Pessary Types

Many different types of pessaries are currently available, most made of medical grade silicone or rubber. Although the majority were designed for specific types of prolapse, many have the indication for prolapse as well as SUI. Clinical use of the pessary is typically based on a "best fit" choice (Table 8-1.1). The best pessary is the one that elevates the prolapse and remains in place during ambulation. In addition, it should sit in the vaginal canal without causing pain or becoming obstructive in terms of voiding and bowel evacuation. The health care provider must be prepared to try several different types and sizes until the correct pessary is found for each individual patient. Because of variations in pelvic anatomy, optimal fitting of a pessary may be challenging. In addition, the large number of pessary types, each with various sizes, further complicates the process. Because pessary fitting is a trial and error process, a clinician must have a large inventory of pessaries of varying sizes in order to accomplish appropriate fitting of patients (Figures 8-1.2-8-1.8).

Table 8-1.1. Pessary types and indications

Pessary

Sizes

Indications

Large

Enterocele

Rectocele

Incontinence

Smith-Hodge

G-9

X

X

X

Risser

G-9

X

X

X

Marland

2-8

X

X

Incontinence dish (mm)

SS-8S

X

X

Incontinence ring

G-1G

X

X

Ring (with or without support)

G-9

X

X

X

X

Gerhrung (with or without knob)

G-9

X

X

X

Gellhorn (in)

1--31 2 J 2

X

X

X

X

X

Schaatz (in)

1--3-

X

X

X

X

Doughnut (in)

2-3-

X

X

X

X

X

Inflatable (in)

2-3-

X

X

X

X

X

Cube

G-7

X

X

X

X

X

Source: Adapted from Oster and Javert3 (Table 1).

Figure 8-1.2. Ring pessary (a) with and (b) without support. (Courtesy of Milex Products, a division of Cooper Surgical.)

Figure 8-1.2. Ring pessary (a) with and (b) without support. (Courtesy of Milex Products, a division of Cooper Surgical.)

Figure 8-1.3. Shaatz pessary. (Courtesy of Milex Products,a division of Cooper Surgical.)
Figure 8-1.4. Donut pessary. (Courtesy of Milex Products,a division of Cooper Surgical.)

Figure 8-1.5. Gehrung pessary. (Coui"tesy of Milex Products, a division of C°°per Surgical.) Figure 8-1.6. Gellhorn pessary. (Courtesy of Milex Products, a division of Cooper Surgical.]

Figure 8-1.7. Smith-Hodge pessary (a] with and (b) without support. (Courtesy of Milex Products,a division of Cooper Surgical.)
Figure 8-1.8. Cube pessary. (Courtesy of Milex Products,a division of Cooper Surgical.)

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