Priority 15 from the Pessary use for Prolapse PSP

UNCERTAINTY: Do the risks and complications of pessaries increase with long-term use? (JLA PSP Priority 15)
Overall ranking	15
JLA question ID	0054/15
Explanatory note	As with the other risks and complications question, future research could help us to know whether longer term use of pessaries has any impact on the number of problems women experience with pessary use. Examples: What is the prevalence of erosions when using a pessary? Should the amount of discharge increase the longer the pessary is inserted?
Evidence	None identified
Health Research Classification System category	Renal and urogenital

Extra information provided by this PSP
Original uncertainty examples	Where follow-up cannot be assured, pessariesa re an unsuitable treatment modality due to the risk of serious complications. We do however believe that lack of follow-up would result in this or similar complications irrespective of type of pessary used. ~ Does long term use cause other health problems? ~ What is the prevalence of erosions when using a pessary? ~ What is the risk that a neglected /forgotten pessary inserted for an elderly patient will cause significant complications? ~ Risk factors for failure? ~ What are the risks of long-term pessary use (attended or unattended)? ~ Should the amount of discharge increase the longer the pessary is inserted? ~ A consultant once told me that the tissue of the vaginal wall becomes a little worn from long-term use of a pessary and therefore, surgery for a prolapse repair can be more difficult. Is this a common view of consultants? ~ Is there any evidence of a pessary eroding the tissue between the vagina and rectum?
Submitted by	4 x women, 1 x both, 4 x healthcare professionals, 2 x literature

Extra information provided by this PSP

Original uncertainty examples

Where follow-up cannot be assured, pessariesa re an unsuitable treatment modality due to the risk of serious complications.
We do however believe that lack of follow-up would result in this or similar complications irrespective of type of pessary used. ~
Does long term use cause other health problems? ~ What is the prevalence of erosions when using a pessary? ~ What is the risk that a neglected /forgotten pessary inserted for an elderly patient will cause significant complications? ~ Risk factors for failure? ~ What are the risks of long-term pessary use (attended or unattended)? ~ Should the amount of discharge increase the longer the pessary is inserted? ~ A consultant once told me that the tissue of the vaginal wall becomes a little worn from long-term use of a pessary and therefore, surgery for a prolapse repair can be more difficult. Is this a common view of consultants? ~ Is there any evidence of a pessary eroding the tissue between the vagina and rectum?

Submitted by

4 x women, 1 x both, 4 x healthcare professionals, 2 x literature

PSP information
PSP unique ID	0054
PSP name	Pessary use for Prolapse
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8 September 2017