pessaries and conservative therapies. A variety of pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery.
To determine the effectiveness of pessaries (mechanical devices) for pelvic organ prolapse.
We searched the Cochrane Incontinence Group Specialised Register of trials (searched 13 March 2012), which includes searches of CENTRAL, MEDLINE, PREMEDLINE and handsearching of conference proceedings, and handsearched the abstracts of two relevant conferences held in 2011. We also searched the reference lists of relevant articles.
Randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in one arm of the study.
Abstracts were assessed independently by two authors with arbitration from a third if necessary. Data extraction was completed independently for included studies by two review authors.
To date there is only one published randomised controlled trial assessing the use of pessaries in the treatment of pelvic organ prolapse.
AUTHORS' CONCLUSIONS: The review authors identified one randomised controlled trial comparing ring and Gellhorn pessaries. The results of the trial showed that both pessaries were effective for the approximately 60% of women who completed the study with no significant differences identified between the two types of pessary. However, methodological flaws were noted in the trial, as elaborated under risk of bias assessment. There is no consensus on the use of different types of device, the indications nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of pessaries in comparison with no treatment, surgery and conservative measures.
盆腔器官脱垂很常见，在临床环境中，高达50%的经产妇会出现某种程度的脱垂，尽管许多人没有症状。使用子宫托（一种用于支撑阴道的被动机械装置）治疗脱垂非常普遍，高达77%的临床医生将子宫托用于脱垂的一线治疗。一些症状可能与脱垂有关，治疗方法包括手术、子宫托和保守治疗。描述了多种子宫托，旨在缓解脱垂症状并避免或推迟手术需求。
确定子宫托（机械装置）治疗盆腔器官脱垂的有效性。
我们检索了Cochrane尿失禁小组专业试验注册库（检索时间为2012年3月13日），其中包括对CENTRAL、MEDLINE、PREMEDLINE的检索以及对会议论文集的手工检索，并手工检索了2011年召开的两次相关会议的摘要。我们还检索了相关文章的参考文献列表。
随机和半随机对照试验，研究的其中一组包括用于盆腔器官脱垂的子宫托。
摘要由两位作者独立评估，如有必要由第三位作者进行仲裁。两位综述作者为纳入研究独立完成数据提取。
迄今为止，仅有一项已发表的随机对照试验评估了子宫托在盆腔器官脱垂治疗中的应用。
综述作者确定了一项比较环形子宫托和Gellhorn子宫托的随机对照试验。该试验结果表明，对于约60%完成研究的女性，两种子宫托均有效，两种类型的子宫托之间未发现显著差异。然而，如在偏倚风险评估中所阐述的，该试验存在方法学缺陷。对于不同类型装置的使用、适应症以及更换和随访护理模式尚无共识。迫切需要进行随机研究，以探讨子宫托与不治疗、手术及保守措施相比的应用情况。
