Impact of Self‐Management on Fitting Success and Continuation of Ring Pessary Therapy for Pelvic Organ Prolapse

AIM: Ring pessary therapy is a widely used conservative treatment for pelvic organ prolapse (POP). In Japan, pessary self-management (SM) is recognized as a management option that may reduce adverse events; however, its adoption in routine clinical practice remains limited, and clinical data are scarce. This study aimed to identify factors associated with successful fitting and continuation of ring pessary therapy, focusing on the role of SM. METHODS: We retrospectively reviewed the medical records of 90 patients with POP who initiated ring pessary therapy at our institution between 2010 and 2020. Patient characteristics, anatomical parameters, pessary management methods (SM or clinic management [CM]), and reasons for discontinuation were analyzed. Kaplan-Meier analysis, multivariate logistic regression, and Cox proportional hazards models were used to evaluate factors associated with fitting success and continuation. RESULTS: Among the 90 patients, 66 (73.3%) selected SM and 24 (26.7%) CM. Successful fitting was achieved in 62 patients (93.9%) in the SM group and in 8 patients (33.3%) in the CM group. SM was independently associated with successful fitting and longer continuation. Among patients with successful fitting, continuation rates were significantly higher in the SM group than in the CM group (p < 0.0001). The median pessary size among successfully fitted patients was 62 mm. In exploratory analyses, patients who discontinued therapy due to pain or discomfort tended to have shorter total vaginal length (TVL) and lower TVL/height ratios. CONCLUSIONS: Ring pessary therapy is a useful conservative treatment option for Japanese women with POP. SM may facilitate successful fitting and prolonged continuation when appropriate patient instruction and follow-up are provided.