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Directive clinique n° 411 : Utilisation des pessaires

Published:November 25, 2020DOI:https://doi.org/10.1016/j.jogc.2020.11.012

      RÉSUMÉ

      Objectif

      Passer en revue l'utilisation, l'entretien et l'ajustement des pessaires.

      Population cible

      Les femmes qui ont besoin d'utiliser un pessaire en raison d'un prolapsus génital et/ou d'une incontinence urinaire d'effort. L'utilisation peut être indiquée chez les femmes enceintes dans certains scénarios cliniques liés à la grossesse, dont l'incarcération utérine et le risque de travail préterme liée à l'incompétence du col.

      Options

      Les pessaires constituent une option pour les femmes atteintes d'un prolapsus et/ou d'une incontinence urinaire d'effort. De plus, certains types de pessaires peuvent être utilisés chez des patientes atteintes d'incompétence du col ou d'une incarcération utérine.

      Issues

      Il est possible de trouver un pessaire efficace chez la plupart des femmes atteintes d'un prolapsus génital ou d'une incontinence urinaire d'effort de façon à obtenir un excellent soulagement des symptômes, un taux de satisfaction élevé et des complications minimes.

      Bénéfices, risques et coûts

      Les femmes atteintes d'un prolapsus génital et/ou d'une incontinence urinaire d'effort peuvent choisir d'utiliser un pessaire pour traiter leurs symptômes au lieu de subir une intervention chirurgicale ou dans l'attente d'une telle intervention. Des complications majeures ont été observées seulement en cas de soins de pessaire négligés. Les complications mineures (telles que les pertes vaginales, les odeurs et les érosions) sont généralement traitables avec succès.

      Données probantes

      Des recherches ont été effectuées dans la base de données Medline afin de récupérer les articles pertinents publiés jusqu'en décembre 2018. Le présent document constitue une mise à jour de la mise à jour technique de la SOGC publiée en 2013, laquelle a été la première directive clinique publiée à l'international relativement à l'utilisation des pessaires. Une ligne directrice australienne sur l'utilisation des pessaires pour le traitement du prolapsus a été publiée plus tard en 2013.

      Méthodes de validation

      Les auteures ont évalué la qualité des données probantes et la solidité des recommandations au moyen des critères du cadre méthodologique du Groupe d’étude canadien sur les soins de santé préventifs (annexe A).

      Professionnels concernés

      Gynécologues, obstétriciens, médecins de famille, physiothérapeutes, résidents et moniteurs cliniques (fellows).

      DÉCLARATIONS SOMMAIRES

      • 1
        Il est possible de trouver un pessaire efficace chez la plupart des femmes atteintes d'un prolapsus génital ou d'une incontinence urinaire d'effort pour le traitement de leurs symptômes (II-2).
      • 2
        Le taux de satisfaction chez les femmes qui utilisent un pessaire est très élevé (I).
      • 3
        Certains pessaires peuvent prévenir une récidive d'incarcération utérine (III).
      • 4
        Le rôle des pessaires spécifiquement conçus pour prévenir le travail préterme n'est pas clair (I).
      • 5
        Les complications associées à l'utilisation d'un pessaire sont généralement mineures, les pertes vaginales étant le problème le plus fréquent (II-3).
      • 6
        Il est possible de traiter l’érosion vaginale par le retrait du pessaire et une œstrogénothérapie vaginale optionnelle (II-2).

      RECOMMANDATION

      • 1
        Il y a lieu d'envisager l'utilisation d'un pessaire chez toute femme éprouvant des symptômes incommodants dus à un prolapsus génital et/ou une incontinence urinaire d'effort (I, A).

      Mots clés

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