Vaginal Prolapse Pessary Material Trial PVC vs Silicon

October 10, 2024 updated by: Lo Cheuk Yin, Princess Margaret Hospital, Hong Kong

Effect of Materials of Vaginal Ring Pessary for Pelvic Organ Prolapse on the Effects of Complications and Patient's Satisfaction

The goal of this clinical trial is to determine the effect of vaginal ring pessary material on pessary complications and patients' satisfaction.

Participants who are using PVC (polyvinyl chloride) pessary will be randomized to

  1. PVC vaginal ring pessary
  2. Silicon vaginal ring pessary

Their pessary-related complications, patients' satisfaction, pain during pessary exchange and prolapse related symptoms with reference to PFDI-20 score will be assessed in a period of six months.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Pelvic organ prolapse (POP) is a common gynaecological condition which attains prevalence of 15% women. It causes negative impact on physical, emotional and psychosexual aspects, thus significantly impairs patients' activities of daily living and quality of life. Treatment modalities include conservative, pessary and surgical management. Vaginal pessary is inexpensive, non-invasive and an attractive treatment option for women who possess high anaesthetic and surgical risks. Pessary-related complications include vaginal ulcer, vaginitis which would require temporary discontinuation of pessary use in order to prevent serious complications such as incarceration and fistula formation. If complications can be minimised, it is more likely that patients' satisfaction can further improve.

Vaginal pessaries are primarily made of polyvinyl chloride (PVC) or silicone. PVC has been the material of choice for local practice based on its long history in clinical use and cheaper cost. A new PVC pessary is inserted at each consultation if vaginal condition is satisfactory. In view of the increasing number of POP patients who opt for long term pessary use, silicone has emerged as alternative material of choice in recent years. Despite being more expensive, silicone pessaries can be washed and re-inserted for 20 washes/10 years if remained intact and not visibly damaged. As silicone pessary is more pliable, it can facilitate the process of pessary insertion and removal by squeezing of the pessary to pass through narrow introitus. On the other hand, it may be more easily compressed by abdominal pressure and dislodged when straining. The UK clinical guideline for best practice in the use of vaginal pessaries for POP in 2021 suggested there is no clear preference of offering one type of pessary over another, further supported by the latest publication of a multi-centre pessary study in the UK in 2023.

The primary objective is to determine the effect of vaginal ring pessary material on pessary complications and patients' satisfaction. The secondary objectives are to explore the effect of pessary material on procedural pain during pessary exchange as well as prolapse-related symptoms. It is hypothesised that silicone pessaries, compared to PVC pessaries, can reduce the rate of pessary-related complications from 30% to 10% and also result in higher patients' satisfaction.

This is a single-blinded, randomised placebo-controlled trial conducted in the pessary clinic in Princess Margaret Hospital

Participants are assessed for eligibility when they present to pessary clinic for routine pessary care.

Participants are recruited and assigned randomly in 1:1 ratio to receive either

  • Treatment arm: replacement of a new silicone pessary
  • Control arm: replacement of a new PVC pessary Participants are randomly assigned to one of the two groups in 1:1 ratio. Randomization is carried out by an independent statistician according to computer-generated random numbers in random blocks of two, four and six, allocated by sequentially numbered, sealed opaque envelopes. When participants are prepared for pessary care inside the examination room, the new pessary will be prepared by research assistant outside the examination room according to the allocation result. The attending staff will conduct routine pessary care including pessary removal, vaginal examination and pessary replacement. Participants are not informed of the material of the new pessary. Standard patient information leaflet regarding pessary care with hotlines is provided. A 6-month follow up appointment will be arranged.

Participants will subsequently attend follow up 6 months later. A questionnaire will be given by the research assistant before the consultation to enquire for any pessary-related symptoms, and their satisfaction on the current pessary. During the consultation, the attending staff will remove the study pessary and assess the vaginal condition. The study is concluded by a short questionnaire and routine pessary care follows subsequently.

Data Collection Patient age, parity, menopausal status, stage of prolapse on presentation, previous duration of pessary use, history of pessary complications are obtained from hospital record as demographic data.

Symptoms of pessary-related complications and patients' satisfaction are collected by self-administered questionnaires. Signs of pessary-related complications are assessed and documented by the attending staff.

Statistical Analysis Baseline characteristics and outcomes of PVC pessary group and silicone pessary group are compared using independent t-test, Mann-Whitney U test, Pearson's chi-square test or Fisher's exact test, where appropriate.

Odds ratio for complications with 95% confidence interval was calculated. The within-group changes of patient satisfaction and severity of prolapse with POP-Q were assessed using Wilcoxon signed-rank test.

Sample size calculation Previous pessary study in our unit has shown the rate of pessary-related complications with follow-up interval of 6-month was 30% (only PVC pessary was available) Assuming the complication rate of silicone pessary use with 6-month follow-up interval is 10%, configuring 80% power of detection, 5% of beta error and 20% of dropout rate, 140 participants are needed for recruitment.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
140

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

  • Name: Kai Wan Lee, FRCOG
  • Phone Number: 852-29903430

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion criteria

  • At least 18 years old who understand written traditional Chinese
  • Diagnosed with stage 1-4 POP according to the standard of Pelvic organ prolapse Quantification (POP-Q)
  • Using PVC pessary as long term management for POP
  • Willing to participate and provide a written informed consent.

Exclusion criteria

  • Do not understand or comprehend written traditional Chinese
  • Cannot provide written consent
  • Vaginal complication requiring discontinuation of pessary use
  • Unable to follow up clinic 6 months later
  • Pregnant or lactating
  • Recruited in other research studies

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Silicon ring pessary
Change to silicon ring pessary of nearest size
Procedure: Pessary care, change of pessary
Insertion of a new pessary by gynaecologist if not contraindicated, silicon or polyvinyl chloride pessary of same size, blinded to patient
Placebo Comparator: PVC ring pessary
Change of same PVC ring pessary
Procedure: Pessary care, change of pessary
Insertion of a new pessary by gynaecologist if not contraindicated, silicon or polyvinyl chloride pessary of same size, blinded to patient

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Pessary related complications
Time Frame: 6 months
Patient reported symptoms such as vaginal bleeding, vaginal discharge, pessary dislodgement Physician reported complications such as ulcers formation, vaginitis
6 months
Patient satisfaction
Time Frame: 6 months
Visual analogue score 1- 10 [Minimal satisfaction: 1, Maximal satisfaction: 10]
6 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Pain during pessary exchange
Time Frame: 6 months
Visual analogue scale 1- 10 [Minimal pain: 1, Maximal pain: 10]
6 months
Prolapse related symptoms
Time Frame: 6 months
PFDI 20 summary score (Pelvic Floor Disability Index) [Minimal symptoms: 0 Maximal symptoms: 300]
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Princess Margaret Hospital, Hong Kong

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Cheuk Yin Lo, MBBS, Princess Margaret Hospital, Canada

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 15, 2024

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 31, 2025

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 30, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 8, 2024

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 10, 2024

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 15, 2024

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 15, 2024

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 10, 2024

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Pessary material trial

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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