Effects of Pelvic Organ Prolapse Ring Pessary Therapy on Intravaginal Microbial Flora

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2015 Sep 18

PMID 26377332

Citations 7

Authors

Kazuaki Yoshimura

Nobuo Morotomi

Kazumasa Fukuda

Toru Hachisuga

Hatsumi Taniguchi

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: The purpose of this paper is to report our evaluation of changes in intravaginal microbial flora after ring pessary therapy for pelvic organ prolapse (POP) using conventional and our clone library method.

Methods: Thirteen patients with POP who were fitted with a ring pessary participated in this longitudinal study that incorporates data from before and 1 month after beginning ring pessary therapy. Changes in intravaginal microbial flora were evaluated by conventional methods, i.e., vaginal pH, lactobacillary grade (LAC grade), Nugent score, and culture-based bacterial detection methods. In addition, we performed our clone library method using 16S ribosomal RNA (rRNA) sequencing of vaginal fluid.

Results: Conventional methods revealed that most patients had abnormal intravaginal microbial flora. Mean numbers of detected bacterial species by the culture-based and our clone library method were 3.1 (1-6) and 11.8 (1-25), respectively. Our clone library method showed that Lactobacillus spp. increased in four and decreased in two cases after ring pessary therapy but reappeared after therapy in two cases; no Lactobacillus spp. were detected in five cases.

Conclusions: Our study showed that ring pessary therapy did not always disturb intravaginal microbial flora, especially for patients with Lactobacillus spp. prior to ring pessary insertion. Anaerobic circumstances in the vagina after therapy seem to have induced the growth of anaerobic bacteria.

Citing Articles

Microbiome alterations in women with pelvic organ prolapse and after anatomical restorative interventions.

Kim M, Lee S, Kim H, Kwon M, Yoo J, Kim M Sci Rep. 2023; 13(1):17547.

PMID: 37845312 PMC: 10579314. DOI: 10.1038/s41598-023-44988-6.

Pessaries for pelvic organ prolapse: evaluation of vaginal discharge and pain during pessary cleaning in an outpatient setting.

Kruyt L, van der Ploeg J, Lammers K, van Etten-Debruijn B, Niemeijer A, Hakvoort R Int Urogynecol J. 2023; 35(2):333-339.

PMID: 37796331 DOI: 10.1007/s00192-023-05648-5.

Analysis of questions by patients with pelvic organ prolapse about vaginal pessaries resulting in a checklist for their physicians.

Wagner J, Fink T, Arabin B Arch Gynecol Obstet. 2023; 309(1):329-337.

PMID: 37597024 DOI: 10.1007/s00404-023-07177-4.

Adapting to Challenging Circumstances: Pessary Care in a Racially Diverse Urban Population Within a U.S. Epicenter of the COVID-19 Pandemic.

Kadam Halani P, Gelman E, Duchein Y, Roselli N, Leegant A Female Pelvic Med Reconstr Surg. 2021; 28(2):121-125.

PMID: 34171881 PMC: 8808767. DOI: 10.1097/SPV.0000000000001085.

Should phenotype of previous preterm birth influence management of women with short cervix in subsequent pregnancy? Comparison of vaginal progesterone and Arabin pessary.

Care A, Muller-Myhsok B, Olearo E, Todros T, Caradeux J, Goya M Ultrasound Obstet Gynecol. 2018; 53(4):529-534.

PMID: 29920812 PMC: 6593812. DOI: 10.1002/uog.19118.

