Top

International Urogynecology Journal

Published in:

01-08-2019 | Original Article

Vaginal pessaries in the management of symptomatic pelvic organ prolapse in rural Kilimanjaro, Tanzania: a pre-post interventional study

Authors: Benjamin C. Shayo, Gileard G. Masenga, Vibeke Rasch

Published in: International Urogynecology Journal | Issue 8/2019

Abstract

Introduction and hypothesis

The objective of this study was to evaluate the outcomes of vaginal pessaries in managing symptomatic pelvic organ prolapse (POP) in a low-income setting.

Methods

A pre-post interventional study was conducted in the Kilimanjaro region, Tanzania. Seventy-one women with symptoms and a POP stage II or more on the POP quantification test were fitted with a vaginal pessary. Pelvic examination, POP Distress Inventory (POPDI-6) and POP Impact Questionnaire (POPIQ-7) were completed at baseline, after 3 months and after 12–18 months. Changes in the POPDI-6 and POPIQ-7 scores, complications and satisfaction associated with pessary use before and after the intervention were obtained.

Results

Pessary treatment was associated with a reduction in the overall POPDI score from 55.0 (50.0, 60.0) at baseline to 25.0 (25.0, 30.0) after 12–18 months’ use. The overall POPIQ score was reduced from 54.2 (41.7, 66.7) at baseline to 25.0 (25.0, 29.2) after 12–18 months’ use of the pessary. Vaginal discharge was reported in 72.4 and 32.4% of the women after 3 and 12–18 months’ use respectively, whereas 72.4 and 25% of the women had some degree of granuloma, erosion or infection at 3 and 12–18 months respectively. Despite the reported complications, 78% of the women were satisfied with the pessary when interviewed after 12–18 months and 81% wanted to continue using it.

Conclusions

Vaginal pessary improves symptoms and quality of life associated with symptomatic POP. Therefore, it may be a treatment option in managing POP in low-income countries such as Tanzania.

Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90. https://doi.org/10.1007/s00192-013-2169-9.CrossRefPubMed

Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127–35. https://doi.org/10.1007/s00192-010-1215-0.CrossRefPubMed

Masenga GG, Shayo BC, Rasch V. Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: a population based study in Tanzanian rural community. PLoS One. 2018;13(4):e0195910. https://doi.org/10.1371/journal.pone.0195910.CrossRefPubMedPubMedCentral

Awwad J, Sayegh R, Yeretzian J, Deeb ME. Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study. Menopause. 2012;19(11):1235–41. https://doi.org/10.1097/gme.0b013e31826d2d94.CrossRefPubMed

Scherf C, Morison L, Fiander A, Ekpo G, Walraven G. Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG. 2002;109(4):431–6.CrossRef

Wusu-Ansah OK, Opare-Addo HS. Pelvic organ prolapse in rural Ghana. Int J Gynaecol Obstet. 2008;103(2):121–4. https://doi.org/10.1016/j.ijgo.2008.06.014.CrossRefPubMed

Megabiaw B, Adefris M, Rortveit G, Degu G, Muleta M, Blystad A, et al. Pelvic floor disorders among women in Dabat district, Northwest Ethiopia: a pilot study. Int Urogynecol J. 2013;24(7):1135–43. https://doi.org/10.1007/s00192-012-1981-y.CrossRefPubMed

Gjerde JL, Rortveit G, Muleta M, Adefris M, Blystad A. Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia. Int Urogynecol J. 2017;28(3):361–6. https://doi.org/10.1007/s00192-016-3077-6.CrossRefPubMed

Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):125–30. https://doi.org/10.1016/j.ejogrb.2010.12.039.CrossRefPubMed

10.

Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9. https://doi.org/10.1097/01.AOG.0000222903.38684.cc.CrossRefPubMed

11.

Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025–9. https://doi.org/10.1016/j.ajog.2003.10.711.CrossRefPubMed

12.

Komesu YM, Rogers RG, Rode MA, Craig EC, Gallegos KA, Montoya AR, et al. Pelvic floor symptom changes in pessary users. Am J Obstet Gynecol. 2007;197(6):620.e1–6. https://doi.org/10.1016/j.ajog.2007.08.013.CrossRef

13.

Patel M, Mellen C, O’Sullivan DM, LaSala CA. Impact of pessary use on prolapse symptoms, quality of life, and body image. Am J Obstet Gynecol. 2010;202(5):499.e1–4. https://doi.org/10.1016/j.ajog.2010.01.019.CrossRef

14.

