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International Urogynecology Journal

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01-09-2021 | COVID-19 | Clinical Opinion

Pessaries and rectovaginal fistulae: consequences of delayed clinical follow-up in the Covid-19 pandemic

Authors: Jordan Mendelson, Bogdan Grigorescu, Catherine Quinn, George Lazarou

Published in: International Urogynecology Journal | Issue 9/2021

Abstract

Introduction and hypothesis

While 2017 guidelines from The American College of Obstetricians & Gynecologists called for pessary replacement every 3 to 4 months, a recent study in Obstetrics and Gynecology suggested that uninterrupted pessary use up to 6 months is not an independent risk factor for development of pessary-related complications.

Methods

Our recent experience throughout the Covid-19 pandemic highlights the potential ramifications of delayed clinical follow-up.

Results

During the Covid-19 pandemic, 3 of our patients developed rectovaginal fistulae secondary to Gellhorn pessary erosion in the context of delayed clinical follow-up. Our patients had previously attended routine appointments every 3 months without complications until missed appointments secondary to the pandemic led to fistulae formation.

Conclusion

We believe that delayed clinical follow-up of pessary management beyond 3 months due to the Covid-19 pandemic may lead to fistula complications in elderly women with Gellhorn pessaries.

Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Reports Urol. 2019;11:179–88. https://doi.org/10.2147/RRU.S191555.CrossRef

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

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

Robert M, Schulz JA, Harvey MA, et al. Technical update on pessary use. J Obstet Gynaecol Can. 2013;35(7):664–74. https://doi.org/10.1016/S1701-2163(15)30888-4.CrossRefPubMed

Powers K, Lazarou G, Wang A, et al. Pessary use in advanced pelvic organ prolapse. Int Urogynecol J. 2006;17(2):160–4. https://doi.org/10.1007/s00192-005-1311-8.CrossRef

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(3):182–6. https://doi.org/10.1007/s00192-004-1226-9.CrossRef

Hanson LAM, Schulz JA, Flood CG, Cooley B, Tam F. Vaginal pessaries in managing women with pelvic organ prolapse and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J. 2006;17(2):155–9. https://doi.org/10.1007/s00192-005-1362-x.CrossRef

Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–38. https://doi.org/10.1016/S0140-6736(07)60462-0.CrossRefPubMed

Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1173–8. https://doi.org/10.1007/s00192-008-0574-2.CrossRefPubMed

10.

Practice Bulletin No. 176: Pelvic Organ Prolapse. Obstet Gynecol. 2017;129(4):e56-e72. https://doi.org/10.1097/AOG.0000000000002016.

11.

Propst K, Mellen C, O’Sullivan DM, Tulikangas PK. Timing of office-based pessary care. Obstet Gynecol. 2020;135(1):100–5. https://doi.org/10.1097/AOG.0000000000003580.CrossRefPubMed

12.

Miceli A, Fernández-Sánchez M, Polo-Padillo J, Dueñas-Díez JL. Is it safe and effective to maintain the vaginal pessary without removing it for 2 consecutive years? Int Urogynecol J. 2020;31(12):2521–8. https://doi.org/10.1007/s00192-020-04240-5.CrossRefPubMed

13.

Thys SD, Hakvoort RA, Asseler J, Milani AL, Vollebregt A, Roovers JP. Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study. Int Urogynecol J. 2020;31(8):1567–74. https://doi.org/10.1007/s00192-019-04200-8.CrossRefPubMedPubMedCentral

14.

Melon J. Commentary on “effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study.”. Int Urogynecol J. 2020;31(8):1575. https://doi.org/10.1007/s00192-019-04211-5.CrossRefPubMed

15.

Anderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic. JAMA Netw Open. 2021;4(1):e2034882. https://doi.org/10.1001/jamanetworkopen.2020.34882.CrossRefPubMedPubMedCentral

Title: Pessaries and rectovaginal fistulae: consequences of delayed clinical follow-up in the Covid-19 pandemic
Authors: Jordan Mendelson
Bogdan Grigorescu
Catherine Quinn
George Lazarou
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keyword: COVID-19
Published in: International Urogynecology Journal / Issue 9/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-021-04926-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pessaries and rectovaginal fistulae: consequences of delayed clinical follow-up in the Covid-19 pandemic

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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