Name of the Procedure:

Common Names: Pessary Placement
Medical Terms: Pessary Insertion (rubber, any type) - HCPCS Code A4561

Summary

A pessary is a medical device inserted into the vagina to provide structural support to pelvic organs. Made of rubber and available in various types, pessaries can help alleviate symptoms associated with pelvic organ prolapse and incontinence.

Purpose

Medical Conditions:

• Pelvic organ prolapse (e.g., cystocele, rectocele, uterine prolapse)
• Stress urinary incontinence

Goals:

• Provide support to pelvic organs
• Relieve symptoms of prolapse and incontinence
• Improve quality of life

Indications

• Feeling of pelvic pressure or a bulge in the vagina
• Urinary incontinence
• Difficulty with bowel movements
• Discomfort or pain during daily activities due to prolapse

Preparation

• No specific fasting required
• May need to adjust medications, especially blood thinners
• Diagnostic tests such as pelvic exams and ultrasounds for proper sizing and type determination

Procedure Description

1. The patient lies in a lithotomy position (on back, legs in stirrups).
2. A pelvic exam is conducted to ensure correct pessary size and type.
3. The pessary is lubricated and folded.
4. The pessary is carefully inserted into the vagina and positioned to support the pelvic organs.
5. The placement is checked, and the patient is educated on self-care and maintenance.

Tools Used: Rubber pessary, lubricant

Anesthesia: Typically not required; local anesthesia if necessary for comfort

Duration

The procedure typically takes about 15-30 minutes.

Setting

• Outpatient clinic
• Gynecologist's office

Personnel

• Gynecologist or healthcare professional trained in pessary fitting
• Nurse for assistance and patient education

Risks and Complications

Common Risks:

• Vaginal irritation or discharge
• Pressure sores

Rare Risks:

• Vaginal infection
• Bleeding

Management:

• Proper hygiene and regular follow-up visits
• Prompt treatment of any infections or complications

Benefits

• Immediate relief from the discomfort of prolapse or incontinence
• Non-surgical option with minimal risks
• Quick recovery and return to normal activities

Recovery

• Patients can usually resume normal activities immediately
• Follow-up visits to check pessary placement and condition every few months
• Regular cleaning and maintenance of the pessary as instructed

Alternatives

Other Options:

• Pelvic floor exercises (e.g., Kegels)
• Physical therapy
• Surgery (e.g., pelvic reconstructive surgery)

Pros and Cons:

• Pessary: Non-surgical, immediate relief but requires maintenance
• Exercises/Therapy: No devices, natural but may take time and consistent effort to see results
• Surgery: Long-term solution, higher risk and longer recovery time

Patient Experience

During Procedure:

• Some pressure or mild discomfort during insertion
• Generally, no pain if properly fitted

After Procedure:

• Initial sensation of having a foreign object, which typically subsides
• Minor spotting or discharge
• Instructions on hygiene and self-care to ensure comfort