Vaginal Pessary vs Vaginal Pessary Combined with Local Estrogen: Genitourinary Effects in Postmenopausal Women with Pelvic Organ Prolapse

Year 2023, , 176 - 179, 01.05.2023

Bugra Sahin , Gizem Cura Şahin

https://doi.org/10.53394/akd.1021433

Abstract

Aim: To investigate and compare the vaginal and urinary effects of the use of a vaginal pessary ring and vaginal local oestrogen together with pessary prescribed for postmenopausal women with pelvic organ prolapse (POP) who did not wish to have a POP operation.
Method: This prospective case-control study was conducted in the Gynaecology and Obstetrics Clinics of Turhal State Hospital and Tokat State Hospital between May 2021 and July 2021. Two groups were formed of 25 patients given a vaginal pessary ring for treatment, and 25 who were given vaginal local oestrogen together with the pessary ring. Comparisons were made between the groups in respect of age, gravida, parity, pelvic pain, vaginal itching-discharge-dryness-bleeding, findings of urinary incontinence, the presence of bacteria in the urine, and white blood cells (WBC) and c reavtive protein (CRP) values.
Results: In the comparisons of women using pessary alone and those using local oestrogen together with the pessary, the complaints of pelvic pain (p=0.034) and vaginal dryness (p=0.037) were determined at a higher rate in the group that used the pessary alone.
Conclusion: The reason for the higher rate of pelvic pain and vaginal dryness seen in the women using pessary alone is that without oestrogen the pessary has the effect of a foreign body on the vaginal mucosa, thereby increasing vaginal inflammation. However, local oestrogen increased the complaint of unnecessary vaginal bleeding in some patients. Taking all these findings in to consideration, the use of pessary and local oestrogen should be applied carefully in POP treatment.

Keywords

Pelvic organ prolapse, vaginal local oestrogen, vaginal pessary.

Vajinal Pessere Karşılık Vajinal Pesser ve Lokal Östrojen Tedavisi: Pelvik Organ Prolapsusu Olan Postmenapozal Kadınlarda Genitoüriner Etkilerinin Karşılaştırılması

Abstract

Amaç: Postmenapozal dönemde pelvik organ prolapususu (POP) olup POP operasyonu olmak istemeyen kadınlara tedavi amaçlı verilen vajinal pesser halka ile pesser ile beraber vajinal lokal östrojen kullanımının vajinal ve üriner etkilerinin araştırılması-karşılaştırılması amaçlanmıştır.
Yöntem: Prospektif vaka kontrol çalışmamızda Turhal Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniği ile Tokat Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde Mayıs 2021 ve Temmuz 2021 tarihleri arasında; postmenapozal dönemde olup POP’u olan ve POP ameliyatı olmak istemeyen toplamda 50 kadın hasta; tedavi amaçlı 25’ine sadece vajinal pesser halka ve diğer 25’ine de pesser ile birlikte vajinal lokal östrojen alacak şekilde iki gruba ayrıldı. Her iki hasta grubuna da tedaviler 3 ay süre ile uygulandı. Gruplar; yaş, gravida, parite, pelvik ağrı, vajinal kaşıntı-akıntı-kuruluk-kanama şikayetleri ve üriner inkontinans bulguları ile idrarda bakteri varlığı ve kanda lökosit (wbc) ve C reaktif protein (CRP) değerleri açısından karşılaştırıldı.
Bulgular: Sadece pesser kullanan kadınlar ve pesser ile birlikte lokal östrojen kullanan kadınlar karşılaştırıldıklarında sadece pesser kullanan kadınlarda pelvik ağrı (p=0.034) ve vajinal kuruluk (p=0.037) şikayetleri daha yüksek oranda bulundu. Ancak; pesser ile lokal östrojen kullanan grupta ise vajinal kanama şikayeti (p=0.042) daha az oranda izlendi.
Sonuç: Sadece pesser kullanan kadınların daha yüksek oranda pelvik ağrı, vajinal kuruluk şikayetlerinin daha fazla oranda görülmesinin nedeni, pesserin östrojenden yoksun vajinal mukozaya yabancı cisim etkisiyle vajinal inflamasyonu arttırmasıdır. Ancak; lokal östrojenin bazı hastalarda gereksiz vajinal kanama şikayetleri arttırdığı saptanmıştır. İşte tüm bunlar göz önünde bulundurularak pesser ile lokal östrojen; POP tedavisinde dikkatli bir şekilde uygulanmalıdır.

Keywords

Pelvik organ prolapsusu, vajinal lokal östrojen, vajinal pesser.

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