Manchana Tarinee
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
Arch Gynecol Obstet. 2024 May;309(5):2203-2209. doi: 10.1007/s00404-023-07299-9. Epub 2024 Jan 8.
To evaluate long-term continuation rates, adverse events of ring pessary use at a minimum of 5 years follow-up, and factors associated with discontinuation in symptomatic pelvic organ prolapse (POP).
Women with symptomatic POP who were treated with vaginal ring pessary and had successful fittings were included. Adverse events and reasons for discontinuation of pessary use were recorded. Patients who were lost to follow-up were defined as discontinuation.
During 12 year-period, 239 of 329 POP patients (72.6%) had successful fittings with ring pessary. The mean age was 67.8 ± 8.9 years (range 27-86) and 70% of patients had advanced stage. The cumulative probability of continued ring pessary use was 84.1%, 64.4%, 49.3%, and 33.5%, at 1, 3, 5, and 10 years, respectively. Most common reason for discontinuation was frequent expulsion (21.6%), followed by vaginal erosion (16.5%), no prolapse improvement (12.4%), and inability or inconvenience to do self-care (9.3%). However, 9 patients (9.3%) had improvement of prolapse and were able to discontinue pessary insertion. Age above 70 years, wide introitus, and incapability of self-care are independent factors associated with long-term discontinuation. Adverse events occurred in 23.4% of patients, 18.8% of them had vaginal erosion, 11.7% vaginal discharge/infection, and 18.4% de novo SUI. However, no statistical significance existed between those who continued and discontinued pessary use due to these adverse events.
Ring pessary is an effective treatment in symptomatic POP, with acceptable long-term continuation rates and minor adverse events. Self-care of pessary is very important aiming to minimize adverse events. Advanced age, wide introitus and incapability of self-care were associated factors for long-term discontinuation.
评估阴道环子宫托使用的长期持续率、至少5年随访期内使用阴道环子宫托的不良事件，以及有症状盆腔器官脱垂（POP）患者中与停用相关的因素。
纳入有症状POP且接受阴道环子宫托治疗并成功适配的女性。记录不良事件及停用子宫托使用的原因。失访患者定义为停用。
在12年期间，329例POP患者中有239例（72.6%）成功适配阴道环子宫托。平均年龄为67.8±8.9岁（范围27 - 86岁），70%的患者为晚期。阴道环子宫托持续使用的累积概率在1年、3年、5年和10年时分别为84.1%、64.4%、49.3%和33.5%。最常见的停用原因是频繁脱出（21.6%），其次是阴道糜烂（16.5%）、脱垂无改善（12.4%）以及无法或不便进行自我护理（9.3%）。然而，9例患者（9.3%）脱垂情况改善且能够停止子宫托置入。70岁以上、阴道口宽以及无自我护理能力是与长期停用相关的独立因素。23.4%的患者发生不良事件，其中18.8%有阴道糜烂，11.7%有阴道分泌物/感染，18.4%有新发压力性尿失禁。然而，因这些不良事件继续使用和停用子宫托的患者之间无统计学差异。
阴道环子宫托是治疗有症状POP的有效方法，长期持续率可接受且不良事件较少。子宫托的自我护理对于将不良事件降至最低非常重要。高龄、阴道口宽和无自我护理能力是长期停用的相关因素。
