WHAT ARE THE CLINICAL FACTORS THATARE PREDICTIVE OF PERSISTENT PESSARY USE AT 12 MONTHS?
M. C. CHAN1, M.HYAKUTAKE 1, M. YASKINA 2, J. A. SCHULZ 3;
1Obstetrics and Gynecology, Univ. of Alberta,Edmonton, Canada, 2Women and Children’s Health ResearchInstitute, Univ. of Alberta, Edmonton, Canada, 3Lois HoleHosp. for Women, Dept. of Obstet, Edmonton, Canada.
Introduction: Urinaryincontinence and pelvic organ prolapse are highly prevalent in womenand cause significant impact on quality of life. Urinary incontinenceaffects up to 50% of women; pelvic organ prolapse affects 50-70% ofparous women. Treatment options for pelvic organ prolapse or urinaryincontinence include pelvic floor exercise, expectant management,pessaries or surgery.1 Pessaries are devices that are usedas a conservative management option to treat urinary incontinence andpelvic organ prolapse.1 There is evidence to supportoutcomes in quality of life and symptom improvement to be the samewith pessary or surgical management.2
Many women usepessaries which avoids surgical intervention with its associatedmorbidity and cost. However, not all women are good candidates forpessary use. There is some evidence suggesting patients withpersistent use at 4 weeks are likely to wear the pessary for 5 yearsor more.1 Additionally, patients with prior surgery are less likelyto have successful fit. There is limited data on patientcharacteristics for long term pessary use greater than 12months.
Objective: The objective of this study was todetermine clinical factors predictive of persistence with pessary usefor incontinence and pelvic organ prolapse in a tertiary care centerat 12 months post fitting. Studying patient characteristics forpredictive long term pessary use will contribute to better patientcounselling, management, and health resource distribution.
Methods:A retrospective outpatient chart review of patients fitted withpessaries for first time fitting January to June 2014. Any woman over18 years of age fitted with a pessary at that time was included inthe study. Data points included: age, parity, number ofcomorbidities, occupation, distance from tertiary clinic, diagnosis,self care versus nurse care, pessary type, prior pelvic surgery anduse at 12 months. Exclusion criteria were: pregnant, previouslyfitted with pessary or patient was not fitted with pessary (for avariety of reasons due to patient choice or inability to fit). Allstatistical analyses were performed using IBM SPSS Statistics Ver. 24(IBM Corp).
Results: Approximately 330 women wereregistered to be seen in a tertiary care clinic involving specializednurses to fit and care for pessaries. 152 of these women wereincluded in the retrospective chart review. With a multivariatelogistic regression analysis a patient’s diagnosis of prolapse orincontinence (p=0.014, OR = 7.7, 95% CI 1.51-39.35), complications(p=0.00002, OR=0.004, 95 % CI 0.0004-0.054), and number of pessariestried (p = 0.04, 2-3 pessaries trial vs. 1; OR = 15.69, 95% CI1.80-136.99 and 4 or more vs. 1; OR = 15.97, CI 1.34-190.47) werestatistically significant . Parity, chief complaint, number ofcomorbidities, distance from clinic site, nurse versus self care orprevious surgery were not statistically significant to pessary use atone year.
Patients with prolapse had 7 times higher odds (95% CI1.51-39.35) to use a pessary at one year than patients withincontinence. Complications were a strong predictive factor forpessary use. Patients without complications had 250 times higher odds(95% CI 18.52-2500) of pessary use at 12 months. Patients who tried2-3 pessaries had 16 times higher odds (95% CI 1.80-136.99) of usinga pessary at 1 year than patients who tried just one type ofpessary.
Conclusions: This study has found lack ofcomplications, number of pessaries tried, and primary diagnosis ofprolapse are significant factors for continued pessary use at 12months. In terms of number of pessaries trialed, our study did notdifferentiate if this was secondary to patient, clinic or nursingfactors. Future research in this area can better help contribute tomore comprehensive pessary clinic care.
1. Journal ofObstetrics and Gynecology Canada 35(7eSuppl):S1-S11
2. InternationalUrogynecology Journal 26: 1305-1312.