TABLE 2.
Characteristics of Standard Pessaries Used by Patients Before Study Enrollment and Patient-Specific Pessaries Used in the Study
| Patient | Standard Pessary | Patient-Specific Pessary | ||||
|---|---|---|---|---|---|---|
| Type | Dimensions (Length, Width, Height) |
Type | Dimensions (Length, Width, Height) |
Example of Patient-Desired Pessary Features | Example of Patient-Centered Design Decisions | |
| P1 | Circular ring with support | 83, 83, 12 | Oval ring with support | 91, 80, 15 | Desired a stiffer, more supportive pessary for exercise | Ring thickness increased from 12 mm to 15 mm |
| P2 | Circular ring with support | 70, 70, 12 | Oval ring with support | 77, 68, 12 | Desired a softer pessary | Softer silicone used for fabrication (durometer 40 rating) |
| P3 | Circular ring with support and knob | 70, 70, 12 | Oval ring with support and knob | 75, 70, 13 | Desired improved anti-incontinence | Pessary length increased to position knob under the mid-urethra |
| P4 | Circular ring with support and knob | 76, 76, 12 | Oval ring with support and knob | 86, 76, 12 | Desired a pessary that is easier to fold | Pessary notch along the bending axis increased by 40% |
| P5 | Marland | 89, 89, 44 | Marland | 89, 89, 39 | Desired a smaller pessary for improved comfort | Elevated platform height decreased from 44 mm to 39 mm |
| P6 | Marland | 64, 64, 37 | Marland | 74, 68, 37 | Desired improved fit with reduced dislodgement | Pessary dimensions customized to optimize fitting |
| P7 | Cube | 44, 44, 44 | Oval ring with support | 74, 68, 14 | Desired to improve self-maintenance (previously failed ring placement) | Oval ring pessary dimensions customized to optimize fitting |
| P8 | Gellhorn | 57, 57, 8.5 | Gellhorn | 62, 52, 9 | Desired to improve self-maintenance; desired less irritation to posterior vagina from Gellhorn stem | Pessary dimensions customized to facilitate self-maintenance; stem angled 20 degrees anteriorly |
For ring Marland, and Gellhorn pessaries, length is represented by the maximum dimension of the disc portion. Height is represented by the vertical dimension of the pessary normal to the disc (ie, ring thickness, Marland horn height, or Gellhorn stem length). Units are in millimeters. The patient-specific pessary presented is the one identified as most favorable by the patient after the trial period. Changes in outcomes for individual patients are depicted in Figure 2. Three patients (P1, P2, and P8) elected to undergo a second round of patient-specific pessary treatment.