Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse
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Pessary
Introitus
Uterine prolapse
A case of benign mixed tumor of the vagina is presented and the literature on this rare type of vaginal tumor is reviewed. The origin is likely to be the paravestibular glands, as the tumor is always located near the introitus. Follow-up studies indicate benign biologic behavior, and simple excision is the treatment of choice.
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Benign tumor
Mixed tumor
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Abstract Introduction and hypothesis The objective was to evaluate the efficacy of pessaries in the treatment of stage IV pelvic organ prolapse (POP) and identify the influencing factors. Methods One hundred and fifty-seven patients with stage IV symptomatic POP were admitted to the hospital for pessary fitting. A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting in whom use continued 2 weeks later. The rates of successful pessary fitting, patient satisfaction, remission of prolapse and urinary symptoms, and the occurrence of factors associated with successful pessary fitting were calculated and predictors of appropriate pessary type selection were analyzed. Results A total of 130 patients with stage IV POP had a successful pessary fitting (82.8%). The satisfaction rate associated with the two types of pessaries was more than 90%. The success rate among patients undergoing a ring pessary fitting trial was 44.6%, and 84.3% of the patients were self-managed. Prolapse symptoms significantly improved in 90% of cases, and urinary symptoms improved in 58–93% of cases from baseline. The number of vaginal deliveries, history of hysterectomy and vaginal introitus/total vaginal length (TVL) ratio were independent risk factors associated with unsuccessful pessary fitting. Conclusion For patients with stage IV POP, the successful fitting rate is as high as 80% or more. More vaginal deliveries, a history of hysterectomy, and a larger vaginal introitus/TVL ratio (ratio >0.6) were predictors of unsuccessful pessary fitting.
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Introitus
Uterine prolapse
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Abstract Aim To identify factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse (POP). Methods This prospective observational study included 611 consecutive women with symptomatic POP in a tertiary‐care hospital. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted or refitted with a pessary and continued to use it 2 weeks later. Parametric and nonparametric tests were used for the data analysis. Results A total of 524 patients had successful pessary fittings (85.8% success rate). The success rate of the ring pessary with support was 57.9%, of the Gellhorn pessary was 69.1%. Stage IV prolapse (odds ratio [OR], 2.12), posterior compartment prolapse (OR, 1.92), genital hiatus (OR, 1.41), and vaginal introitus (OR, 1.40) were independent predictors of unsuccessful ring with support pessary fitting. Vaginal length (OR, 0.74/0.60 for ring with support/Gellhorn) and history of POP reconstructive surgery (OR, 2.50/2.58 for ring with support/Gellhorn) were independent predictors of both ring with support and Gellhorn pessary fitting. Conclusions Stage IV prolapse, posterior compartment prolapse, large genital hiatus, and wide vaginal introitus were risk factors for unsuccessful fitting of ring pessary with support. Short vaginal length and a history of POP reconstructive surgery were risk factors for unsuccessful fitting of both pessaries.
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The paper shows the indications, preoperative and intraoperative evaluation as well as the way to make a new vagina. The authors advise to use part of colon sigmoideum to make a new vagina, this vagina is very much like the real one and the function is unlimited. During the operation the shortest possible part of colon sigmoideum should be taken in order to avoid oversecretion (mucorrhoea). After taking the segment and making termino-terminal anastomosis the tunnel should be made between the bladder and rectum and the segment should be stitched to the introitus of the vagina. For three weeks after the operation the patient should keep a tampon in the [figures: see text] new vagina and we suggest the dilatation of the introitus for three months. After the three months period we advise the sexual intercourse. The number of postoperative complications was minimal and the sexual intercourse was normal.
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Vaginal foreign bodies are common in children, but are quite rare in adults. This is the case report of a foreign body inserted into the vagina with the intention of reducing a pelvic organ prolapse. A 65 year old lady presented to our hospital with history of white discharge per vagina for 6 months. She had history of four normal home deliveries by traditional birth attendant (TBA). On pelvic examination, a sphere shaped foreign body was found in the upper part of vagina. Under anaesthesia, the foreign body was removed successfully from the vagina using outlet forceps. The foreign body was a wood apple, measuring about 6x6 cm in diameter which the lady had inserted into her vagina to act like a vaginal pessary in order to reduce the uterovaginal prolapse which she had developed 10 years ago.
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Pelvic examination
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Pessary
Uterine prolapse
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Uterine prolapse and cervical elongation are rare conditions that can complicate pregnancy, labor, and its management. To minimize complications, proper management of this conditionis necessary. A 26-year-old woman referred to our outpatient clinic with a lump protruding from her vagina. She was 16 weeks pregnant. Physical examination revealed uterine prolapseand cervical elongation, so to prevent the complications of the protruded cervix, a pessary was inserted. She had the pessary during the first stage of labor until the rupture of membranes(at 6 cm cervical dilatation). After removal of the pessary, although the cervix was out of introitus, the active phase of labor initiated and a normal vaginal delivery was done. Newonset prolapse during pregnancy with more probability is due to cervical elongation. During labor and delivery, this condition could be managed with conservative methods, includingpessary placement. and this condition could be managed with conservative methods including pessary placement during pregnancy and labor.
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Introitus
Conservative Management
Cervical insufficiency
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Introitus
Pessary
Uterine prolapse
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Pessary
Introitus
Uterine prolapse
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Pelvic organ prolapse (POP) is a condition of herniation of the pelvic organs into the vagina or past the introitus. Management options include pessary use. A very rare complication of pessary usage is erosion resulting in a vesicovaginal or rectovaginal fistula. We present two cases of patients who were found to have rectovaginal fistulas from Gellhorn pessary usage. Both patients were surgically treated with colostomies. Pessary management of POP is very common and accepted form of treatment. For optimal outcomes with pessary use, we recommend that patients be actively managed with individualized periodic evaluations. Estrogen cream may be considered for prevention and treatment of eroded vaginal epithelium. J Clin Gynecol Obstet. 2015;4(1):193-196 doi: http://dx.doi.org/10.14740/jcgo308w
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Introitus
Rectovaginal Fistula
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