Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Int Urogynecol J. 2024 Jan;35(1):59-67. doi: 10.1007/s00192-023-05594-2. Epub 2023 Aug 5.
The objective was to evaluate the efficacy of pessaries in the treatment of stage IV pelvic organ prolapse (POP) and identify the influencing factors.
One hundred and fifty-seven patients with stage IV symptomatic POP were admitted to the hospital for pessary fitting. A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting in whom use continued 2 weeks later. The rates of successful pessary fitting, patient satisfaction, remission of prolapse and urinary symptoms, and the occurrence of factors associated with successful pessary fitting were calculated and predictors of appropriate pessary type selection were analyzed.
A total of 130 patients with stage IV POP had a successful pessary fitting (82.8%). The satisfaction rate associated with the two types of pessaries was more than 90%. The success rate among patients undergoing a ring pessary fitting trial was 44.6%, and 84.3% of the patients were self-managed. Prolapse symptoms significantly improved in 90% of cases, and urinary symptoms improved in 58-93% of cases from baseline. The number of vaginal deliveries, history of hysterectomy and vaginal introitus/total vaginal length (TVL) ratio were independent risk factors associated with unsuccessful pessary fitting.
For patients with stage IV POP, the successful fitting rate is as high as 80% or more. More vaginal deliveries, a history of hysterectomy, and a larger vaginal introitus/TVL ratio (ratio >0.6) were predictors of unsuccessful pessary fitting.
目的是评估阴道子宫托治疗 IV 期盆腔器官脱垂（POP）的疗效，并确定影响因素。
157 例 IV 期有症状 POP 患者入院进行子宫托适配。成功的子宫托适配定义为患者在初次适配时成功佩戴子宫托，并且 2 周后仍继续使用。计算了成功适配子宫托的比例、患者满意度、脱垂和尿症状缓解率，以及与成功适配子宫托相关的因素，并分析了合适子宫托类型选择的预测因素。
共 130 例 IV 期 POP 患者成功适配子宫托（82.8%）。两种子宫托的满意度均超过 90%。行环形子宫托适配试验的成功率为 44.6%，84.3%的患者为自我管理。90%的患者脱垂症状明显改善，58-93%的患者尿症状从基线改善。阴道分娩次数、子宫切除术史和阴道入口/总阴道长度（TVL）比值是与子宫托适配失败相关的独立危险因素。
对于 IV 期 POP 患者，成功适配率高达 80%或更高。更多的阴道分娩、子宫切除术史和更大的阴道入口/TVL 比值（比值>0.6）是子宫托适配失败的预测因素。
