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Pessary Fitting


Description

Pessaries are devices fitted and worn in the vagina to provide support to the pelvic organs. Pessaries are available in various sizes and shapes and are categorized as supportive (eg, ring, lever, Gellhorn, Gehrung, Shaatz) or space occupying (eg, doughnut, cube, inflatable).

Indications

Pelvic organ prolapse, urinary incontinence, cervical incompetence (lever or ring type), drug delivery. Pessaries are often used as either an alternative to surgery or as a presurgical trial ( Box 286.1 ).

BOX 286.1
Indications for Common Pessaries

  • Malposition: Lever type (Hodge)

  • Prolapse

    • Uterine: Gellhorn, ring, doughnut, cube

    • Vaginal: Doughnut, cube, ball (Gehrung)

    • Cystocele/Rectocele: Gehrung, Shaatz

  • Incompetent cervix: Lever, ring

  • Incontinence: Doughnut, lever, ring

  • Preoperative: Based on the defect

  • Drug delivery: Specialized ring (17β-estradiol, medroxyprogesterone, prostaglandin E 2 )

Contraindications

Undiagnosed vaginal bleeding, significant vaginal atrophy, latex sensitivity. Patients who are unable or unwilling to manage the periodic insertion and removal of the device are poor candidates.

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