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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Pelvic organ prolapse can be associated with stress UI. Initial management involves advice to avoid straining (e.g. lifting heavy weights or with constipation), weight loss if BMI > 30 kg/m2 and PFE. Pessaries can be helpful but may impact sexual function and cause vaginal discharge or bleeding; there may also be difficulty removing the pessary or pessary expulsion.87 Pessaries will need changing and should not remain in for more than six months. The final option is surgery, possibly including hysterectomy.
The Role of Cerclage and Pessaries
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Israel Hendler, Howard J.A. Carp
The pessary should be removed if delivery is imminent or if contractions are effective. However, in normal circumstances, the pessary, as a suture, is removed at approximately 37 weeks. If there is cervical edema, removal may be painful. In any case, the cervix should be pushed back through the inner ring of the pessary dome.
Pessary Care
Published in Teresa Tam, Matthew F. Davies, Vaginal Pessaries, 2019
Pelvic organ prolapse is a quality-of-life disorder that affects a significant portion of the female population. A pessary is a useful tool at the clinician's disposal for the treatment of symptoms brought on by pelvic organ prolapse. It can also help to manage some urinary symptoms such as stress urinary incontinence related to urethral hypermobility and/or urinary outflow obstruction related to pelvic organ prolapse. In addition, it can alleviate anorectal symptoms associated with a rectocele.1 A properly fitted pessary can significantly improve the quality of life for those afflicted with symptoms related to pelvic organ prolapse.2,3 Care and follow-up for patients wearing a pessary require a commitment by the patient (and in some cases her care providers) as well as customization of follow-up recommendations from the treating clinician.
Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis
Published in Climacteric, 2022
F. Ai, Y. Wang, J. Wang, L. Zhou, S. Wang
In total, 272 scientific publications were identified through database searching according to the defined search strategy. After excluding the 76 duplicate studies, 196 were unique. Subsequently, 186 articles were excluded by screening the title and abstract, leaving 10 articles for further evaluation. After thoroughly reviewing the full-text article of each study, five articles were excluded that did not meet the inclusion criteria, and the remaining five articles [17–21] were eligible for the quantitative analysis. Of these articles, three were randomized controlled trials (RCTs) [18,20,21], one article was a prospective study [17] and the remaining article was a retrospective cohort study [19]. The process of study selection is summarized in Figure 1. None of the investigations included in our study showed any conflict of interest regarding pessary acquisition. The median follow-up duration varied from 2 weeks to 29.5 months. The study populations were postmenopausal women with symptomatic POP who used pessaries. The pessary types used in the included studies were the ring, Gellhorn, incontinence ring, ring with support, incontinence dish or others. All women were assessed for vaginal health at baseline, and there were no statistically significant differences in the RCTs included in our study. The main characteristics of the population in the identified studies are summarized in Table 1. The methodological quality of the studies was included in the meta-analysis (Figure 2 and Table 2).
Staged repair of concomitant rectovaginal fistula and pelvic organ prolapse after removal of a neglected pessary
Published in Baylor University Medical Center Proceedings, 2020
Stacy Mathews, Shaked Laks, Carola LaFollette, T. Ignacio Montoya, Pedro A. Maldonado
Surgical management was divided into three staged procedures after consultation with colorectal surgery. First, the pessary was removed through the vagina and rotated anteriorly out of the rectovaginal fistula (Figure 2). The fistula was located 6 to 7 cm proximal to the vaginal introitus to the right of the midline. Given the location in the upper mid vagina, there was little concern for involvement of the anal sphincter complex. The defect was approximately 2 × 1 cm. There was approximately 3 to 4 cm between the superior edge of the fistula and the posterior fornix. Due to tissue inflammation, size, and location of the fistula, a laparoscopic loop ileostomy was performed by colorectal surgery to allow tissue scarring with a temporary proximal bowel diversion. An interval fistula repair was performed 2 months later. It was then detected that two fistulas were connected by a bridge of fibrotic tissue. Each fistula was repaired separately, and closure was confirmed on rectal exam. Loop ileostomy takedown and correction of the vaginal prolapse was scheduled for 6 months after fistula repair. Ileostomy takedown was performed by colorectal surgery staff followed by a transvaginal hysterectomy, high uterosacral ligament suspension, anterior/posterior colporrhaphy, and cystoscopy. At 2-week and 2-month follow-up, the vaginal apex and anterior/posterior compartments were well supported and there was no evidence of fistulae recurrence. At 1-year postoperative follow-up, the patient continued to do well.
Presentation of two cases with uterine prolapse occuring in pregnancy
Published in Journal of Obstetrics and Gynaecology, 2020
Erkan Elci, Gulhan Elci, Sena Sayan
The most common complications include abortion (15–21%), preterm delivery (18%), pelvic pain, vaginal discharge, urinary retention and increased urinary tract infections (Sepulveda and Cabrera 1984). In the second case, the patient did not have any complaints except for oedema and vaginal discharge in the cervix by the advanced weeks of her pregnancy. While in the first case complications such as; urinary tract infection, urinary retention, cervical ulcer, constipation, preterm labour and placental ablation during labour; developed due to patient failures. In the second case, during the first gestational weeks, as in the literature, the use of pessary, resting in the trendelenburg position and genital hygiene were recommended (Guariglia et al. 2005). In the literature, it was preferred to use pessary until adequate uterine growth (first six months). Büyükbayrak et al. (2010) reported that pessary application prevented possible complications in pregnancy. In the second case, the use of ring pessary which showed to prevent complications during pregnancy; however, this could not prevent the progression of the prolapse.