Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands.
Int Urogynecol J. 2024 Sep;35(9):1797-1805. doi: 10.1007/s00192-024-05864-7. Epub 2024 Jul 24.
This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM).
A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation.
A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01).
Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.
本研究调查了子宫托自我管理（PSM）。主要结果是向患有盆腔器官脱垂（POP）的患者教授 PSM 的频率。次要结果是与临床管理（CM）相比，PSM 与治疗持续时间、副作用、转为手术以及治疗开始后第一年看医生的次数之间的关联。
对 2019 年在荷兰三家医疗中心就诊并接受 POP 子宫托治疗的 300 名患者进行回顾性队列研究。使用 t 检验、卡方检验和逻辑回归比较 PSM 与 CM，并确定与治疗持续时间相关的因素。
共有 35%的患者接受了 PSM 指导，其中 92%能够成功进行 PSM。进行 PSM 的患者中有 83%继续治疗，而接受 CM 的患者中有 75%（p=0.16），分别有 26%和 39%出现副作用（p=0.18）。疼痛或不适与治疗终止相关（p<0.01）。在适合 PSM 的子宫托患者亚组分析中，PSM 组的治疗持续时间显著高于 CM 组（97%比 74%；p<0.01）。
尽管能够进行 PSM 的能力很高（92%），但只有 35%接受子宫托治疗的患者接受了 PSM 指导。在 PSM 亚组中，治疗终止率显著降低，当评估适合 PSM 的子宫托患者亚组时。CM 组中有大量适合 PSM 的子宫托患者，这意味着推广 PSM 有很大的收益。
