A randomized clinical trial comparing internal and external pessaries in the treatment of pelvic organ prolapse in postmenopausal women: A pilot study

• Published in: Clinics (São Paulo, Brazil) Brazil), 2024-01, Vol.79, p.100335, Article 100335
• Main Authors: Hosoume, Renato Sugahara, Peterson, Thais Villela, Soares Júnior, José Maria, Baracat, Edmund Chada, Haddad, Jorge Milhem
• Format: Article
• Language: English
• Subjects: Aged; Female; Humans; MEDICINE, GENERAL & INTERNAL; Middle Aged; Original; Pelvic organ prolapse; Pelvic Organ Prolapse - therapy; Pessaries - adverse effects; Pessary; Pilot Projects; Postmenopause; Quality of Life; Randomized controlled trial; Treatment Outcome
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1016/j.clinsp.2024.100335

•Internal and external pessaries improved the quality of life of women with pelvic organ prolapse.•The use of an internal pessary changed the POP-Q stage related to prolapse of the anterior and apical vaginal compartments in women with pelvic organ prolapse.•Studies investigating alternative treatments for Pelvic organ prolapse, such as the use of an external pessary, are extremely important. Internal vaginal pessary is among the leading treatments for pelvic organ prolapse (POP); however, it has a high adverse event rate. An external pessary was recently developed as an alternative. The study's objective was to compare the efficacy of external and internal pessaries in treating POP in postmenopausal women. This parallel randomized (1:1 ratio) open-blind study included 40 symptomatic women with stage 2 or 3 POP. They were randomized into two groups: group 1 (internal pessary) and group 2 (external pessary) (n = 20 in each); and evaluated at the start of and 3 months after the treatment. Statistical analysis was performed to compare the results within and between the groups before and after the 3-month treatment. The groups were homogeneous, except for the variables previous pregnancies (p = 0.030) and POP-Q score of apical prolapse (p = 0.023) whose values were higher in group 2. A significant improvement in quality of life was observed in both groups after 3 months of follow-up; however, internal pessaries were found to be more effective (p < 0.001). In group 1 there were differences between the initial and final POP-Q scores of anterior (0.004) and apical prolapse (p = 0.005). The complication rate associated with internal pessary use was high (p = 0.044). The present data suggested that external pessaries have a similar effect to internal ones for the treatment of POP and improvement of the quality of life of postmenopausal women.