Using a national dataset, we sought to assess patterns of pessary care in older women with pelvic organ prolapse (POP) and subsequent outcomes, including rates of complications and surgical treatment of POP.
Public Use Files from the United States Centers for Medicare and Medicaid Services were obtained for a 5% random national sample of beneficiaries from 1999 to 2000. Diagnostic and procedural codes (ICD-9-CM and CPT-4) were used to identify women with pelvic organ prolapse (POP) and those treated with pessary. Individual subjects were followed longitudinally for nine years. Across this duration, patient care and outcomes (e.g., return clinic visits, repeat pessary placements, complications, and rate of surgical treatment of prolapse) were assessed.
Of 34,782 women diagnosed with POP, 4,019 (11.6%) were treated with a pessary. In the initial three months after pessary placement, 40% underwent a follow-up visit with the provider who had placed the pessary, and through nine years after the initial fitting, 69% had such a visit. During this period, 3% of subjects developed vesicovaginal or rectovaginal fistulas, and 5% had a mechanical genitourinary device complication. Twelve percent of women underwent surgery for POP by one year; with 24% by nine years.
Pessary can be effectively used for management of POP in older women. Despite this, a low percentage of Medicare beneficiaries undergo pessary fitting. Lack of continuity of care results in a small, but unacceptable rate of vaginal fistulas.