Self-management versus nurse-led care of vaginal pessary in patients with pelvic organ prolapse

Objectives: To compare the outcomes and complications of self-management and nurse-led care in patients with pelvic organ prolapse (POP).Methods: This retrospective study reviewed medical records of patients aged >18 years with a diagnosis of POP who used a ring vaginal pessary and attended at least two follow-up visits, with an interval of >3 months, at the outpatient urogynaecology POP nurse clinic of Queen Elizabeth Hospital, Hong Kong, between 1 January 2021 and 31 December 2023. Patients were assessed at each follow-up visit. Satisfaction with vaginal pessary use wasassessed using a visual analogue scale ranging from 0 to 100. Quality of life was assessed using the Pelvic Floor Distress Inventory-20.Results: In total, 812 patients were included in the analysis. Of these, 343 were able to perform regular vaginal pessary self-management and 469 required nurse-led care. The two groups were comparable in terms of POP stage. Patients who performed self-management were younger at initiation of vaginal pessary (64.1 vs 70.0 years, p<0.001) and had fewer follow-up visits during the 3-year study period (3.83 vs 5.48, p<0.001). The proportion of patients with vaginal discharge was higher in the self-management group (43.4% vs 37.1%, p=0.068), but the proportion of patients with vaginal ulcers with deep tissue penetration and scarring or vaginal erosion on examination was lower in the self-management group (6.4% vs 11.9%, p=0.008). Self-management and nurse-led care groups had comparable vaginal pessary satisfaction scores (74.05 vs 74.31, p=0.87) and showed improvements in quality of life scores between the first and last follow-up visits.Conclusion: Vaginal pessary self-management can reduce healthcare service utilisation. Caregiver involvement in self-management may enhance adherence. Patients who performed self-management had a lower rate of vaginal ulcers on examination, which may increase the longevity of pessary use.