Application: The urethra pessary consists of flexible silicone with a steel spring filling which keeps the form. It is elastic and can be easily changed by the patient herself. The circumference of the ring is relatively thin. Preferably patients with incontinence are treated with the urethra pessary. An intact pelvic floor (also if reduced) is required. The pessary can also prevent the development of a stress incontinence by its suburethral supporting effect. The thickening of the pessary is supposed to support the transition between bladder and urethra and thus to avoid an opening of the upper urethra under stress situations like coughing or movements (picture). A shifting can also avoid seeping of urine into the urethra, which may have a positive effect on urge.or a mixture of stress and urge incontinence.
Sizes: The diameters of the pessaries range from a minimum of 45 to a maximum of 100 mm. The pessary which achieves the best continence when coughing in the standing position and which also allows for micturition should be chosen. Often one will have to change to a larger pessary after 1 or 2 months, due to a relaxation of the vaginal tissue. If the thickening is not sufficient, the size can be individually fit by gluing additional caps. When inserting the pessary, the ring will be pushed through the vaginal vault upwards so that the thickening lifts the transition between bladder and urethra (picture).
Use: The physician adaptsjhe pessary on the first examination with a filled bladder on the examination chair.. Subsequently, the patient is asked to cough, press and to move and the loss of urine is registered. With an ideal position of the pessary, also a severe stress incontinence is immediately redressed. This may motivate the patient and the treatment team to continue. If the incontinence is redressed, there is no doubt about the diagnosis of stress incontinence. For the insertion the pessary is covered with estrogen cream. After the test, the position of the pessary should be checked again. The pessary can be changed easily by the patient herself, i.e. she has to remove it in the evening and to insert it in the morning. The coating with estrogen cream facilitates the insertion and improves the local blood circulation as well as the formation of epithelium and connective tissue. Exclusively creams containing estriol should be used (shorter adhesion to the receptor). Since one needs a relatively small amount of cream (small surface) for the gliding effect, we recommend to use a higher dispensed estriol containing 1 mg estriol / 1 g cream. Urethra pessaries are usually worn during daytime, sometimes only under extreme stress (e.g. sport). The change of the pessary may be done while standing, whereby the patient may put one
foot on a stool or the edge of a bed, in a position comparable to the insertion of a tampon; if this is too difficult, it may be sufficient to insert the pessary while spreading the legs, if necessary while leaning against a wall or while lying. The patient should be trained how to insert the pessary (e.g. first to press the ring part and then push it to the upper part of the vagina whereby the thickening lies under the symphysis) and how to remove it (surrounding of the ring with her forefinger, edging and loosening of the pessary). The fixation of a thread on both sides of the thickening, which can be adapted individually (longer for obese patients) may facilitate the handling and avoid a dislocation of the thickening under the bladder. However, older patients may prefer a change by the physician or a nurse at 1-4 week intervals. Under these conditions, one should insert an estriol cream or ovulum once a week. Also if surgery is planned in the long term, the pessary, in combination with local estrogens, can be used as a preparation before the operation".
Side Effects/Complications: The therapy with this pessary is meant - in combination with additional measures (physiotherapy, estrogens) - to cure or at least to reduce the patient's problems of incontinence. The daily change bv the patient or the change by the physician and/or nursing staff with local estrogen therapy avoids complications like infections, bleedings or even ulcers. Stress incontinence does not need any therapy during the night anyway. If any problems with incontinence remain despite having changed the sizes and despite training, the diagnosis and choice of the pessary have to be reconsidered. It is possible that the thickening cannot get upwards because of insufficient levator muscles or an obstructed vaginal wall. Under these conditions, one has to change to a cube pessary and local estriol therapy - at least temporarily. Contraindications for estriol creams should be considered (e.g. pregnancy, lactation period, estrogen-dependent tumors). If the patient is not able to change the pessary herself, it may be advisable to integrate a nurse or a member of the family into the procedures.
Advice: The product should only be used by one patient and can be stored by room temperature. The pessary may be cleaned under warm running water without using any disinfectant.