This study compared pessary self-management to clinic-based care for pelvic organ prolapse (POP). Involving 340 women, results showed no significant difference in pelvic floor-specific quality of life at 18 months. Self-management proved less costly with fewer complications, instilling greater patient confidence. These findings offer a potential, cost-effective alternative in POP care.
https://doi.org/10.1016/j.eclinm.2023.102326
Pelvic organ prolapse (POP) is a condition where one or more pelvic organs, such as the vaginal walls, uterus, or vaginal vault, descend, leading to associated symptoms. Studies indicate that 30–40% of women have prolapse on examination, but only 5–10% report symptoms. Additionally, there is a 9.5% lifetime risk of undergoing prolapse surgery, with up to 18.5% of these women requiring further procedures. Due to concerns about surgical mesh, attention has shifted to conservative treatment options.
One such option is the vaginal pessary, an inexpensive device inserted into the vagina to provide support to the pelvic organs. Globally, two-thirds of women initially opt for a vaginal pessary to address prolapse symptoms.
The study and its design
A recent study, conducted between May 2018 and February 2020 with follow-up until September 2021, explored a new approach to managing POP: pessary self-management compared to traditional clinic-based care. The trial involved 340 women recruited from 21 centres where pessary care was routinely provided.
In the clinic-based care group, women received standard care with healthcare professionals removing, cleaning, and re-inserting or renewing their pessaries during appointments. The median pessary change interval in this group was 186 days.
Results and findings
The study found no statistically significant difference between the pessary self-management group and the clinic-based care group in terms of the primary outcome: women’s pelvic floor-specific quality of life at 18 months. The main reason for non-response at follow-up was participants choosing to withdraw from the trial.
At 18 months, a majority of participants in both groups were still on treatment, but there was a notable crossover from self-management to clinic-based care. Interestingly, self-management was associated with lower costs due to reduced resource use and health-seeking behaviour.
Conclusion and implications
In conclusion, the study did not show evidence that pessary self-management was superior or inferior to clinic-based care regarding the primary clinical outcome. However, self-management proved to be a less costly option with fewer reported complications and increased confidence among participants. Women who self-managed were more likely to perceive an improvement in their pessary care.
This research sheds light on a potential alternative for managing pelvic organ prolapse, emphasising cost-effectiveness and patient confidence. Further exploration of these findings may contribute to evolving standards of care for women dealing with POP.