Is Pelvic floor morphology a predictor of successful pessary retention? Original research and review of the literature

Frances Sya Paterson



Vaginal pessaries are known to be an effective treatment modality for pelvic organ prolapse (POP). Pessaries form an important part of the physicians’ armamentarium in the treatment of pelvic organ prolapse, but currently many of the factors affecting the success of pessary use are poorly understood.


This study was designed to determine the association between pessary retention (PR) at one year and functional pelvic floor morphology i.e. Levator hiatal distance and area and Levator avulsion.


This retrospective study reviewed 73 records of patients with symptomatic POP at a tertiary Urogynaecologic centre. This cohort had previously been studied for pelvic floor morphology in a multi-ethnic population, had 4D trans-perineal pelvic floor ultrasound, and opted for a vaginal pessary as a treatment option.



Our population had a mean age of 59.4 years (range, 32 – 91 years), with a mean BMI of 29.4 kg/m2 (range, 20 – 42 kg/m2), and POP-Q stage of 3. The level of prolapse was found to be related to PR (p=0.077). We further explored this concept using symmetric measures of association (Ɣ=-0.353), indicating that pessary retention decreases with increasing prolapse severity. PR was also found to be inversely associated with prior pelvic reconstructive surgery (n = 63; p = 0.055; Ɣ=-0.417).

There was a mildly significant relationship (p=0.052) between hiatal distance on contraction and PR.

Author's affiliations

Frances Sya Paterson, Steve Biko Academic Hospital, University of Pretoria

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Pelvic organ prolapse; vaginal pessary; pelvic floor; levator distension

Cite this article

South African Journal of Obstetrics and Gynaecology 2018;24(3):. DOI:10.7196/sajog.1360

Article History

Date submitted: 2018-06-06
Date published: 2018-12-14

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