Study Of The Influencing Factors And Efficacy Of Pessary Treatment For Pelvic Organ Prolapse

Objective:The purposes of this study are to identify relevant factors, which may affect the pessary treatment for women with pelvic organ prolapse, and to investigate the effect of long-term continuous pessary insertion on patients’ pelvic floor anatomy and pelvic floor functions.Methods:From November2012to November2014, there were273patients presenting with symptomatic pelvic organ prolapse, who received pessary treatments in the Women’s Hospital, School of Medicine, Zhejiang University. They were admitted and inserted pessary by special pelvic floor gynecologist. Positions of prolapse were divided into anterior compartment, middle compartment and posterior compartment. Degree of prolapse was divided into I to IV degrees according to POP-Q system, and multiple pelvic prolapse was described by the highest degree of compartment. The clinical data of patients were collected including age, childbearing history, pelvic surgery history, disease course and degree of prolapse etc. Patients who were successfully inserted pessary were surveyed by telephone follow-up or outpatient visit, in order to collect the information such as pessary using, subjective symptom, sex life and reasons of treatment interrupted. The efficacy, influencing factors along with the long-term effect of pessary insertion on patients’ pelvic floor anatomy and pelvic floor functions were evaluated by methods of POP-Q system, pelvic floor3-D ultrasonography, pelvic floor questionnaire (PFIQ-7) and prolapsed and incontinence sexual function questionnaire (PISQ-12). All data in this study are presented as mean±S.D. Data were analyzed with Student’s t-test, Mann-Whitney U test and analysis of variance (ANOVA), followed by Scheffe’s post hoc test. Significance levels were measured at p<0.05.Results:The age ranges of all273patients were from27to89. The average age was63.02±11.62years old. Most of them were in ages of60to69, accounting for39.2%(107/273). Among them,17cases were single located prolapse, including8cases of anterior compartment,6cases of middle compartment and3case of posterior compartment, while the other256cases were multiple located prolapse. Among all patients,3cases were stage I(1.1%),17cases were stage Ⅱ (6.2%),95cases were stage Ⅲ(34.8%), and158cases were stage IV (57.9%) according to the Pelvic Organ Prolapse Quantification (POP-Q) system.166cases out of all273cases (60.8%) were fitted with pessary satisfactorily, among them there were18cases failed in the first time while succeeded in the second attempt after one month pelvic floor function training.107patients failed with pessary treatments,35of them had achieved anatomical reduction of the prolapsed organs in the fitting process, but refused to use pessary for some subjective factors (such as ideological concerns, self-management problems). There was no significant differences between success group and failure group in age, years of menopause, disease course, body mass index(BMI), childbearing history, POP-Q stage, total vaginal length, morphology of levator ani muscle and so on(P>0.05for all). Compared to failure group, the degree of the prolapse in the anterior compartment was milder in success group (P<0.05).166cases with pessary successfully fitted were followed up. Among them,38cases (22.9%) were lost to follow-up,8cases switched to surgical treatment in the follow up of6months because of dissatisfaction to pessary treatment,55cases used pessary irregularly for some subjective reasons. There were65cases that regularly used pessary for at least6months. The age range of these65patients was from43to85years old and the average age was64.6±9.20years old. The period of pessary therapy ranged from6months to18months, and the average period was12months. Among them9cases were stage Ⅱ,21cases were stage Ⅲ and35cases were stage IV. During treatments, there were17cases with vaginal secretion increase and2cases with vaginal bleeding (rate of complication was29.2%). After corresponding treatment such as local delivery of antibiotics and/or estrogen, all these patients had clinically significant improvement of symptoms and continued the pessary treatment. Statistical analysis showed that POP-Q stages of these65cases significantly alleviated after the long term pessary treatment (p<0.05), while there were no significant changes of the anteroposterior and transverse diameters of the patients’ pelvic diaphragm hiatus, angle and thickness of the levator ani muscle (P>0.05for all); The total scores of the PFIQ-7significantly decreased after long term pessary treatment(P<0.05), while there was no significant difference of PISQ-12scores between before and after long term pessary treatment(P>0.05) Conclusion:Pessary is a suitable treatment for majority patients presenting with pelvic organ prolapse. The principal factors influencing the effect of pessary treatment were patients’ subjective reasons and degree of the prolapse of organs of the anterior pelvic compartment. Long-term continuous using of pessary could effectively alleviate symptoms of pelvic organ prolapse and could also improve patients’life quality.