Chan Michelle C, Hyakutake Momoe, Yaskina Maryna, Schulz Jane A
Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB.
Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB.
J Obstet Gynaecol Can. 2019 Sep;41(9):1276-1281. doi: 10.1016/j.jogc.2018.11.015. Epub 2019 Feb 1.
Urinary incontinence and pelvic organ prolapse are highly prevalent in women and have a significant impact on quality of life. Pessaries are devices that are used as a conservative management option. Many women use pessaries, which avoid surgical intervention with its associated morbidity and cost. However, not all women are good candidates for pessary use. The objective of this study was to determine clinical factors leading to persistent pessary use for incontinence or pelvic organ prolapse in a tertiary care centre at 12 months. Studying patient characteristics for long-term pessary use will contribute to better patient counselling, management, and health resource distribution.
This study was a retrospective outpatient chart review of new pessary fittings in patients in a tertiary care urogynaecology clinic between January and June 2014. Any woman over 18 years of age fitted with a pessary at that time was included in the study. All statistical analyses were performed using IBM SPSS Statistics version. 24 (IBM Corp., Armonk, NY) (Canadian Task Force Classification II-3).
A total of 152 women were fitted with pessaries. A multivariable logistic regression analysis found that a patient's diagnosis of prolapse or incontinence (P = 0.01) and a lack of complications (P < 0.0001) were statistically significant for persistent pessary use at 12 months. Patients with prolapse had 7.7 times higher odds (95% CI 1.51-39.35) of using a pessary at 12 months than did patients with incontinence. Patients without complications had 250 times higher odds (95% CI 18.52-2500) of pessary use. Patients who tried two to three pessaries had 16 times higher odds (95% CI 1.80-137.00) of persistent use than patients who trialed just one.
This study has found that a lack of complications, the number of pessaries tried, and a primary diagnosis of prolapse are significant factors for continued pessary use at 12 months.
尿失禁和盆腔器官脱垂在女性中极为常见，对生活质量有重大影响。子宫托是一种用于保守治疗的器械。许多女性使用子宫托，从而避免了手术干预及其相关的发病率和费用。然而，并非所有女性都适合使用子宫托。本研究的目的是确定在一家三级医疗中心，导致患者在12个月时持续使用子宫托治疗尿失禁或盆腔器官脱垂的临床因素。研究长期使用子宫托的患者特征将有助于更好地为患者提供咨询、管理和合理分配卫生资源。
本研究是对2014年1月至6月期间在一家三级医疗泌尿妇科门诊接受新子宫托适配的患者进行的回顾性门诊病历审查。当时任何年龄超过18岁且安装了子宫托的女性都纳入研究。所有统计分析均使用IBM SPSS Statistics 24版本（IBM公司，纽约州阿蒙克）（加拿大工作组分类II-3）。
共有152名女性安装了子宫托。多变量逻辑回归分析发现，患者的脱垂或尿失禁诊断（P = 0.01）以及无并发症（P < 0.0001）在12个月时持续使用子宫托方面具有统计学意义。脱垂患者在12个月时使用子宫托的几率比尿失禁患者高7.7倍（95%置信区间1.51 - 39.35）。无并发症的患者使用子宫托的几率高250倍（95%置信区间18.52 - 2500）。尝试使用两到三种子宫托的患者持续使用的几率比只试用一种的患者高16倍（95%置信区间1.80 - 137.00）。
本研究发现，无并发症、尝试使用子宫托的数量以及脱垂的初步诊断是12个月时持续使用子宫托的重要因素。
