Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua Napoleão de Barros, 608-Vila Clementino, São Paulo, SP, CEP: 04024-002, Brazil.
Int Urogynecol J. 2022 Nov;33(11):3237-3246. doi: 10.1007/s00192-022-05133-5. Epub 2022 Mar 14.
The objective was to investigate the rate of adherence to pessary treatment for pelvic organ prolapse (POP), to identify factors associated with long-term (longer than 1 year) use of vaginal pessaries in Brazilian women with POP and its impact on quality of life (QoL).
A prospective observational study assessed 247 consecutive women candidates for a pessary to manage symptomatic POP. Patients were fitted with a ring pessary and follow-up visits were performed at 1, 6, and 12 months. Pessary complications and reasons for discontinuation were recorded. Prolapse Quality of Life Questionnaire (P-QoL) was applied at baseline and after 1 year of treatment. We used a logistic regression model for the analyses, with p < 0.05 for significance.
A total of 236 women were included in the study, of whom 110 (46.6%) maintained the pessary treatment for longer than 12 months. The main reason for pessary discontinuation was the patient opting for surgery (50.8%). Vulvovaginitis was the main long-term complication (44.5%), followed by vaginal ulceration (16.4%) and urinary urgency (10%). No prior hysterectomy (OR = 2.26; 95% CI 1.19-4.31), vaginal estrogen use (OR = 1.94; 95% CI 1.06-3.52), and mean age (OR = 1.03; 95% CI 1.01-1.06) were variables associated with long-term use of vaginal pessary (p < 0.05 for all). Total P-QoL score significantly changed with pessary use (519.1 at baseline and 260 after 12-month treatment, p < 0.00).
Our study suggests that no prior hysterectomy, the local estrogen therapy, and age might be factors associated with use of a ring vaginal pessary for longer than 1 year. Long-term pessary users had a significant improvement in their quality of life.
目的在于调查盆腔器官脱垂（POP）患者对阴道子宫托治疗的依从率，识别与巴西 POP 患者长期（1 年以上）使用阴道子宫托相关的因素，及其对生活质量（QoL）的影响。
前瞻性观察研究纳入了 247 例连续就诊的阴道子宫托治疗的 POP 症状患者。为患者适配环形子宫托，并在 1、6 和 12 个月时进行随访。记录子宫托并发症和停用原因。基线和治疗 1 年后应用脱垂生活质量问卷（P-QoL）。采用 logistic 回归模型进行分析，p 值<0.05 为差异有统计学意义。
共纳入 236 例患者，110 例（46.6%）患者的子宫托治疗时间超过 12 个月。子宫托停用的主要原因是患者选择手术（50.8%）。阴道炎症是最主要的长期并发症（44.5%），其次是阴道溃疡（16.4%）和急迫性尿失禁（10%）。无子宫切除术史（OR=2.26；95%CI 1.19-4.31）、阴道雌激素使用（OR=1.94；95%CI 1.06-3.52）和平均年龄（OR=1.03；95%CI 1.01-1.06）是与阴道子宫托长期使用相关的变量（p 值均<0.05）。使用子宫托后，P-QoL 总分显著改变（基线 519.1，12 个月治疗后 260，p<0.00）。
本研究表明，无子宫切除术史、局部雌激素治疗和年龄可能是与 1 年以上环形阴道子宫托使用相关的因素。长期使用子宫托的患者生活质量显著改善。
