Factors associated with pessary discontinuation in women with pelvic organ prolapse: A retrospective observational study.

Introduction: Pessary therapy is an effective conservative option for pelvic organ prolapse management, yet discontinuation remains frequent. This study aimed to identify factors associated with pessary discontinuation among women with pelvic organ prolapse.

Materials and methods: This retrospective observational study included women who attended a pessary fitting visit in two tertiary care centers between July 2022 and February 2025. Data were extracted from medical records and supplemented by a telephone survey. Pessary discontinuation was defined as non-use of the device at the time of the survey. Associations with pessary discontinuation were assessed using univariable and multivariable logistic regression models.

Results: Among 152 women screened, 87 responded to the survey and were included in the analysis. At the time of the interview, 39 women had discontinued pessary use. In univariable analysis, discontinuation was associated with urinary-predominant baseline complaint, associated urinary symptoms, unmasked stress urinary incontinence after prolapse reduction, prior hysterectomy, discomfort during use, pessary expulsion, and vaginal pain. In multivariable analysis, prior hysterectomy (aOR=5.33; 95% CI, 1.31-28.16; P=0.028), associated urinary symptoms (aOR=2.87; 95% CI, 1.05-8.60; P=0.046), and unmasked stress urinary incontinence after prolapse reduction (aOR=10.07; 95% CI, 1.46-204.60; P=0.044) remained associated with discontinuation after adjustment.

Conclusion: Pessary discontinuation was associated with prior hysterectomy, urinary symptoms, and unmasked SUI after prolapse reduction. Careful fitting, tailored counseling, and early reassessment may help optimize adherence.

Level of evidence: Level 1.