MORBIDITY OF PATIENTS WITH PELVICORGAN PROLAPSE IN TREATMENT WITH VAGINAL PESSARIES
B. MUNOZ1, E. CORTES1, J. MARIN 2;
1Urogynecologyand Reconstructive Pelvic Surgery, UMAE "Luis Castelazo Ayala"IMSS, Mexico City, Mexico, 2Urogynecology andReconstructive Pelvic Surgery, UMAE, Mexico City, Mexico.
Introduction: Pelvic organprolapse (POP) affects 40% of postmenopausal women and it has effectsover the bladder and intestinal functions, as well as on the qualityof life. It constitutes the most frequent condition (10% up to 70%)in the disorders resulting from the dysfunction of the pelvic floor,preceded by urinary incontinence. There is evidence that with the useof the vaginal pessary success rates between 71 to 90% are reportedwith respect to the symptoms related to a foreign body and vaginalpressure. These satisfactory results are observed once the pessariesare placed, so they have a high rate of success with minimalcomplications, and they may be used securely in cases of pelvic organprolapse and urinary incontinence. This therapeutic tool is withinthe reach of patients, and its use is reversible at the moment thatthe patient opts for a definitive treatment or once her comorbidityfactors allow a radical treatment to this pathology.
Objective:To determine the comorbidity frequency, evolution, acceptance, andadherence to the conservative treatment of pelvic organ prolapsethrough the use of vaginal pessaries.
Methods:Observational, descriptive, and retrospective study. The review of 60clinical records corresponding to patients suffering from genitalprolapse and who were treated with vaginal pessaries during theperiod from January 2013 to January 2015 was performed, collectingdemographical and clinical data (evolution, adherence to thetreatment, acceptance, and associated complications). Descriptivestatistics were performed, with tables and graphics of frequenciesfor qualitative variables, and measures of central tendencies anddispersion for the quantitative variables
Results: A totalof 60 patients with a diagnosis of pelvic organs prolapse and whowere undergoing conservative treatment with pessary were studied.Mean age was 74.75 years of age; weight of 61.75 Kg, and a averageheight of 1.50 m. The body mass index was found to be altered in 70%of the patients. Multiparity was frequent in this group of patients,who reported 3 to 4 childbirths. In regards to the POP status, theIIIBa appeared with greater frequency. The Gellhorn was the most usedpessary in 90% of the patients. Leucorrhea was the symptom mostcommonly encountered in 8.3% of the patients, and where only 13%developed bacterial forms in the vaginal culture, being E.coli themost frequent pathogen. The most frequent complication was theerosion of the vaginal mucous membrane at 12%. 27% of the patientspresented POP in association with urinary incontinence (UI). The mostfrequent type of UI was the urgent urinary incontinence at a 50%. Thefailure of the conservative treatment was observed for 12% of thepatients, because of the association with UI and because of thepatient’s decision to adopt a definitive surgicaltreatment.
Conclusions: The use of a vaginal pessary as aconservative treatment for pelvic organs prolapse is safe, with lowfrequency of complications, and showing adequate acceptance by thepatients for its long-term use.
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