Dr Arabin pessaries Pelvic organ prolapse
The ring pessary is made from flexible silicone with a steel spring filling, that helps the ring maintain it's form. It is very easy for the patient to self manage. The circumference of the ring is relatively thin. Used in patients with a slight prolapse and mild cases of incontinence.. A stable pelvic floor is required for this pessary. It can also prevent stress incontinence.
The thick ring pessary is made of flexible silicone. In contrast to normal ring pessary it does not include a steel spring filling but consists of a larger circumference of the ring part. Thus overlay surface is larger and the risk of necrosis of the vaginal wall may decrease. Preferably older patients with descensus and mild cases of prolapse without incontinence are treated with this type. A stable pelvic floor is required.
The bowl or sieve bowl pessaries consist of flexible silicone. Therefore they are elastic and can be easily folded and can be inserted and removed without causing pain. Preferably mild forms of pelvic relaxation and prolapse are treated by the bowl pessary. In patients with a cystocele the pessary supports both the medial and the lateral defect. The contact to the pelvic floor (Figure) also increases adhesion. However, an intact pelvic floor is required for this pessary.
The Hodge pessary consists of silicone with a half-stiff aluminium filling to aid in optimal comfort and allowing to the pessary to be manipulated into various shapes adapting to the patients needs.
The Hodge pessary is meanwhile only used in cases with incontinence, if ring pessaries are not tolerated because of anatomical aberrations.
It may be helpful in assisting the support of a retroverted uterus.
The cube pessary is suitable for all degrees of uterine prolapse. The vacuum effect achieves a good adhesion so that this pessary can even be used in cases when the pelvic floor is not strong enough to support other pessaries. Cubes are suitable for patients with scar tissue damage. Cube pessaries are suitable for managing stress incontinence, cystocele and rectocele. In addition, the pessaries are used before prolapse operations in order to improve the tissue circulation (application with estriol cream). This pessary is particularly helpful in treating athletes and runners who have symptoms of prolapse or SUI.
The tandem pessary is custom made of two cubes of flexible silicone. Patients with grade 3-4 uterine or vaginal vault prolapse may be treated with the tandem pessary. The reduction of the prolapse may not be possible if the vagina cannot retain a single cube pessary. Similar to the cube pessary, the vacuum effect of the concave surface achieves a good adhesion. In addition, the tandem pessary can be useful in case of stress incontinence whereby the lower cube takes on the supporting function of the urethra and the upper cube mainly assures the adhesion of the pessary.
The club pessary is made of flexible silicone. It is recommended for patients with grade 3 to 4 prolapse of vagina and uterus. It is particularly helpful in cases where urethra, ring or bowl pessaries do not sustain the pressure and where a cube pessary might increase stress incontinence. Grade 4 prolapse may represent a big problem for the patient and a challenge for the physician. Before inserting the pessary, the prolapsed organs have to be reposed.