An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Marwa Abdulaziz, MSc;* Lynn Stothers, MD, MHSc, FRCSC;† Darren Lazare, MD, FRCSC;§ Andrew Macnab, MD (London), FRCPC, FRCPCH, FCAHS†

Goal: to assess the complications of pessary placement and their frequency

34 articles included in the systematic review, articles were from the years 1952-2014

• 13 of the studies discussed complications in relation to size

Outcomes:

• The most common complications were vaginal discharge/vaginitis, vesicovaginal fistula, erosion ulceration, foul odor and and bleeding. These complications are related to pessary shape, material and duration in situs.
• Overall most common complication: superficial vaginal mucosal erosion- risk factors include long term uninterrupted use or placement of pessary that is too large.
• Vaginal discharge and infection may affect as much as 1/3 of users
• Serious complications include fistulas. Vesicovaginal fistulas are seen with neglected pessaries and are most often seen with shelf design. Rectovaginal fistulas are more common with rubber or PVC pessaries when compared to polyethylene pessaries.
• Several reports discussed pessaries as a cause of vaginal and cervical cancer. It has been suggested that patients are predisposed by inflammation and viral infections.
• There were three cases that related pessaries to death, all three reported long term use of pessaries.
• Complication severity was classified according to Clavien-Dindo system
• They didn’t feel comfortable stating a number for how often complications occur, but other studies have stated a number <10%.

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