QUALITY OF LIFE AND VAGINAL SYMPTOMSIN WOMEN WITH PELVIC ORGAN PROLAPSE USING PESSARIES: PROSPECTIVESTUDY
C. JULIATO, S. COELHO, E.CASTRO, M. MARANGONI, L. BRITO;
Univ. of Campinas, Campinas,Brazil.
Introduction: Pelvic Organprolapse is a high prevalence pathology that mainly affects qualityof life, increasingly becoming an important issue in women’s healthcare worldwide. Vaginal pessary is a conservative option treatmentfor pelvic organ prolapse (POP) that could improve quality of life.Beside this, some studies have shown that some common complaints ofits use may include vaginal discomfort and increased vaginaldischarge.
Objective: To determine if the usage of vaginalpessary can improve quality of life and vaginal symptoms in womenwith POP .
Methods: It was performed a prospectivestudy in Women Hospital , from january 2015 to december 2015,including 19 women with POP and with surgical impossibility or desireto use pessary. Women answered a standardized questionnaireand two validated questionnaire: SF- 36 e o ICIQ-VS before andafter at least 6 months pessary insertion. Statistical analysis wasperformed with SAS version 9.4 for Windows (SAS Institute, Cary, NC,USA). The characterization of the total sample was performed usingsimple and relative frequencies for the categorical variables anddescriptive measures (mean and standard deviation) for thequantitative variables. This study was approved by InstitutionalReview Board.
Results: The mean age of the women was 76 (±7.9) years and 47.4% were white. 89.5% of the women have 3 or morevaginal deliveries. BMI mean was 24.6 (± 1.3) kg/m2. All women werepostmenopausal and did not use hormone therapy. According to PelvicOrgan Prolapse Quantification (POP-Q), 84.2% of women had apical andanterior prolapse stage 3 or 4 and 68.4% had posterior prolapse. Withregard to sexual activity, 6 of 19 (31.5%) women had sexual activity.Regarding urinary symptoms previous pessary usage, 78.9% of womenrefer some urinary symptoms: 31.6% SUI, 42.1% urgency, 42% nocturiaand 15% nocturnal enuresis. The pessary usage mean was 10.6 (6-24)months. Only one women had pessay expusion. All women have usedvaginal ring pessary. After pessary use, 5 women have had complaintsof vaginal discharge and 2 have had vaginal ulceration. In physicalexamination, 27.7% has vaginal discharge. After at least 6 monthspessary use, when women were asked, 77.7% of then have improved ingenital symptoms . According to SF 36 questionnaire, there wasimprove in 3 domains: general health perceptions (p=.0009), vitality(p=.049) social role functioning (p=.0007). ICIQ- VS has showed asignificant reduction in score 28 points (30 to 2) reduction invaginal symptoms (p=.0001) and 9.1 points (8.5 to 0.4) in quality ofscore (p=.0001). There was no difference in sexual matters, but only31.5 % of included women has sexual active.
Conclusions:Pessary use in women with POP produce a positive effect on women´squality of life, reducting vaginal symptoms, improving vitalityfeelings and social role functioning
References: Am JObstet Gynecol. 2015;212(1):60.e1-6; Int Urogynecol J.2011;22(3):273-8; Int Urogynecol J. 2011;22(6):637-44