Abstract
It is expected that with the rising female life expectancy the prevalence of pelvic
organ prolapse will increase. From ancient times mechanical devices have been used
to reposition prolapsed organs. Given that surgical correction of prolapse is associated
with high recurrence rates, pessaries offer a favorable alternative. In spite of the
antiquity of pessary usage the evidence for its use, the effectiveness of symptom
relief, and the nuances of clinical management with the pessary in situ have not been
studied methodically. There is a need for controlled trials to assess the efficacy
of pessaries as opposed to other non-surgical and surgical methods of treating pelvic
organ prolapse. Additionally, the long term effects and complications of pessary usage
have not been assessed in trials, and knowledge about the potential complications
caused by the pessary rests mainly on anecdotal data.
This review provides a historical perspective and appraises the current knowledge
regarding the indications, effectiveness and the potential complications associated
with pessary use. Data were obtained from an electronic search of Medline (1966–2010)
and by hand searching the citations which were not available online. Keywords used
were pelvic organ prolapse, pelvic floor dysfunction, vaginal pessary and urinary
incontinence. Textbooks are also quoted where relevant.
Most studies report moderate success rates in the short term following insertion of
a pessary for the management of prolapse and concur in the remission of almost all
symptoms attributable to the prolapse. Reported success is variable in the remission
of urinary and bowel symptoms. We conclude that based on the available evidence (mostly
retrospective and prospective cohort studies), treatment with a vaginal pessary is
a feasible option that can be offered in the short term to women with prolapse. There
is a need for controlled trials to assess the long term efficacy.
Keywords
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Article info
Publication history
Published online: January 14, 2011
Accepted:
December 26,
2010
Received in revised form:
November 29,
2010
Received:
August 13,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
