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Session: Poster session 2 (Odd numbers)
Session starts: Friday 27 January, 10:00
Presentation starts: 10:00

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Irina De Alba Alvarez (University of Twente)
Anique Bellos-Grob (University of Twente)
Frank Simonis (University of Twente)
Frieda van den Noort (University of Twente)

Abstract:
Introduction: Pelvic Organ Prolapse (POP) is the decent of pelvic organs due to the weakness of the pelvic floor muscles. Conservative treatment by means of pessary (silicone ring) treatment is first line of choice for POP patients. The purpose of a pessary is to lift the pelvic organs to reduce the physical POP complaints. Pessary placement, however, has a limited success rate, with reported successful pessary fitting of 41% [1]. The mechanical working mechanism (e.g. why does it stay in place or drop-out) is poorly understood. We previously established that POP is larger in upright as compared to supine position [2], [3] , which should be considered when assessing the orientation and location of the pessary. However, most studies are done in supine position without considering the effect of gravity on the pelvic floor. The aim of this project is to evaluate the effect of pessary insertion on the lowest point of the bladder and cervix, and the volume of the bladder with patients in upright position. Method: This prospective study included 15 POP patients, wearing a pessary for at least 3 months. Data was acquired with a tilting 0.25T MRI system. The PICS reference line was used for the measurements of organ location and volume [4], [5]. Statistically significant differences were determined by means of the Wilcoxon signed-rank test. Results: In upright position after pessary insertion, we found a decreased bladder volume (mean =2.30ml) as compared to no pessary in situ (mean =8.69ml) (p<0.01). The lowest point of the bladder was raised after pessary insertion from 30mm below the PICS line to 10mm below the PICS line (p<0.01). The lowest point of the cervix was raised after pessary insertion from 2mm above the PICS line to 21mm above the PICS line (p<0.01). Conclusion: When assessing the effect of pessary insertion in upright position, we can conclude that it lifts the bladder and uterus significantly. This study includes the first steps towards a full understanding of the true working mechanism of a pessary.