Kuhn A, Bapst D, Stadlmayr W, Vits K, Mueller MD. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril. 2009;91(5):1914–8. https://doi.org/10.1016/j.fertnstert.2008.02.142.CrossRefPubMed

15.

Krause HG, Natukunda H, Singasi I, Hicks SS, Goh JT. Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda. Int Urogynecol J. 2014;25(11):1555–9. https://doi.org/10.1007/s00192-014-2442-6.CrossRefPubMed

16.

Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.CrossRefPubMed

17.

Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRef

18.

Pagano M, Gauvreau K. Principle of biostatistics. 2nd ed. Pacific Grove: Duxbury; 2000.

19.

Abdool Z, Thakar R, Sultan AH, Oliver RS. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22(3):273–8. https://doi.org/10.1007/s00192-010-1340-9.CrossRefPubMed

20.

Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007;196(4):405 e1–8. https://doi.org/10.1016/j.ajog.2007.02.018.CrossRef

21.

Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(1):56–9. https://doi.org/10.1016/j.ijgo.2011.02.006.CrossRefPubMed

22.

Manchana T. Ring pessary for all pelvic organ prolapse. Arch Gynecol Obstet. 2011;284(2):391–5. https://doi.org/10.1007/s00404-010-1675-y.CrossRefPubMed

23.

Manchana T, Bunyavejchevin S. Impact on quality of life after ring pessary use for pelvic organ prolapse. Int Urogynecol J. 2012;23(7):873–7. https://doi.org/10.1007/s00192-011-1634-6.CrossRefPubMed

24.

Sung VW, Wohlrab KJ, Madsen A, Raker C. Patient-reported goal attainment and comprehensive functioning outcomes after surgery compared with pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2016;215(5):659 e1–7. https://doi.org/10.1016/j.ajog.2016.06.013.CrossRef

25.

Tenfelde S, Tell D, Thomas TN, Kenton K. Quality of life in women who use pessaries for longer than 12 months. Female Pelvic Med Reconstr Surg. 2015;21(3):146–9. https://doi.org/10.1097/SPV.0000000000000154.CrossRefPubMed

26.

Bai SW, Yoon BS, Kwon JY, Shin JS, Kim SK, Park KH. Survey of the characteristics and satisfaction degree of the patients using a pessary. Int Urogynecol J. 2005;16:182–6. https://doi.org/10.1007/s00192-004-1226-9.CrossRef

27.

Robert M, Govan AJ, Lohani U, Uprety A. Feasibility of using pessaries for treatment of pelvic organ prolapse in rural Nepal. Int J Gynaecol Obstet. 2017;136(3):325–30. https://doi.org/10.1002/ijgo.12061.CrossRefPubMed

28.

Wolff B, Williams K, Winkler A, Lind L, Shalom D. Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse. Int Urogynecol J. 2017;28(7):993–7. https://doi.org/10.1007/s00192-016-3228-9.CrossRefPubMed

29.

Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Int Urogynecol J. 2011;22(6):637–44. https://doi.org/10.1007/s00192-011-1390-7.CrossRefPubMedPubMedCentral

30.

Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG Int J Obstet Gynaecol. 2009;116(13):1715–21. https://doi.org/10.1111/j.1471-0528.2009.02380.x.CrossRef

31.

Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417–32.CrossRef

Title: Vaginal pessaries in the management of symptomatic pelvic organ prolapse in rural Kilimanjaro, Tanzania: a pre-post interventional study
Authors: Benjamin C. Shayo
Gileard G. Masenga
Vibeke Rasch
Publication date: 01-08-2019
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 8/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3748-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Vaginal pessaries in the management of symptomatic pelvic organ prolapse in rural Kilimanjaro, Tanzania: a pre-post interventional study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2019

The transition from resident to consultant

Treatment of subacute rectosigmoid obstruction secondary to uterosacral ligament suspension

National BSUG audit of stress urinary incontinence surgery in England

Does spinal anesthesia lead to postoperative urinary retention in same-day urogynecology surgery? A retrospective review

Commentary on: “Does spinal anesthesia lead to postoperative urinary retention in same day urogynecology surgery: a retrospective review”

The underutilization of obliterative and constrictive surgery in the surgical treatment of pelvic organ prolapse