E-Posters-Outcomes of Nurse-Led Pessary Clinic for Pelvic Organ Prolapse

Outcomes of Nurse-Led Pessary Clinic for Pelvic Organ Prolapse - Sophia Lalani, BSc

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This study aimed to report the outcomes of women who underwent vaginal pessary insertion for the treatment of pelvic organ prolapse (POP) in a nurse-led pessary clinic at a tertiary urogynaecology center. Data were obtained from a case review of 210 patients who attended the clinic between July 2012 and February 2018. The primary outcome was discontinuation of pessary. <br /><br />At three months, 58% of patients had discontinued pessary use, and the overall treatment failure rate for the cohort was 72%. The primary reasons for discontinuation included lack of efficacy, pain or discomfort, vaginal discharge, and subsequent surgery. 15% of patients eventually underwent surgery for POP. The average length of pessary use for those continuing beyond three months was 16 months. <br /><br />When comparing the type of pessary used, only the ring pessary was associated with a lower risk of discontinuation. The prolapse compartment did not alter the risk of discontinuation. <br /><br />The study concluded that nurse-led pessary insertion at their institution is associated with a high rate of discontinuation and treatment failure, likely due to the tertiary nature of the unit and the prevalence of women with complex recurrent prolapse. Lower rates of discontinuation were seen with ring pessary insertion, likely because they are used as a first-line treatment in less severe or complex cases. Pessary use should be considered routine for all women regardless of the compartment of prolapse, as there were similar discontinuation rates in various compartments and a low risk profile. The role of different pessary subtypes deserves further study to improve patient counseling and pessary selection.

Keywords

vaginal pessary insertion

pelvic organ prolapse

nurse-led pessary clinic

treatment outcomes

discontinuation of pessary

surgery for POP

type of pessary

risk of discontinuation

complex recurrent prolapse

patient counseling