Calles Sastre Laura, Almoguera Pérez-Cejuela Belén, Pereira Sánchez Augusto, Herrero Gámiz Sofía, Magrina Javier F, Ríos Vallejo Mar, Pérez Medina Tirso
Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain.
Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
J Pers Med. 2023 Jun 27;13(7):1056. doi: 10.3390/jpm13071056.
Forty percent of women will experience prolapse in their lifetime. Vaginal pessaries are considered the first line of treatment in selected patients. Major complications of vaginal pessaries rarely occur.
PubMed and Embase were searched from 1961 to 2022 for major complications of vaginal pessaries using Medical Subject Headings (MeSH) and free-text terms. The keywords were pessary or pessaries and: vaginal discharge, incontinence, entrapment, urinary infections, fistula, complications, and vaginal infection. The exclusion criteria were other languages than English, pregnancy, complications without a prior history of pessary placement, pessaries unregistered for clinical practice (herbal pessaries), or male patients. The extracted data included symptoms, findings upon examination, infection, type of complication, extragenital symptoms, and treatment.
We identified 1874 abstracts and full text articles; 54 were assessed for eligibility and 49 met the inclusion criteria. These 49 studies included data from 66 patients with pessary complications amenable to surgical correction. Clavien-Dindo classification was used to grade the complications. Most patients presented with vaginal symptoms such as bleeding, discharge, or ulceration. The most frequent complications were pessary incarceration and fistulas. Surgical treatment included removal of the pessary under local or general anesthesia, fistula repair, hysterectomy and vaginal repair, and the management of bleeding.
Pessaries are a reasonable and durable treatment for pelvic organ prolapse. Complications are rare. Routine follow-ups are necessary. The ideal patient candidate must be able to remove and reintroduce their pessary on a regular basis; if not, this must be performed by a healthcare worker at regular intervals.
40%的女性一生中会经历子宫脱垂。阴道子宫托被认为是特定患者的一线治疗方法。阴道子宫托的主要并发症很少发生。
在PubMed和Embase数据库中检索1961年至2022年期间使用医学主题词（MeSH）和自由文本词的阴道子宫托主要并发症。关键词为子宫托或子宫托和：阴道分泌物、尿失禁、嵌顿、尿路感染、瘘、并发症和阴道感染。排除标准为非英语语言、妊娠、无子宫托放置史的并发症、未注册用于临床实践的子宫托（草药子宫托）或男性患者。提取的数据包括症状、检查结果、感染、并发症类型、生殖器外症状和治疗方法。
我们共识别出1874篇摘要和全文文章；54篇进行了资格评估，49篇符合纳入标准。这49项研究纳入了66例适合手术矫正的子宫托并发症患者的数据。采用Clavien-Dindo分类法对并发症进行分级。大多数患者出现阴道症状，如出血、分泌物或溃疡。最常见的并发症是子宫托嵌顿和瘘。手术治疗包括在局部或全身麻醉下取出子宫托、瘘修补、子宫切除和阴道修补以及出血处理。
子宫托是治疗盆腔器官脱垂的一种合理且持久的治疗方法。并发症很少见。需要进行常规随访。理想的患者必须能够定期自行取出和重新放置子宫托；如果不能，则必须由医护人员定期进行操作。
