Evaluation Of Vaginal Culture Results in Patients Using Vaginal Pessary
Research Article
DOI:
https://doi.org/10.5281/zenodo.10530035Keywords:
Pelvic Organ Prolapse, Pessary, Vaginal CultureAbstract
Abstract
Introduction: Although surgery is the main treatment in cases with uterine prolapse, the use of vaginal pessary is an important alternative in cases where surgery cannot be performed due to comorbid diseases and patient avoidance of surgery. With the use of pessaries, the pelvic organs are held in place and a significant improvement in the patient's quality of life is achieved.
Objective: Obviosly Usage of vaginal pessaries cause to vaginal infection. The aim of this study to determine solutions of the problems that patients may encounter and better evaluate this situation in the light of vaginal culture results taken from patients.
Method: 22 patients who applied to Gynecology and Obstetrics outpatient clinics and used vaginal pessaries due to pelvic organ prolapse for various reasons were included in the study. Previous vaginal culture results due to infection were evaluated retrospectively in the patients who are using pessaries. The cases were examined in terms of age, gravida, parity, height, weight, BMI, existing complaint, comorbidity, reason for not being able to undergo surgery, shape and degree of pelvic organ prolapse, whether it was accompanied by incontinence, and pathological findings using ultrasonography.
Results: During sterile speculum examination of the patients with vaginal discharge due to pessary use intense leukorrhea was detected in just 1 patient (4%) and 9 patient (40.9%) had minimal leukorrhea. Although the patient had a complaint, no evidence of infection was detected in 12 of the patients (54.5%) during the examination. The vaginal culture results shows that 7 of 22 patients (31%) were reported as "no growth". Normal flora elements grew in 12 of them (54%). Pathogenic microorganisms were observed in only 3 (13.6%) patients.The causative microorganism Echechia coli was observed in 2 of the patients with growth in vaginal culture, and Enterococcus faecealis was observed in 1.
Conclusion: As a result of this study, it is seen that local antibiotics used prophylactically and local estrogen given to prevent tissue damage provide adequate treatment in patients using vaginal pessaries, but it is more valuable to show the presence of infection by vaginal examination rather than culture to improve the quality of life of patients
References
Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. American journal of obstetrics and gynecology. 2002;186(6):1160-1166.
Pott-Grinstein E, Newcomer JR. Gynecologists' patterns of prescribing pessaries. The Journal of reproductive medicine. 2001;46(3):205-208.
McIntosh L. The role of the nurse in the use of vaginal pessaries to treat pelvic organ prolapse and/or urinary incontinence: a literature review. Urologic Nursing. 2005;25(1)
de Boer TA, Salvatore S, Cardozo L, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn. 2010;29(1):30-9. doi:10.1002/nau.20858
Vierhout ME. The use of pessaries in vaginal prolapse. Eur J Obstet Gynecol Reprod Biol. Nov 10 2004;117(1):4-9. doi:10.1016/j.ejogrb.2003.10.037
Deger R, Menzin A, Mikuta J. The vaginal pessary: past and present. Postgrad Obstet Gynecol. 1993;13(18):1-8.
Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams Obstetrics. Williams Obstetrics, 26. McGraw Hill; 2022:1267:chap 65.
Hoda SA, Cheng E. Robbins Basic Pathology. American Journal of Clinical Pathology. 2017;148(13):713-748. doi:10.1093/ajcp/aqx095
van de Wijgert JH, Borgdorff H, Verhelst R, et al. The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One. 2014;9(8):e105998. doi:10.1371/journal.pone.0105998
Gorodeski GI, Hopfer U, Liu CC, Margles E. Estrogen acidifies vaginal pH by up-regulation of proton secretion via the apical membrane of vaginal-ectocervical epithelial cells. Endocrinology. Feb 2005;146(2):816-24. doi:10.1210/en.2004-1153
Marrazzo JM, Koutsky LA, Eschenbach DA, Agnew K, Stine K, Hillier SL. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis. May 1 2002;185(9):1307-13. doi:10.1086/339884
Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. Dec 2010;13(6):509-22. doi:10.3109/13697137.2010.522875
Garcia LS. Clinical microbiology procedures handbook. vol 3.1. American Society for Microbiology Press; 2010.
de Castro EB, Brito LGO, Giraldo PC, Teatin Juliato CR. Does the Vaginal Flora Modify When a Synthetic Mesh is Used for Genital Prolapse Repair in Postmenopausal Women? A Pilot, Randomized Controlled Study. Female Pelvic Med Reconstr Surg. Jul/Aug 2019;25(4):284-288. doi:10.1097/spv.0000000000000539
Rogenhofer K, Scharl A, Späth G, Engelbrecht V. [Vaginal foreign body -- cause for a rectovaginal fistula]. Zentralbl Gynakol. Apr 2005;127(2):96-8. Vaginaler Fremdkörper als Ursache einer rektovaginalen Fistel. doi:10.1055/s-2005-836327
Binstock MA, Semrad N, Dubow L, Watring W. Combined vesicovaginal-ureterovaginal fistulas associated with a vaginal foreign body. Obstet Gynecol. Nov 1990;76(5 Pt 2):918-21.
Bash KL. Review of vaginal pessaries. Obstet Gynecol Surv. Jul 2000;55(7):455-60. doi:10.1097/00006254-200007000-00025
Jones KA, Harmanli O. Pessary use in pelvic organ prolapse and urinary incontinence. Rev Obstet Gynecol. Winter 2010;3(1):3-9.
Malhotra N, Chanana C, Lal S. Forgotten vaginal pessary discovered after 30 years. J Gyn Obset. 2007;6:13.
Wu V, Farrell SA, Baskett TF, Flowerdew G. A simplified protocol for pessary management. Obstetrics & Gynecology. 1997;90(6):990-994.
Bar-Hava I, Orvieto R, Ferber A, et al. Asymptomatic postmenopausal intrauterine fluid accumulation; characterization and significance. Climacteric. 1998;1(4):279-283.
Goldstein SR. Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the hole. Obstetrics & Gynecology. 1994;83(5):738-740.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Medica Ruha
This work is licensed under a Creative Commons Attribution 4.0 International License.
