A string can be attached to the ring to aid in insertion and removal. Patients can easily be taught to do this by themselves. Calcitriol Gehrung. If a cystocele or rectocele accompanies the third-degree uterine prolapse, a Gehrung pessary��which rests along the anterior vaginal wall like a bridge��may be the most helpful. The Gehrung can be manually molded to fit each patient. The Gehrung can be difficult to insert.7 Mar-land. The flexible silicone Mar-land pessary and the Incontinence Dish can be used for minor degrees of prolapse and for the relief of stress incontinence. These pessaries decrease urethral hypermobility by compressing the urethra against the upper posterior portion of the symphysis pubis and elevating the bladder neck. Space-Occupying Pessaries Gellhorn.
The Gellhorn is generally the pessary of choice for more advanced-stage prolapse, or in a patient who is no longer sexually active. Removal and insertion of this pessary is more difficult and therefore cannot be done by the patient. Most patients can be successfully managed with the 2.5-, 2.75-, and 3-inch size. This pessary has a concave portion attached to a stem that faces into the vagina. To insert the Gellhorn, the pessary is folded in half with the use of lubricant on the leading edge to ease insertion. Once the pessary is behind the pubic symphysis, it will expand and rest against the leading edge of prolapse, forming suction. To remove the Gellhorn, the knob is grasped, generally with the help of a ring forceps, while the concave end of the pessary is rotated to release the suction and the pessary is pulled downward, folded, and removed.
Donut. The donut pessary may be used to relieve the symptoms of a cystocele or rectocele as well as a secondor third-degree uterine prolapse. As it is not compressed easily, it is one of the hardest to insert and, in particular, to remove. Cube. The cube pessary is flexible silicone7 and is an option in the case of stage III and IV prolapse. The pessary has a string on one end for ease of removal. To insert, the cube pessary is compressed and inserted into the vagina. The cube forms suction with the leading edge of prolapse and oftentimes vaginal secretions are trapped in the crevices of the pessary, leading to malodorous discharge; it is usually the pessary of last resort. This pessary should be removed on a nightly basis when possible.
Patient Evaluation Carfilzomib and Pessary Placement When a patient presents for treatment of POP or urinary incontinence, a thorough evaluation including a comprehensive history and symptoms assessment, expectations for treatment, obstetrical history, and surgical history must be performed. After a thorough examination, treatment options should be discussed. Once the decision to use a pessary is made, the clinician will choose the type of pessary based on severity of prolapse, presence or absence of a uterus, sexual activity, and concomitant stress urinary incontinence.