Self-care Pessary Management and Factors Associated With Long-Term Pessary Use

Importance There is limited evidence on predictors and complications of long-term pessary use and how outcomes vary by management strategy. Objectives The objectives of this study were to compare outcomes of pessary self-care (SC) versus office-based care (OC) and identify factors associated with long-term pessary use in patients with pelvic organ prolapse (POP). Study Design We conducted a retrospective cohort study of patients fitted with a pessary for POP and with >3 months of use between 2008 and 2017. Patients were classified by pessary management strategy (SC vs. OC) and duration of use. Patient characteristics, complications, and reasons for discontinuation were compared between groups using bivariable and multivariable analyses. Results The study included 275 patients who used a pessary for a median of 17.1 (range: 3–110) months. Of 268 with follow-up, 89 (33%), 107 (40%), and 72 (27%) used the pessary for P ≤0.01). SC users had fewer space-occupying pessaries (61 (28.6%) vs 40 (64.5%), P P Conclusions In this cohort, the majority of patients were able to self-manage a pessary. Duration of use was associated with patient characteristics but not with management type.