Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial

Autor: Begüm Özel, Nuzhath A. Hussain, Diane Thomas, Christina E. Dancz, Daphne K. Walker
Rok vydání: 2017
Předmět:
Zdroj: Int Urogynecol J
ISSN: 1433-3023
0937-3462
Popis: INTRODUCTION AND HYPOTHESIS: The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP). METHODS: This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1 cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3 weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher’s exact test. RESULTS: Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3–37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77 days (interquartile range 49–99 days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p = 0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p = 0.003). CONCLUSIONS: Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.
Databáze: OpenAIRE
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