Self-management of vaginal pessaries for prolapse: the TOPSY trial key findings

Women with symptomatic pelvic organ prolapse are offered a choice of conservative and surgical treatment options. Two thirds of women choose a vaginal pessary, a support device inserted in the vagina. This article reports the finding of a randomized controlled trial published in 2023 evaluating the cost-effectiveness of self-management of pessary compared to clinic-based care. Women were recruited in 21 centres across the UK and 340 women were randomized to pessary self-management or clinic-based care. The primary outcome measure was prolapse-specific quality of life and secondary outcomes were generic quality of life, pelvic floor symptoms, sexual function, self-efficacy, pessary complications, pessary use and pessary confidence. Participants’ health care resource use was measured. The trial showed that at 18 month follow-up self-management was not associated with better or worse quality of life than clinic-based care. Women in the self-management group reported fewer pessary complications and lower healthcare resource use.

Rohna Kearney MD FRCOG Consultant Urogynaecologist, The Warrell Unit, Saint Mary's Hospital, Manchester, Division of Developmental Biology and Medicine, School of Medical Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK. Conflicts of interest: Rohna Kearney declares payment as an expert scientific advisor from the British Standards Institute, the author declare a grant from National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme related to the research described in this article

Suzanne Hagen CStat PhD Professor of Health Services Research in the School of Health and Life Sciences, Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK. Conflicts of interest: the author declare a grant from National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme related to the research described in this article

Carol Bugge RN PhD Professor of Nursing, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. Conflicts of interest: the author declare a grant from National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme related to the research described in this article

Source: Rohna Kearney, Suzanne Hagen, Carol Bugge. Self-management of vaginal pessaries for prolapse: the TOPSY trial key findings. Obstetrics, Gynaecology & Reproductive Medicine. Volume 34, Issue 8, 2024. Pages 229-231, ISSN 1751-7214, https://doi.org/10.1016/j.ogrm.2024.05.004.

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