{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:42:18Z","timestamp":1792424538272,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T00:00:00Z","timestamp":1656979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJUI Compass"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic literature review using search terms such as \u2018prolapse\u2019, \u2018stress urinary incontinence\u2019 and \u2018pessary or pessaries or pessarium\u2019 on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient\u2010level data were extracted from case reports to further describe complications on an individual level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall median age of the patients was 82\u2009years (range 62\u201398). The most frequent complications were vesicovaginal fistula (25%, <jats:italic>n<\/jats:italic>\u00a0=\u20099\/36), rectovaginal fistula (19%, <jats:italic>n<\/jats:italic>\u00a0=\u20097\/36), vaginal impaction (11%, <jats:italic>n<\/jats:italic>\u00a0=\u20094\/36) and vaginal evisceration of small bowel through vaginal vault (8%, <jats:italic>n<\/jats:italic>\u00a0=\u20093\/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non\u2010surgical treatment of the complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self\u2010care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow\u2010up that is required.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bco2.174","type":"journal-article","created":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T03:54:38Z","timestamp":1656993278000},"page":"415-423","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Rare complications of pessary use: A systematic review of case reports"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9944-4845","authenticated-orcid":false,"given":"Stefan","family":"Dabic","sequence":"first","affiliation":[{"name":"Department of Urology Weill Cornell Medicine\/New York Presbyterian  New York New York 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