Elting L M, van der Vaart L R, van der Vaart C H, Vollebregt A
Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, The Netherlands.
Department of Obstetrics and Gynaecology, Reinier de Graaf Ziekenhuis, Delft, The Netherlands.
Arch Gynecol Obstet. 2024 Dec;310(6):3279-3288. doi: 10.1007/s00404-024-07846-y. Epub 2024 Nov 30.
Pelvic organ prolapse is a distressing condition affecting women. Pessary therapy is a conservative and effective treatment option. However, 20-60% of women discontinue pessary treatment within 24 months.
To identify patient characteristics associated with discontinuation of pessary treatment for symptomatic pelvic organ prolapse up to 24 months and to explore whether a prediction model can be developed.
Prospective observational study in 22 Dutch hospitals with a follow-up duration of 24 months.
Baseline patient characteristics from 6 different domains were compared between women who continued pessary therapy and women who discontinued pessary therapy within 24 months. Women with initial fitting failure were not included in analysis. Univariable and multivariable analysis were applied to identify predictors.
Of the 251 women included in analysis, 102 stopped using a pessary at 24 months (40.6%). After multivariable analysis, age (OR 0.95, 95% CI 0.92-0.98, p < 0.001) and the presence of patient-reported allergies (OR 2.48, 95% CI 1.32-4.66, p = 0.005) were found to be predictive for pessary discontinuation within 24 months. These two factors explain 11% of the models' variance. However, in 49% of patient-reported allergies, the allergy was not specified.
Younger women and those who reported allergies at baseline were less likely to continue pessary use. However, the high number of unspecified reported allergies and the lack of a clear scientific explanation, suggests that a direct causal link is unlikely and warrants additional research.
盆腔器官脱垂是困扰女性的一种疾病。子宫托治疗是一种保守且有效的治疗选择。然而，20%至60%的女性会在24个月内停止子宫托治疗。
确定与有症状的盆腔器官脱垂患者在24个月内停止子宫托治疗相关的患者特征，并探讨是否可以建立预测模型。
在22家荷兰医院进行的前瞻性观察研究，随访期为24个月。
比较了在24个月内继续使用子宫托治疗的女性和停止使用子宫托治疗的女性在6个不同领域的基线患者特征。初始佩戴失败的女性未纳入分析。采用单变量和多变量分析来确定预测因素。
纳入分析的251名女性中，102名（40.6%）在24个月时停止使用子宫托。多变量分析后发现，年龄（比值比0.95，95%置信区间0.92 - 0.98，p < 0.001）和患者报告有过敏史（比值比2.48，95%置信区间1.32 - 4.66，p = 0.005）可预测24个月内子宫托停用情况。这两个因素解释了模型方差的11%。然而，在患者报告的过敏史中，49%未明确说明过敏情况。
年轻女性和基线时报告有过敏史的女性继续使用子宫托的可能性较小。然而，大量未明确说明的过敏报告以及缺乏明确的科学解释表明，不太可能存在直接因果关系，需要进一步研究。
