OBJECTIVE: 

To evaluate the existing evidence on the efficacy of pessaries in improving quality of life when used for the treatment of pelvic organ prolapse (POP).

DATA SOURCES: 

We searched for the terms “pelvic organ prolapse” and “pessar/y/ies/ium or vaginal support device,” and “safety or safe or outcome or complication or efficacy or effective or effectiveness” in PubMed, EMBASE, and CINAHL on March 16, 2020. A search was also performed on ClinicalTrials.gov, with no studies fitting our strict inclusion and exclusion criteria.

METHODS OF STUDY SELECTION: 

Studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. Three reviewers independently screened studies.

TABULATION, INTEGRATION, AND RESULTS: 

Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was change in mean pretreatment and posttreatment questionnaire scores, which included those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire - Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I²-statistic. Eight studies including 627 patients were included for systematic review. The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%) when reported. Although variable, the majority of studies conducted 3-month follow-up. A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use: PFDI-20 mean change −46.1 (95% CI −65.4 to −26.8); PFIQ-7 mean change −36.0 (95% CI −46.0 to −26.0); POPIQ-7 (Pelvic Organ Prolapse Impact Questionnaire-7) mean change −16.3 (95% CI −26.8 to −5.7). No significant heterogeneity was found.

CONCLUSION: 

Based on improvements in standardized questionnaire scores, pessaries are effective treatment options for POP.

SYSTEMATIC REVIEW REGISTRATION: 

PROSPERO, CRD42020172618.

中文翻译：

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子宫托在盆腔器官脱垂治疗中的作用：系统评价和荟萃分析

客观的： 

评估关于子宫托用于治疗盆腔器官脱垂 (POP) 时改善生活质量的疗效的现有证据。

数据源： 

我们于 3 月在 PubMed、EMBASE 和 CINAHL 中搜索了术语“盆腔器官脱垂”和“pessar/y/ies/ium 或阴道支撑装置”以及“安全性或安全性或结果或并发症或功效或有效性或有效性” 2020 年 16 日。还在ClinicalTrials.gov上进行了搜索，没有符合我们严格的纳入和排除标准的研究。

研究选择方法： 

报告治疗前和治疗后平均分数和标准化问卷的子宫托治疗后的标准差的研究被包括在内。在儿科人群、妊娠和使用非脱垂子宫托的研究被排除在外。三位评价员独立筛选研究。

制表、积分和结果： 

数据提取是根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行的。当至少三项研究报告时，数据被汇总用于荟萃分析。主要研究结果是平均治疗前和治疗后问卷得分的变化，其中包括 PFDI-20（盆底压力量表 - 简表 20）、PFIQ-7（盆底影响问卷 - 简表 7）和子量表 POPIQ （盆腔器官脱垂影响问卷长表）。使用随机效应模型来结合估计和使用 I ^{2捕获研究间异质性}-统计。包括 627 名患者在内的八项研究被纳入系统审查。平均 (SD) 年龄为 63.0±12.2 岁，大多数患者报告时为 III 期脱垂 (48.1%)，随后为 II 期脱垂 (43.2%)。尽管存在差异，但大多数研究都进行了 3 个月的随访。注意到治疗前和治疗后评分的负变化，表明使用子宫托后有所改善：PFDI-20 平均变化 -46.1（95% CI -65.4 至 -26.8）；PFIQ-7 平均变化 -36.0（95% CI -46.0 至 -26.0）；POPIQ-7（盆腔器官脱垂影响问卷-7）平均变化 -16.3（95% CI -26.8 至 -5.7）。未发现明显的异质性。

结论： 

基于标准化问卷评分的改进，子宫托是 POP 的有效治疗选择。

系统审查注册： 

普洛斯彼罗，CRD42020172618。