Gold Ronen S, Baruch Yoav, Amir Hadar, Gordon David, Groutz Asnat
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Am Geriatr Soc. 2021 Sep;69(9):2518-2523. doi: 10.1111/jgs.17223. Epub 2021 May 12.
To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP).
A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week.
The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center.
The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries.
Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery.
The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion.
Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.
为患有严重盆腔器官脱垂（POP）的老年女性提供一种灵活的阴道子宫托使用方案。
一项前瞻性队列研究，对140例连续的患有严重POP的老年女性（年龄≥65岁）使用个体化适配的阴道子宫托进行治疗。初次放置后，邀请每位患者在1个月后进行首次评估，并随后每隔1个月进行后续随访。每次检查时，取出子宫托并检查阴道是否有感染、出血或糜烂。建议所有患者每周使用两次阴道雌激素乳膏。
该研究于2020年在一家三级医疗中心的泌尿妇科诊所进行。
研究队列包括140例连续的患有严重且有症状的POP并接受阴道子宫托治疗的老年女性。
主要结局包括随访就诊之间的时间间隔、子宫托相关并发症、更换子宫托的需求、暂时取出子宫托的需求以及患者最终是否接受POP手术。
放置子宫托时患者的平均年龄为76.7±9.2岁（范围65 - 100岁）。随访检查之间的平均间隔为3.3±1.1个月（范围1 - 6个月）。大多数患者（83.6%）使用有支撑的环形子宫托，但只有少数患者能够自行维持子宫托位置。在140例患者中，最终只有5例（3.6%）患者接受了POP手术，11例（7.9%）患者因大量阴道分泌物或浅表糜烂不得不取出阴道子宫托2 - 4周。此外，12例（8.6%）患者在放置子宫托后出现了压力性尿失禁。
为老年女性有症状的POP定制阴道子宫托管理是有效且安全的，对于无法或不愿接受盆腔重建手术的老年女性是一种合适的治疗选择。
