Abstract:
BACKGROUND : Vaginal pessaries are known to be an effective treatment modality for pelvic organ prolapse (POP). Pessaries form an
important part of the physician’s armamentarium in the treatment of POP, but currently many of the factors affecting their successful use
are poorly understood.
OBJECTIVES : To determine the association between pessary retention (PR) at 1 year, and functional pelvic floor morphology, i.e. levator
hiatal distance and area, and levator avulsion.
METHODS : This retrospective study reviewed the records of 73 patients with symptomatic POP at a tertiary urogynaecological centre. This
multi-ethnic cohort had previously been studied for pelvic-floor morphology, had had 4D transperineal pelvic-floor ultrasound, and had
opted for a vaginal pessary as a treatment option.
RESULTS : Our population had a mean age of 59.4 (range 32 - 91) years, and mean body mass index of 29.4 (range 20 - 42) kg/m2, with a
mean assessment of stage 3 in the Pelvic Organ Prolapse Quantifications System (POP-Q). The level of prolapse was found to be related
to PR (p=0.077). We further explored this concept using symmetric measures of association (γ=–0.353), indicating that PR decreases
with increasing prolapse severity. PR was also found to be inversely associated with prior pelvic reconstructive surgery (n=63; p=0.055;
γ=–0.417). There was a strong correlation that failed, however, to achieve significance by a small margin (p=0.052) between hiatal
distance on contraction and PR.
CONCLUSION : This study found an inverse relationship between PR and hiatal distance on contraction, prior pelvic surgery and the severity
of prolapse. This was a pilot study with a limited number of participants, and the authors plan a prospective study to further clarify the
association between long-term PR and functional pelvic floor morphology.
