Rare complications of pessary use: A systematic review of case reports
Abstract Introduction Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients...
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| Format: | Article |
| Language: | English |
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Wiley
2022-11-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.174 |
| _version_ | 1811189388597526528 |
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| author | Stefan Dabic Christina Sze Stephanie Sansone Bilal Chughtai |
| author_facet | Stefan Dabic Christina Sze Stephanie Sansone Bilal Chughtai |
| author_sort | Stefan Dabic |
| collection | DOAJ |
| description | Abstract Introduction Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events. Methods We performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level. Results Overall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications. Conclusion Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required. |
| first_indexed | 2024-04-11T14:35:05Z |
| format | Article |
| id | doaj.art-5081ad81e6514f50aa19734fc03cf79c |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-04-11T14:35:05Z |
| publishDate | 2022-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-5081ad81e6514f50aa19734fc03cf79c2022-12-22T04:18:22ZengWileyBJUI Compass2688-45262022-11-013641542310.1002/bco2.174Rare complications of pessary use: A systematic review of case reportsStefan Dabic0Christina Sze1Stephanie Sansone2Bilal Chughtai3Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USADepartment of Urology Weill Cornell Medicine/New York Presbyterian New York New York USADepartment of Urology Weill Cornell Medicine/New York Presbyterian New York New York USADepartment of Urology Weill Cornell Medicine/New York Presbyterian New York New York USAAbstract Introduction Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events. Methods We performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level. Results Overall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications. Conclusion Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.https://doi.org/10.1002/bco2.174adverse effectsfistulaincontinencepessaryprolapserare complications |
| spellingShingle | Stefan Dabic Christina Sze Stephanie Sansone Bilal Chughtai Rare complications of pessary use: A systematic review of case reports BJUI Compass adverse effects fistula incontinence pessary prolapse rare complications |
| title | Rare complications of pessary use: A systematic review of case reports |
| title_full | Rare complications of pessary use: A systematic review of case reports |
| title_fullStr | Rare complications of pessary use: A systematic review of case reports |
| title_full_unstemmed | Rare complications of pessary use: A systematic review of case reports |
| title_short | Rare complications of pessary use: A systematic review of case reports |
| title_sort | rare complications of pessary use a systematic review of case reports |
| topic | adverse effects fistula incontinence pessary prolapse rare complications |
| url | https://doi.org/10.1002/bco2.174 |
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