Clinical Characteristics Associated With Unsuccessful Pessary Fitting Outcomes
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.090 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".