Vaginal pessary is considered first line non-invasive treatment for symptomatic pelvic organ prolapse especially in patients that do not desire or are not candidates for surgical management. Although there are no clear evidence-based intervals for pessary follow-up routine removal and cleaning is recommended in order to prevent severe complications from prolonged use like fistulas, urosepsis, and fecal impaction. Several case studies have discussed the sequelae of neglected and subsequently incarcerated pessaries that are difficult to remove in office and require surgical intervention.

In this video we present the case of a 90-year-old female that had a pessary in place for approximately twenty years with no follow-up that subsequently became incarcerated and required surgical removal.

The video details a methodologic approach to surgical removal of pessary including rectal exam, cystoscopy, and vaginoscopy before and after pessary removal.

The authors recommend this approach as these patients are at increased risk for unrecognized and/or iatrogenic complications. Additionally, incarcerated pessary removal may require an individualized and multidisciplinary approach.