Melhora sintomática e anatômica do prolapso de órgãos pélvicos em usuárias de pessários vaginais

Abstract

The vaginal pessary is a conservative method for treating pelvic organ prolapse (POP). It is able to reduce symptoms with minimal complications improving quality of life (QOL). This study's hypothesis was that the use of pessaries decreases quantitative measures of Pelvic organ prolapse quantification (POP-Q) and improves women's QOL. The objective was to evaluate the effects of the use of ring pessary on the quantitative measurements of POP by the pelvic organ prolapse quantification (POP-Q) and on QOL. Prospective cohort study that evaluated women with POP, users of vaginal pessaries, seen at the Pessary / Urogynecology outpatient clinics of Maternidade Escola Assis Chateaubriand (MEAC) and Hospital Geral de Fortaleza (HGF). A consecutive sampling was carried out with 136 women who were successful in testing the ring-type pessary, after exclusion criteria, 50 women were included. The study was divided into two stages. Phase I consisted of evaluating POP-Q and QOL before using the pessary. Phase II consisted of the same measurement of these same variables after the minimum period of 4 months of use, with removal of the pessary 72 hours before the new evaluationdivided in two stages. In stage I, with assessment of POP-Q and QOL prior to the use of the ring pessary, and stage II after its use for at least 4 months with pessary removal 72h before clinical evaluation. Wilcoxon tests were performed for necessary comparisons and Spearman’s tests for calculating correlations. There was a decrease in POP in at least one of the vaginal compartments in the women included. When assessing individual measures (Ba, Bp and C), it was observed reductions in all measures. As for staging, 44% had a reduction in the anterior vaginal wall prolapse (PAVW), 54% a reduction in the posterior vaginal wall prolapse (PVWP) and 56% in the apical prolapse (AP). The reductions were more evident in the oldest patients in the treatment. There was also an improvement in the general and specific quality of life of women. The ring pessary proved to be a good therapeutic option, with a reduction in POP-Q measurements and/or absence of POP progression in the short-term and an improvement in women's QOL.