Rantell Angie, Abdool Zeelha, Fullerton Morgan E, Gedefaw Abel, Lough Kate, Miotla Pawel, Mukhtarova Narmin, Neumann Patricia, Spencer Jordan, Warner Kristina J, Brown Heidi W
King's College Hospital & Brunel University, London, UK.
Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa.
Int Urogynecol J. 2025 Mar;36(3):533-550. doi: 10.1007/s00192-024-06020-x. Epub 2025 Jan 28.
This manuscript is part of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP), Chapter 3, Committee 1 focusing on pessary management of POP.
A narrative review was conducted by an international, multi-disciplinary group of clinicians working in the field of pelvic health following a search of the literature using the MeSH terms "pelvic organ prolapse" OR "urogenital prolapse" OR "vaginal prolapse" OR "uterovaginal prolapse" AND "pessary" OR "support device" OR "intravaginal device." Relevant studies, as determined after review using the Covidence manuscript review platform, were included.
A total of 540 articles were reviewed, of which 313 were included for this narrative review. The reported pessary fitting success rate ranges from 41% to 96.6%, and the continuation of successful use rate varied from 21% to 97.7%. The most likely predictors of unsuccessful fitting trials were previous POP surgery, previous hysterectomy, short vaginal length, wide genital hiatus, and posterior compartment involvement. Following successful pessary placement in individuals with POP, vaginal bulge and pressure resolved in over 90%. A significant improvement in obstructive voiding was reported in 40-97% of participants, urinary urgency in 38%, urgency urinary incontinence in 29-77%, and stress urinary incontinence in 9-45%. Older age and women who can self-manage the pessary care or had family support were factors associated with pessary continuation. Common reasons reported for discontinuation included expulsion, vaginal pain/discomfort, unwillingness to continue, erosions, desire for surgery, bleeding, symptoms not improved with pessary, and incontinence. More serious complications (fistula, bowel obstruction, pessary impaction, and vaginal cancer) are rare, and occur usually in older women in whom pessary maintenance has been neglected. There is no high-quality evidence to guide pessary choice. The current literature lacks studies specifically focused on determining the role of preventative measures, i.e., estrogen, pessary type/material as regards to pessary-associated complications (PACs). The review identified a lack of information about the relevant and required training and education (for healthcare professionals and patients) for pessary provision, use, and management.
There is a considerable body of published work on the use of pessaries for POP, including effectiveness, factors associated with success and failure, and complications. However, there is a dearth of published literature regarding how pessary types are selected by providers, how providers are trained, what defines competency in pessary provision, and what constitutes appropriate patient education related to pessary use and management.
本手稿是关于盆腔器官脱垂（POP）的国际妇科泌尿学咨询（IUC）第3章、委员会1的一部分，重点关注POP的子宫托管理。
一个国际多学科临床医生小组对盆腔健康领域的文献进行了叙述性综述，检索词使用了医学主题词表（MeSH）中的“盆腔器官脱垂”或“泌尿生殖系统脱垂”或“阴道脱垂”或“子宫阴道脱垂”以及“子宫托”或“支撑装置”或“阴道内装置”。使用Covidence手稿评审平台评审后确定的相关研究被纳入。
共评审了540篇文章，其中313篇被纳入本叙述性综述。报道的子宫托适配成功率在41%至96.6%之间，成功持续使用率在21%至97.7%之间。适配试验失败最可能的预测因素是既往POP手术、既往子宫切除术、阴道长度短、生殖裂孔宽以及后盆腔受累。在POP患者成功放置子宫托后，超过90%的患者阴道膨出和压迫感消失。40%至97%的参与者报告梗阻性排尿有显著改善，38%的患者尿急症状改善，29%至77%的患者急迫性尿失禁症状改善，9%至45%的患者压力性尿失禁症状改善。年龄较大以及能够自我管理子宫托护理或有家庭支持的女性是与子宫托持续使用相关的因素。报告的停用常见原因包括子宫托脱出、阴道疼痛/不适、不愿继续使用、糜烂、希望手术、出血、子宫托治疗后症状未改善以及尿失禁。更严重的并发症（瘘管、肠梗阻、子宫托嵌顿和阴道癌）很少见，通常发生在忽视子宫托维护的老年女性中。目前尚无高质量证据指导子宫托的选择。当前文献缺乏专门针对确定预防措施（即雌激素、子宫托类型/材料）对子宫托相关并发症（PACs）作用的研究。该综述发现缺乏关于子宫托提供、使用和管理的相关及必要培训与教育（针对医疗保健专业人员和患者）的信息。
关于使用子宫托治疗POP已有大量已发表的研究，包括有效性、与成功和失败相关的因素以及并发症。然而，关于提供者如何选择子宫托类型、提供者如何接受培训、子宫托提供方面的能力如何界定以及与子宫托使用和管理相关的适当患者教育内容的已发表文献却很匮乏。
