Self-Management of Vaginal Pessaries: A Viable Alternative for Pelvic Organ Prolapse

By Staff Writer

May 21, 2024

Introduction

Pelvic organ prolapse (POP) affects up to 65% of women, particularly as they age. This condition, where pelvic organs descend into the vaginal canal, can significantly impact a woman’s quality of life. Traditional treatment options include both conservative measures and surgery. However, recent research highlights the potential benefits of self-management of vaginal pessaries, a conservative treatment option. The TOPSY trial compared self-management with clinic-based care for women using vaginal pessaries.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, descend from their usual position into the vaginal canal. Symptoms include a sensation of something “coming down” into the vaginal space, urinary and bowel issues, sexual dysfunction, and pain. As the population ages, the prevalence of prolapse is expected to rise, making effective management strategies crucial.

Traditional Treatment Approaches

Prolapse can be managed conservatively or surgically. Conservative treatments often involve the use of vaginal pessaries, mechanical devices inserted into the vaginal canal to support the pelvic organs. Pessaries are widely used, with two-thirds of women in the National Health Service (NHS) opting for this method initially. However, traditional clinic-based pessary care requires women to visit a clinic every six months for removal and replacement, which can be inconvenient.

The TOPSY Trial: A New Approach

The treatment of prolapse with self-care pessary (TOPSY) study aimed to assess the clinical and cost-effectiveness of pessary self-management compared to clinic-based care. The trial involved 340 women from 21 UK centres, randomly assigned to either self-management or clinic-based care. The primary outcome was prolapse-specific quality of life, measured using the Pelvic Floor Impact Questionnaire-7.

Key Findings:

1. Quality of Life: There was no significant difference in prolapse-specific quality of life between the self-management and clinic-based care groups.
2. Complications: Women in the self-management group reported fewer pessary-related complications than those in the clinic-based care group.
3. Cost-Effectiveness: Self-management was more cost-effective, with lower mean costs (£578 vs. £728). The willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained was £564 and a high probability of cost-effectiveness (80.8%).

Implementation and Training

For self-management to be effective, proper training and support are essential. The TOPSY trial provided women with a 30-minute teaching session, an information leaflet, a follow-up call, and access to a telephone helpline. Healthcare professionals also received training to ensure consistent and effective delivery of the intervention.

Future Research and Recommendations

While the TOPSY trial demonstrated the feasibility and benefits of self-management, further research is needed to:

1. Develop Sensitive Quality of Life Measures: Current measures may not fully capture the impact of self-management on women’s quality of life.
2. Assess Effectiveness Across Diverse Populations: Future trials should include a wider range of ethnic groups and women with different abilities.
3. Explore Follow-Up Strategies: Research should investigate whether follow-up can be initiated by women or if planned intervals are necessary.

Conclusion

The TOPSY trial provides robust evidence that self-management of vaginal pessaries is a viable alternative to clinic-based care. It offers women greater control, reduces complications, and is cost-effective. Healthcare professionals and policymakers should consider incorporating self-management into standard pessary care services, providing women with the training and support they need to manage their pelvic organ prolapse effectively.

Reference url

Recent Posts

pharmaceutical pricing issues
      

Pharmaceutical Pricing Issues: Beyond Overpricing and Profit Motives

💊 Are high drug prices justified by R&D investments, or is there more to the story?

In a thought-provoking critique, a recent BMJ article argues that profit motives are driving pharmaceutical pricing issues while highlighting the tough decisions regarding access to Alzheimer’s drugs in the UK. It raises vital concerns about the implications for lower-income countries and emphasizes the need for a balanced discussion on drug pricing and innovation.

Curious about the complexities of pharmaceutical pricing and how they shape global health access? Dive into the full article for a nuanced exploration!

#SyenzaNews #pharmaceuticals #HealthEconomics #healthcarepolicy

Zimislecel type 1 diabetes
   

Cell Therapy for Type 1 Diabetes: Vertex Trial Results and Market Potential

🚀 What if we could revolutionize Type 1 diabetes treatment?

Vertex Pharmaceuticals has made significant strides with its promising phase 1/2 trial results for **zimislecel**, a stem cell-derived therapy that not only restores insulin production but also drastically reduces severe hypoglycemic events. As phase 3 trials commence, this breakthrough could reshape care for T1D patients and potentially reduce long-term healthcare costs.

Curious to learn how zimislecel and other potential cell therapies may redefine diabetes management? Click to read more!

#SyenzaNews #biotechnology #HealthEconomics

biosimilar clinical approach
    

Biosimilar Clinical Approach

🚀 How is the EMA’s new biosimilar clinical approach changing the landscape of drug approvals in Europe?

With a focus on tailored clinical assessments, the EMA is streamlining the pathway for biosimilars by allowing analytical data to take precedence over large-scale comparative efficacy studies. This shift promises to enhance patient access to life-saving therapies while maintaining rigorous safety standards.

Dive deeper into the implications of this innovative regulatory approach and find out how it can impact health economics and market access.

👉 Read more in the full article!
#SyenzaNews #regulatoryaffairs #MarketAccess

When you partner with Syenza, it’s like a Nuclear Fusion.

Our expertise are combined with yours, and we contribute clinical expertise and advanced degrees in health policy, health economics, systems analysis, public finance, business, and project management. You’ll also feel our high-impact global and local perspectives with cultural intelligence.

SPEAK WITH US

CORRESPONDENCE ADDRESS

1950 W. Corporate Way, Suite 95478
Anaheim, CA 92801, USA

© 2025 Syenza™. All rights reserved.