A SIMPLIFIED PROTOCOL FOR PESSARY MANAGEMENT

Objective: To evaluate a simplified protocol for pessary management. M ethods: Women with symptomatic pelvic organ prolapse who opted for pes saries were enrolled in a prospective simplified protocol for pessary management. After the initial pessary fitting, they were seen at 2 wee ks for reexamination and thereafter at 3- to 6-month intervals. Result s: One hundred ten women (mean age 65 years) were enrolled, and 81 (74 %) of them were fitted successfully with a pessary. Life-table analysi s showed that 66% of those who used a pessary for more than 1 month we re still users after 12 months and 53% were still users after 36 month s. The severity of pelvic prolapse did not predict the likelihood of p essary failure except in cases of complete vaginal eversion. Patients complaining of stress incontinence were less likely to have a successf ul pessary fitting and more likely to opt for surgery. Current hormone use and substantial perineal support do not predict greater likelihoo d of pessary fitting success. No serious complications from using the pessary were observed in the study sample. Conclusion: Stringent guide lines calling for frequent pelvic examinations during pessary use can be relaxed safely. Pessaries can be offered as a safe long-term option for the management of pelvic prolapse. (C) 1997 by The American Colle ge of Obstetricians and Gynecologists.