Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Division of Urogynecology, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.
Int Urogynecol J. 2023 Aug;34(8):1765-1770. doi: 10.1007/s00192-023-05462-z. Epub 2023 Jan 30.
The primary objective was to determine the adverse event rate associated with pessary use. Secondary objectives were to determine discontinuation, patient satisfaction, and factors associated with adverse events.
A retrospective observational study included patients attending a nurse-led pessary clinic with ≥ 1 year follow-up. Patients were fitted with a pessary by a urogynecologist and pessary care by a nurse was performed every 3-4 months. Demographic characteristics, pessary fitting, adverse events, their management and discontinuation were recorded. Pearson Chi-square and Fisher exact tests assessed the association between predetermined risk factors and pessary complications or discontinuation. Relative risk and 95% confidence intervals were computed.
215 women were followed for a mean (standard deviation) of 4.4 (1.9) years. Mean age was 73.8 (8.7) years. Adverse event rate was 83.7%; most commonly vaginal discharge, vaginal bleeding and erosions. Women with cardiovascular risk factors were less likely to develop pessary-related adverse events (79.7% vs. 91.9%, p = 0.03). Gellhorn and donut pessaries were more commonly associated with pessary erosions than ring with support pessaries or incontinence rings (RR 2.37 [1.67; 3.38]). Thirty-five (16.3%) women discontinued pessary use at a mean of 3.3 (1.7) years after initial fitting. Having a pessary erosion was not associated with discontinuation (p = 0.698), but recurrent erosions were (p = 0.012).
Adverse events were common among women continuing to use pessaries past 1 year, but adherence and satisfaction rates remained high after 4.4 years. Pessary type and absence of cardiovascular factors were associated with pessary-related adverse events.
主要目的是确定与使用子宫托相关的不良事件发生率。次要目标是确定停药、患者满意度以及与不良事件相关的因素。
回顾性观察研究纳入了在护士主导的子宫托诊所就诊且随访时间超过 1 年的患者。患者由泌尿科医生进行子宫托适配，由护士每 3-4 个月进行一次子宫托护理。记录人口统计学特征、子宫托适配、不良事件、其处理方法和停药情况。采用 Pearson Chi-square 和 Fisher exact 检验评估预定风险因素与子宫托并发症或停药之间的关联。计算相对风险和 95%置信区间。
215 名女性平均（标准差）随访 4.4（1.9）年。平均年龄为 73.8（8.7）岁。不良事件发生率为 83.7%；最常见的是阴道分泌物、阴道出血和糜烂。有心血管危险因素的女性发生与子宫托相关的不良事件的可能性较低（79.7% vs. 91.9%，p=0.03）。Gellhorn 和 donut 子宫托与糜烂的相关性高于带支撑的环形子宫托或失禁环（RR 2.37 [1.67; 3.38]）。35 名（16.3%）女性在初始适配后 3.3（1.7）年停止使用子宫托。子宫托糜烂与停药无关（p=0.698），但反复糜烂与停药相关（p=0.012）。
在使用子宫托超过 1 年的女性中，不良事件较为常见，但在 4.4 年后，仍保持较高的依从性和满意度。子宫托类型和无心血管因素与与子宫托相关的不良事件相关。
