One week as a marker of pessary success: findings from a retrospective cohort study

Background There is no standard timeframe to define a successful pessary fitting. Current literature use a variety of timepoints between 30 minutes to 36-months. This study aims to examine the number of women who continue vaginal pessary at set time intervals after the initial pessary fitting and help identify a timeframe of pessary cessation. Methods A retrospective cohort study was conducted at a large tertiary UK teaching hospital. Women of 18 years old and above who had a pessary fitted for prolapse symptoms were included. Data were collected at 1 week, then 3, 6, 12, 24 and 36 months to capture early and long term pessary continuation. Electrical medical records were reviewed to determine if a woman was continuing with pessary use after initial fitting. A time-to-event analysis was conducted to assess the probability of pessary discontinuation at the predefined time points. Results A total of 98 of 159 women (62%) discontinued pessary use over the predefined time points. The most frequent time point for a women to stop pessary use was during the first week (59 out of 98 women stopped (60%). This was followed by 29 women stopping at 3 month (29.5%), 6 women stopped at 6 months (6.1%) and 3 women stopped at 12 months (3.1%). The remaining 68 (42.8%) women continued using the pessary and were asymptomatic. The most common reason for discontinuation was failure to retain the pessary followed by pain or discomfort. Conclusions Most women who discontinue pessary use do so within the first week after fitting, suggesting that one week may be an appropriate time point for assessing early pessary success.