References

Nugent R, Krohn M, Hillier S . Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991; 29(2):297-301. PMC: 269757. DOI: 10.1128/jcm.29.2.297-301.1991. View

Khaja A, Freeman R . How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists. Int Urogynecol J. 2014; 25(7):941-6. DOI: 10.1007/s00192-014-2329-6. View

Harris K, Hartley J . Development of broad-range 16S rDNA PCR for use in the routine diagnostic clinical microbiology service. J Med Microbiol. 2003; 52(Pt 8):685-691. DOI: 10.1099/jmm.0.05213-0. View

Zhou X, Bent S, Schneider M, Davis C, Islam M, Forney L . Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology (Reading). 2004; 150(Pt 8):2565-2573. DOI: 10.1099/mic.0.26905-0. View

Verhelst R, Verstraelen H, Claeys G, Verschraegen G, Van Simaey L, De Ganck C . Comparison between Gram stain and culture for the characterization of vaginal microflora: definition of a distinct grade that resembles grade I microflora and revised categorization of grade I microflora. BMC Microbiol. 2005; 5:61. PMC: 1266370. DOI: 10.1186/1471-2180-5-61. View

Abdool Z, Thakar R, Sultan A, Oliver R . Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2010; 22(3):273-8. DOI: 10.1007/s00192-010-1340-9. View

Sarma S, Ying T, Moore K . Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG. 2009; 116(13):1715-21. DOI: 10.1111/j.1471-0528.2009.02380.x. View

Alnaif B, Drutz H . Bacterial vaginosis increases in pessary users. Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11(4):219-22; discussion 222-3. DOI: 10.1007/pl00004026. View

Atnip S . Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin North Am. 2009; 36(3):541-63. DOI: 10.1016/j.ogc.2009.08.010. View

10.

Yoshimura K, Morotomi N, Fukuda K, Nakano M, Kashimura M, Hachisuga T . Intravaginal microbial flora by the 16S rRNA gene sequencing. Am J Obstet Gynecol. 2011; 205(3):235.e1-9. DOI: 10.1016/j.ajog.2011.04.018. View

11.

Falagas M, Betsi G, Athanasiou S . Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect. 2007; 13(7):657-64. DOI: 10.1111/j.1469-0691.2007.01688.x. View

12.

Penrose K, Ma Yin J, Tsokos N . Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J. 2013; 25(2):291-3. DOI: 10.1007/s00192-013-2143-6. View

13.

Fredricks D, Marrazzo J . Molecular methodology in determining vaginal flora in health and disease: its time has come. Curr Infect Dis Rep. 2005; 7(6):463-70. DOI: 10.1007/s11908-005-0049-2. View

14.

Collins S, Beigi R, Mellen C, OSullivan D, Tulikangas P . The effect of pessaries on the vaginal microenvironment. Am J Obstet Gynecol. 2014; 212(1):60.e1-6. DOI: 10.1016/j.ajog.2014.07.024. View

15.

Kawanami T, Fukuda K, Yatera K, Kido T, Yoshii C, Taniguchi H . Severe pneumonia with Leptotrichia sp. detected predominantly in bronchoalveolar lavage fluid by use of 16S rRNA gene sequencing analysis. J Clin Microbiol. 2008; 47(2):496-8. PMC: 2643685. DOI: 10.1128/JCM.01429-08. View

16.

Richter H, Burgio K, Brubaker L, Nygaard I, Ye W, Weidner A . Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol. 2010; 115(3):609-617. PMC: 2914312. DOI: 10.1097/AOG.0b013e3181d055d4. View

17.

Fredricks D, Fiedler T, Marrazzo J . Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005; 353(18):1899-911. DOI: 10.1056/NEJMoa043802. View

18.

Ocana V, Silva C, Nader-Macias M . Antibiotic susceptibility of potentially probiotic vaginal lactobacilli. Infect Dis Obstet Gynecol. 2007; 2006:18182. PMC: 1779606. DOI: 10.1155/IDOG/2006/18182. View

19.

Donders G, Vereecken A, Dekeersmaecker A, Van Bulck B, Spitz B . Wet mount microscopy reflects functional vaginal lactobacillary flora better than Gram stain. J Clin Pathol. 2000; 53(4):308-13. PMC: 1731171. DOI: 10.1136/jcp.53.4.308. View