Authors (including presenting author) :
Tong KP, All NTEC Continence Advisors.
Sepcial thanks: Dr. Symphorosa Chan, Dr. Rachel Cheung
Affiliation :
Obsteric and Gynaecology Department, Prince of Wales Hospital.
Introduction :
Pelvic organ prolapse is a common problem in Hong Kong and worldwide. It occurs when there is inadequate support by the pelvic floor muscles and associated ligaments. Cystocele and uterine prolapse are common conditions. Vaginal pessary is commonly used in women with pelvic organ prolapse with high efficacy. However, vaginal pessary requires regular replacement every 6 months. This poses a heavy burden on the health care system and the patient herself. In the nurse clinic, patient and carers are now encouraged and empowered to learn self-management.
Objectives :
To provide one to one vaginal pessary self-management program to
1) encourage the participation of patients and carers
2) enforce patient’s compliance
3) reduce the burden on the health care system
Methodology :
Empowerment
In the nurse clinic, nursing staffs would assess patient’s preference and ability on self-management of vaginal pessary. Capable patients were invited to learn self-management and silicone vaginal pessary would be provided. A bilingual education leaflet on self-management of vaginal pessary was distributed. The patient management was according to the departmental guideline. (Guideline on Gynaecology Nurse Clinic (continence) Vaginal Pessary Replacement). Patient satisfaction was assessed by using patient satisfaction survey.
Engagement
Vaginal pessary self-replacement technique was taught and demonstrated. Patients would have hands-on practice of self-insertion and self-removal of the vaginal pessary. The attending nurse acknowledged and appreciated the women’s efforts. Patients are arranged follow-up to review self-replacement technique. If the technique was satisfactory, they would be considered discharge from the clinic.
Result & Outcome :
In 2024, there were 873 appointments in NTEC. The attendance rates were 95% (832). This included 96 new cases and 736 old cases. Their mean age was 72 years old; 95% of them had stage II or above pelvic organ prolapse. There were 29 (3.4%) episodes of patients being referred back to doctors. About 55% were due to complications of the vaginal pessary and 45% opt for surgery. 21(2.5%) women were encouraged and learnt self-management of vaginal pessary successfully and discharged from the clinic. Most of patients strongly agree (57%) or agreed (43%) that the continence advisors had improved their knowledge and built up their confidence in managing their vaginal pessary. All 21 patients responded that they were happy and full of confidence to manage their prolapse problem by themselves.
