Pessary Placement for Voiding Dysfunction Due to Prolapse Among Neurologically Intact Women.

Abstract

Importance: Literature surrounding conservative management of voiding dysfunction (VD) due to pelvic organ prolapse (POP) is limited.

Objective: The objective of this study was to evaluate the effect of pessaries on VD in women with symptomatic POP.

Study design: This was a retrospective case series of adult women who underwent a pessary fitting for POP and VD between January 2010 to December 2022 at 2 tertiary care centers. Voiding dysfunction was defined as a composite outcome of participant report of obstructive voiding symptoms and postvoid residual volume (PVR) ≥150 mL prior to pessary fitting. Obstructive voiding symptoms were determined by positive response on the Pelvic Floor Distress Inventory-20 to items 5, 6, 19, and/or 20.

Results: Sixty-one participants with POP and VD underwent successful pessary fitting at 2 large academic institutions. Median (range) age was 75 years (35-89) and body mass index of 26.5 (18.0-46.3). Participant reports of "difficult bladder emptying" and "sensation of incomplete bladder emptying" were the most reported symptoms of obstructive voiding. Advanced staged prolapse (prolapse ≥ stage 3) was documented for 84% of participants. Median point C, Ba, and genital hiatus were -2 cm, +3 cm, and 4 cm, respectively, on examination. Median PVR prior to pessary fitting was 263 mL (150-810). Voiding dysfunction resolved in 60 out of 61 participants (98%). Median repeat PVR after pessary placement was 50 mL (0-250).

Conclusion: Pessary placement resolved VD due to POP in 98% of participants. Clinicians can offer pessary placement as nonsurgical management for participants with VD due to POP.