Title: Demographic, Socioeconomic and Functional Health-Related Factors in the selection of
vaginal pessaries used for the conservative treatment of pelvic organ prolapse: a retrospective
study
Version: 1 Date: 29 Apr 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The authors deal with a current subject which is a real public health
issue. Scientific societies have recently published recommendations regarding the use of a
pessary in the management of pelvic organ prolapse in women.
The literature review is correct, the writing fluid. The conclusions are consistent with the
question asked.
However, some details are missing. With the suggested corrections, this manuscript will have
increased in quality.
ADDITIONAL REQUESTS/SUGGESTIONS:
This is a well-written manuscript, with a correct and up-to-date literature review. I suggest
adding a few publications that seem important to me.
The authors claim that pessaries are primarily chosen by elderly patients who are not suitable
for surgery or by patients not wishing to undergo surgical treatment. It’s not totally true.
Indeed, most of savant societies (in France as HAS, CNGOF, Canada…) have published
recommendations stipulating that pessaries have to be proposed as first-line treatment to all
women suffering of POP and to all types of POP. Authors should highlight this in abstract.
“The aim of our study was to confirm whether patients' preferences play a role in the choice of
the pessary types”. This sentence should be in the background section.
In addition, the authors should clarify certain notions in order to make the work more objective.
For example, there is no mention that sexual relations are possible with a ring pessary. The latter
is not a filling device like donut pessaries, which prevent any penetration. Finally, when we talk
about the question of sexual relations, they are not limited to the question of coitus and it would
be good to imply this.
As for surgical technique, it would be good to specify that the delicate question of not resorting to
reinforcing prostheses placed vaginally has made it possible to re-appropriate "old" techniques
such as Richter colposuspension and highlighting of laparoscopic sacral colpopexy
An interesting article comparing pelvic perineal rehabilitation and pessary treatment conclude
that women with POP stage II to III who received vaginal pessary had higher totally goal
achievements and better quality of life than the women received the pelvic floor muscle training.
It should also be highlighted that in terms of effectiveness between surgery and the pessary, the
publication by Abdool et al. demonstrates that women with POP report similar improvement in
urinary, bowel, sexual, and quality of life parameters when treated with a pessary or surgical
correction.
Patient satisfaction information (questionnaire used in particular) would be useful.
A critical issue to document is the type of prolapse and grade. The authors must enlighten us on
this subject. Furthermore, what precessive surgeries were reported and led to failures. Indeed, it
must be remembered that the history of total hysterectomy and the presence of a vulvovaginal
gap are pejorative factors for treatment with a ring pessary because it does not remain in place.
Can the authors clarify this for us?
The comeback of vaginal surgery during and after the COVID-19 pandemic: a new paradigm.
[The gynecological pessary: Is it really a device of another age, a fig leaf?].
Prospective evaluation of outcome of vaginal pessaries versus surgery in women with
symptomatic pelvic organ prolapse.
Abdool Z, Thakar R, Sultan AH, Oliver RS.Int Urogynecol J. 2011 Mar;22(3):273-8. doi:
10.1007/s00192-010-1340-9.