Guideline No. 411: Vaginal Pessary Use

Autor: Marie-Claude Lemieux, Jane Schulz, Marie-Andrée Harvey, Magali Robert
Rok vydání: 2021
Předmět:
Zdroj: Journal of Obstetrics and Gynaecology Canada. 43:255-266.e1
ISSN: 1701-2163
DOI: 10.1016/j.jogc.2020.11.013
Popis: Objective To review the use, care, and fitting of pessaries. Target population Women requiring the use of vaginal pessaries for pelvic organ prolapse and/or stress urinary incontinence. Use may also be indicated for women with certain pregnancy-related clinical scenarios, including incarcerated uterus. Options Pessaries are an option for women presenting with prolapse and/or stress urinary incontinence. In addition, certain types of pessaries can be considered for patients with cervical insufficiency or incarcerated uterus. Outcomes Most women with prolapse or stress urinary incontinence can be successfully fitted with a pessary and experience excellent symptom relief, high satisfaction rates, and minimal complications. Benefits, harms, and costs Women with pelvic organ prolapse and/or stress urinary incontinence may choose to use a pessary to manage their symptoms rather than surgery or while waiting for surgery. Major complications have been seen only when pessaries are neglected. Minor complications such as vaginal discharge, odour, and erosions can usually be successfully treated. Evidence Medline was searched for relevant articles up to December 2018. This is an update of the SOGC technical update published in 2013, which was the first internationally published guidance on pessary use. Subsequently, an Australian guideline on the use of pessaries for the treatment of prolapse was published later in 2013. Validation methods The authors rated the quality of evidence and strength of recommendations using the approach of the Canadian Task Force on Preventive Health Care (Appendix A). Intended audience Gynaecologists, obstetricians, family physicians, physiotherapists, residents, and fellows. SUMMARY STATEMENTS 1Most women can be successfully fitted with a pessary to treat the symptoms of pelvic organ prolapse or stress urinary incontinence (II-2). 2Satisfaction rates for pessary use are very high (I). 3Some vaginal pessaries may prevent recurrence of incarcerated uterus (III). 4The role of pessaries specifically designed to prevent preterm labour is not yet elucidated (I). 5Complications associated with pessary use are usually minor, with vaginal discharge being the most common problem (II-3). 6Vaginal erosions can be treated with removal of the pessary and optional vaginal estrogen supplementation (II-2). RECOMMENDATION 1Pessaries should be considered in all women presenting with bothersome pelvic organ prolapse and/or stress urinary incontinence (I, A).
Databáze: OpenAIRE
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