Mechanical devices (pessaries) for managing pelvic organ prolapse in women

Adams EJ, Thomson AJM, Maher C, Hagen S

Published Online:

January 21, 2009

Pelvic organs, such as the uterus, bladder or bowel, may protrude into the vagina because of weakness in the tissues that normally support them. The symptoms that they cause vary, depending on the type of prolapse. Mechanical devices like plastic pessaries can be used to try to restore the prolapsed organs to their normal position and hence to relieve symptoms. They are used when conservative treatment, like physiotherapy and surgery, either have failed or are not suitable. The review found no randomised trials of mechanical devices from which to gauge their effects.

Abstract (click to read)

Background:

Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting although many are asymptomatic. A number of symptoms may be associated with prolapse and treatments include surgery, mechanical devices and conservative therapies. A variety of mechanical devices or pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery.

Objectives:

To determine the effects of mechanical devices for pelvic organ prolapse.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Trials Register (5 September 2005), MEDLINE (January 1966 to August Week 5 2005), PREMEDLINE (15 September 2005), EMBASE (January 1996 to Week 43 2005), CINAHL (January 1982 to February 2003), PEDro (October 2003), the UK National Research Register (Issue 3, 2003), Controlled Clinical Trials (April 2003) and ZETOC (April 2003). We searched the reference lists of relevant articles.

Selection criteria:

Randomised and quasi-randomised controlled trials which included a mechanical device for pelvic organ prolapse in one arm of the study.

Data collection and analysis:

No eligible, completed, published or unpublished randomised controlled studies were found, therefore no data collection or analysis was possible.

Main results:

There was a dearth of studies on the use of mechanical devices and no published reports of randomised trials were identified. One study on pessary usage was excluded as it was not a randomised trial.

Authors' conclusions:

Currently there is no evidence from randomised controlled trials upon which to base treatment of women with pelvic organ prolapse through the use of mechanical devices/pessaries. There is no consensus on the use of different types of device, the indications, nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of mechanical devices in comparison with no treatment, surgery and conservative measures.

This record should be cited as:

Adams EJ, Thomson AJM, Maher C, Hagen S. Mechanical devices for pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004010. DOI: 10.1002/14651858.CD004010.pub2

Assessed as up to date:

October 26, 2005

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Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Pelvic organ prolapse

Urology > Pelvic organ prolapse

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Mechanical devices (pessaries) for managing pelvic organ prolapse in women

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