Depressive symptoms affect outcomes of pessary use in postmenopausal women with uterine prolapse

The relationship between symptom severity, bother and psychological factors in women with pelvic organ prolapse: A cross-sectional observational study

AIM

The primary aim is to explore the relationship between symptom severity and prolapse bother in women with pelvic organ prolapse (POP). The secondary aim is to determine the association between psychological variables and prolapse bother.

METHODS

A cross-sectional observational study was conducted via online surveys assessing POP bother (visual analog scale for bother), POP symptom severity (International Consultation on Incontinence Questionnaire-Vaginal Symptoms), and psychological measures of depression and anxiety (Kessler psychological distress scale [K-10]), catastrophizing (modified pain catastrophizing scale [mPCS]), and self-efficacy (modified pain self-efficacy questionnaire [mPSEQ]) in women with self-reported POP. Symptom severity, bother and psychological variables were analyzed using linear regression.

RESULTS

Seventy-six women with a mean (SD) age of 42.8 (14.57) years were included in analysis. A moderate to strong positive linear relationship (R²  = 0.449, p < 0.001) was found between symptom severity and POP bother. Prolapse bother and psychological variables were moderately correlated, where increased K-10 scores (R²  = 0.230, p = 0.001), higher mPCS scores (R²  = 0.460, p < 0.001), and lower mPSEQ scores (R²  = 0.460, p < 0.001) were associated with increased POP bother. Moderate and severe catastrophizing was associated with significantly higher POP bother, with mean POP bother scores of 7.861 ± 0.45 (p < 0.001) and 8.652 ± 0.45 (p < 0.001), respectively.

CONCLUSION

A moderate positive relationship between POP bother and symptom severity was found, with greater psychological distress and lower self-efficacy associated with increasing POP bother. Women presenting with POP should be screened for psychological factors to guide management.

The impact of personality traits on pessary treatment outcomes in patients with pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Personality traits can play an important role in outcomes of different chronic disorders. We hypothesize that the pessary treatment outcomes in symptomatic pelvic organ prolapse (POP) can also be influenced by personality traits.

METHODS

This prospective observational study included consecutive women with symptomatic POP seeking pessary treatment between December 2018 and January 2020. The personality profile was measured using the Eysenck Personality Questionnaire (EPQ-R) at baseline, and patient health-related quality of life (HRQoL) was measured using the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory (PFDI-20) at baseline and at 3 months. The correlation between HRQoL and personality traits was investigated by means of linear regression.

RESULTS

In total, 213 patients were included, of which 163 patients (76.5%) achieved success by the 3-month follow-up. No significant differences were found in the EPQ scores between the successful and unsuccessful groups. The scores on both the PFIQ-7 and PFDI-20 correlated significantly with neuroticism and correlated inversely with extraversion at both baseline and the 3-month follow-up. The degree of improvement in PFIQ-7 and PFDI-20 scores was not associated with personality traits.

CONCLUSIONS

Our data indicate that neurotic and introverted women were more bothered by POP-related symptoms, although the improvement in symptoms was not significantly associated with personality traits after 3 months of pessary treatment.

Should we routinely assess psychological morbidities in idiopathic lower urinary tract dysfunction: ICI-RS 2019?

AIMS

Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment.

METHODS

The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019.

RESULTS

Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment.

CONCLUSIONS

Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.

Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use

OBJECTIVES

The aim of the study was (1) to evaluate continuation rates of vaginal ring pessary for pelvic organ prolapse (POP), and (2) to identify predictors for continued pessary use.

METHODS

This retrospective chart review study was conducted in a tertiary center. Women who had a ring with support pessary successfully fitted between January 2009 and December 2013 and had completed up to 3 years of follow-up care were included in the analysis. Demographic and obstetric data, body weight, pelvic organ prolapse stage, and associated symptoms were evaluated. All the women were followed until February 28, 2017, unless surgery to correct POP surgery was required, pessary use was discontinued, or the women died.

RESULTS

A total of 289 women with symptomatic POP (stages II, III, and IV) were evaluated. The median age was 71 years (range 34-83 y), and the median parity was 3 (range 0-8). Among the women with a successful initial fitting, the failure rate was 5.88% (17/289) at 6 months with most of these women choosing to have surgical intervention. This analysis indicates that the probability of the successful continuation of pessary use after 1, 2, 3, 4, and 5 years was 83.0%, 78.2%, 71.3%, 65.3%, and 61.7%, respectively, reported using a Kaplan-Meier plot. The main cause for discontinuation of pessary use before 3 years was the election for surgical intervention. With regard to predictors for continued pessary use, self-care was the only factor that influenced compliance rates after treatment of 3 years.

CONCLUSION

A ring with support pessary can be used successfully to alleviate symptoms of advanced stage prolapse for 3 years or longer. In addition, proper self-management was found to be a strong predictor for prolonged pessary use.

[The gynecological pessary: Is it really a device of another age, a fig leaf?]

OBJECTIVES

The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device' size, insertion, removal, follow-up visits and care.

METHODS

A review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed.

RESULTS

This device appears to be as effective as surgical management to relieve symptoms related to urogenital prolapse and restore body image. It can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. However, despite its moderate cost and its harmlessness, this device remains somewhat little known as regards the practical modalities of its use, which, moreover, appear not consensual.

CONCLUSION

A guide intended for the attention of the patients as well as a film relating to the practical modalities of the device' use were elaborated to improve the knowledge of both professionals and users in order to optimize and secure the care pathway.