Evaluating the effect of pessaries on quality of life in the management of stress urinary incontinence in women.
Stress urinary incontinence (SUI) can have a detrimental effect on quality of life (QoL). The controversy over surgical vaginal mesh, and the subsequent suspension of its use, have reinforced the importance of exploring non-surgical approaches to the treatment of this condition. Well-documented conservative measures include physiotherapy and pelvic floor muscle training, which are key parts of the management strategy for SUI. Additionally, national and international guidelines advocate the use of pessaries for symptomatic improvement in women with SUI. However, there is a lack of current research supporting the effectiveness of, and patient compliance and satisfaction with, pessary use in the treatment of SUI in the UK, thus restricting its availability in National Health Service settings. Consequently, it is a challenge for healthcare professionals to provide patients with evidence-based guidance on pessary use for SUI. The focus of this literature review is to examine the available evidence regarding the efficacy of this treatment modality, and its effect on the QoL of women with mixed urinary incontinence with dominant SUI or SUI alone. A detailed literature search covering the period from 2003 to 2020 was completed, and seven relevant publications were identified. The limitations of the papers included variations between pessary brands, pessary management instructions and additional treatments combined with the pessary use. The findings of this literature review indicate that there is a role for pessaries as part of a holistic multidisciplinary approach in the management of SUI. However, future trials are needed in order to develop the guidelines on pessary selection and long-term management.
Keywords: pessary, quality of life, stress urinary incontinence.