Is hysterectomy or prior reconstructive surgery associated with unsuccessful initial trial of pessary fitting in women with symptomatic pelvic organ prolapse?

There is little data in the literature regarding the feasibility and limitations of pessary therapy after pelvic reconstructive surgery for symptom recurrence for treating urinary incontinence. Hysterectomy is an important risk factor for failure of pessary fitting. We aimed to evaluate the influence of these prior surgeries on subsequent initial trials of fitting a pessary. Six hundred and twenty-nine women with symptomatic pelvic organ prolapse (POP) were included in a prospective cohort study from January 2014 to December 2015. All women had symptomatic stage >= 2 POP. During the study period, various types of pessaries were used for the fitting process. O the 629 women, 489 (77.7 %) had neither hysterectomy nor reconstructive pelvic surgery, and 24 (3.8 %) had hysterectomy for different indications. Initial pessary fitting was possible in all patients in both groups (100 %) 116 (18.4 %) had a total of 159 previous, predominantly vaginal, surgeries for POP, with or without vaginal hysterectomy. In 25/116 (21.5 %) cases, initial fitting was impossible due to altered anatomy. After one surgery, the probability of failure was 18.8 % (15/80) and after two 27.3 % (9/33). Of the three women who had three or more surgeries, one failure occurred. Surgery for POP is an important risk factor for an unsuccessful pessary fitting. It seems conclusive to recommend pessary treatment as a general first-line therapy for symptomatic POP, since after unsuccessful pessary treatment, women can still undergo surgery, whereas reversing treatment options might not always be feasible.