Name of the Procedure:

• Common Name(s): Non-Rubber Pessary
• Medical Term: Pessary, non-rubber, any type (HCPCS Code: A4562)

Summary

A non-rubber pessary is a medical device inserted into the vagina to provide support for pelvic organ prolapse or to manage urinary incontinence.

Purpose

• Medical Conditions: Pelvic organ prolapse, urinary incontinence.
• Goals/Expected Outcomes: To alleviate symptoms of pelvic organ prolapse and prevent urinary leakage, thereby improving the quality of life for the patient.

Indications

• Symptoms/Conditions: Feeling of heaviness or pressure in the pelvis, urinary incontinence, discomfort during sexual activity.
• Patient Criteria: Women diagnosed with pelvic organ prolapse or urinary incontinence who are not suitable candidates for surgery or prefer a non-surgical option.

Preparation

• Pre-Procedure Instructions: Usually, no specific preparation such as fasting is required. Patients may be asked to empty their bladder before the procedure.
• Diagnostic Tests: Pelvic exam, assessment of the degree of prolapse and incontinence.

Procedure Description

1. Examination: The healthcare provider performs a pelvic exam.
2. Fitting: The appropriate size and type of pessary are selected.
3. Insertion: The pessary is folded and gently inserted into the vagina.
4. Adjustment: The provider ensures the pessary is comfortable and provides the needed support.
   • Tools/Equipment: Non-rubber pessary of a specific type and size.
   • Anesthesia/Sedation: Typically, none required.

Duration

• Typical Time: 10-15 minutes.

Setting

• Location: Outpatient clinic or physician's office.

Personnel

• Healthcare Professionals Involved: Gynecologists, primary care physicians, or nurse practitioners.

Risks and Complications

• Common Risks: Vaginal irritation, discomfort, increased vaginal discharge.
• Rare Risks: Infection, ulceration of vaginal tissues. Management includes removal of the pessary and treatment with antibiotics or ointments if necessary.

Benefits

• Expected Benefits: Immediate relief from symptoms such as pressure, incontinence, or discomfort.
• Timeframe: Benefits can be realized immediately upon proper placement and fitting.

Recovery

• Post-Procedure Care: Regular cleaning and periodic follow-up visits to check fit and condition of the pessary.
• Recovery Time: No downtime required; normal activities can typically be resumed immediately. Follow-up appointments as advised by the healthcare provider.

Alternatives

• Other Treatment Options: Pelvic floor exercises (Kegels), surgical repair, use of a rubber pessary.
• Pros and Cons:
  • Pelvic Floor Exercises: Non-invasive but takes time to see results.
  • Surgical Repair: Potentially permanent solution but involves risks of surgery and longer recovery.
  • Rubber Pessary: Similar function but may cause allergic reactions in those sensitive to rubber.

Patient Experience

• During Procedure: Minimal discomfort during insertion.
• After Procedure: Some women might experience mild pressure or vaginal discharge, which usually resolves with time. Pain management typically involves over-the-counter pain relievers if needed. Regular follow-up ensures ongoing comfort and effectiveness.