{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T01:13:08Z","timestamp":1782436388568,"version":"3.54.5"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Forty percent of women will experience prolapse in their lifetime. Vaginal pessaries are considered the first line of treatment in selected patients. Major complications of vaginal pessaries rarely occur. Methods: PubMed and Embase were searched from 1961 to 2022 for major complications of vaginal pessaries using Medical Subject Headings (MeSH) and free-text terms. The keywords were pessary or pessaries and: vaginal discharge, incontinence, entrapment, urinary infections, fistula, complications, and vaginal infection. The exclusion criteria were other languages than English, pregnancy, complications without a prior history of pessary placement, pessaries unregistered for clinical practice (herbal pessaries), or male patients. The extracted data included symptoms, findings upon examination, infection, type of complication, extragenital symptoms, and treatment. Results: We identified 1874 abstracts and full text articles; 54 were assessed for eligibility and 49 met the inclusion criteria. These 49 studies included data from 66 patients with pessary complications amenable to surgical correction. Clavien\u2013Dindo classification was used to grade the complications. Most patients presented with vaginal symptoms such as bleeding, discharge, or ulceration. The most frequent complications were pessary incarceration and fistulas. Surgical treatment included removal of the pessary under local or general anesthesia, fistula repair, hysterectomy and vaginal repair, and the management of bleeding. Conclusions: Pessaries are a reasonable and durable treatment for pelvic organ prolapse. Complications are rare. Routine follow-ups are necessary. The ideal patient candidate must be able to remove and reintroduce their pessary on a regular basis; if not, this must be performed by a healthcare worker at regular intervals.<\/jats:p>","DOI":"10.3390\/jpm13071056","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:25:21Z","timestamp":1687911921000},"page":"1056","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4073-2081","authenticated-orcid":false,"given":"Laura","family":"Calles Sastre","sequence":"first","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4735-0644","authenticated-orcid":false,"given":"Bel\u00e9n","family":"Almoguera P\u00e9rez-Cejuela","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-1007","authenticated-orcid":false,"given":"Augusto","family":"Pereira S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3751-1205","authenticated-orcid":false,"given":"Sof\u00eda","family":"Herrero G\u00e1miz","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier F.","family":"Magrina","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"R\u00edos Vallejo","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4560-453X","authenticated-orcid":false,"given":"Tirso","family":"P\u00e9rez Medina","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.bpobgyn.2005.08.007","article-title":"Classification and evaluation of prolapse","volume":"19","author":"Mouritsen","year":"2005","journal-title":"Best Pract. 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