Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis

Claudia Manzini*, Lisan M. Morsinkhof, C. Huub van der Vaart , Mariëlla I.J. Withagen, Anique T.M. Grob

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

6 Citations (Scopus)
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Objectives: To clarify which parameters are associated with unsuccessful pessary fitting for pelvic organ prolapse (POP) up to three months follow-up.
Methods: Embase, PubMed and Cochrane CENTRAL library were searched in May 2020. Inclusion criteria were: (1) pessary fitting attempted in women with symptomatic POP, (2) pessary fitting success among the study outcomes with a follow-up of maximal three months, (3) baseline parameters compared between successful and unsuccessful group. A meta-analysis was performed using the random effects model.
Main results: 24 studies were included in the meta-analysis. Parameters associated with unsuccessful pessary fitting were: age (OR 0.70, 95% CI 0.56-0.86), BMI (OR 1.35, 95% CI 1.08-1.70), menopause (OR 0.65 95% CI 0.47-0.88), de novo stress urinary incontinence (OR 5.59, 95% CI 2.24-13.99), prior surgery, i.e., hysterectomy (OR 1.88, 95% CI 1.48-2.40), POP surgery (OR 2.13, 95% CI 1.34-3.38), pelvic surgery (OR 1.81, 05% CI 1.01-3.26), and incontinence surgery (OR 1.87, 95% CI 1.08-3.25), Colorectal-Anal Distress Inventory-8 scores (OR 1.92, 95% CI 1.22-3.02), solitary predominant posterior compartment POP (OR 1.59, 95% CI 1.08-2.35), total vaginal length (OR 0.56, 95% CI 0.32-0.97), wide introitus (OR 4.85, 95% CI 1.60-14.68), levator ani avulsion (OR 2.47, 95% CI 1.35-4.53) and hiatal area on maximum Valsalva (OR 1.89, 95% CI 1.27-2.80).
Conclusion: During counselling for pessary treatment a higher risk of failure due to the aforementioned parameters should be discussed, and modifiable parameters should be addressed. More research is needed on the association between anatomical parameters and specific reasons for unsuccessful pessary fitting.
Original languageEnglish
Pages (from-to)1719-1763
Number of pages45
JournalInternational Urogynecology Journal
Issue number7
Early online date17 Jan 2022
Publication statusPublished - Jul 2022


  • Patients’ characteristics
  • Pelvic organ prolapse
  • Pessary fitting
  • Predictive factors
  • Predictive parameters
  • Vaginal pessaries

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