Clinical Characteristics Associated With Unsuccessful Pessary Fitting Outcomes
Notice bibliographique
Résumé
Options for patients with pelvic organ prolapse (POP) include surgery and conservative management using a pessary. Two thirds of patients with POP offered a choice between surgery and pessary initially opt for the pessary. Success rates for pessary fittings vary widely. Previous studies have investigated possible clinical predictors of unsuccessful pessary fitting. However, lack of clear definitions for an unsuccessful fitting hinders research, and studies attempting to identify clinical predictors for unsuccessful fitting are inconsistent. It has been hypothesized that certain individual patient characteristics may predict unsuccessful fitting. When identified, the presence of these factors could be used to counsel patients faced with the treatment choice between pessary and surgery for POP. The aim of this retrospective study was to identify clinical characteristics and quality-of-life/symptom scores associated with an unsuccessful trial of pessary (TOP) in women with POP. Data were collected for 101 women with POP who underwent pessary fittings between 2006 and 2012 at a tertiary urogynecology unit. Treatment options were explained to all participants. Baseline standard POP quantification staging was performed. At baseline, patients completed detailed history and validated pelvic floor quality-of-life and symptom questionnaires. An unsuccessful TOP was defined as an inability to continue use of the pessary beyond 4 weeks from initial fitting. Multivariate stepwise logistic regression analysis was used to build a prediction model for odds of unsuccessful TOP. Patient discomfort was the primary reason for unsuccessful TOP. Multivariate analysis showed that the following clinical characteristics were significantly associated with the likelihood of unsuccessful TOP: age 65 years or younger (odds ratio [OR], 3.13; P = 0.042), smoking history (OR, 3.42; P = 0.049), genital hiatus/total vaginal length ratio greater than 0.8 (OR, 6.70; P = 0.042), and lower POP quantification overall stage (OR, 2.84; P = 0.017). Variables not associated with the likelihood of unsuccessful TOP included sexual activity and concurrent urinary or POP symptoms. These findings show that pessaries remain a good treatment option for women with POP. The data show a number of clinical characteristics that influence the likelihood of unsuccessful TOP. Clinicians can use these results to counsel women with POP faced with a choice between conservative and surgical management.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,090 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».