Evaluation of Marland vs Gellhorn Pessary in Women with Pelvic Organ Prolapse

Objectives: Our primary objective was to compare the success rate of the Gellhorn pessary and Marland pessary in women who failed initial pelvic organ prolapse (POP) treatment with the ring-with-support pessary.

Methods: In this retrospective cohort study, we identified subjects with POP receiving pessary management at a single institution from 1/1/2018 to 1/1/2024. A total of 221 charts were reviewed based on CPT code 57160 for Pessary Fitting. Patients included in the study were those who had failed Ring with support pessary and underwent POP management with either a Marland pessary or Gellhorn pessary. The baseline characteristics of these patients were analyzed using two-sample t-test or Mann Whitney test, and chi-square test or Fisher’s exact test as deemed appropriate for continuous and categorial variables, respectively. Success with pessary of choice was defined as use for greater than or equal to 3 months.

Results: A total of 43 subjects had failed Ring with Support pessary management for their POP; 26 subjects used Gellhorn pessary and 17 subjects used Marland pessary. Descriptive statistics demonstrated that the two groups were comparable (Table 1: Demographic Data between Marland and Gellhorn Pessary). There was no statistically significant difference in success rates between the Marland and the Gellhorn groups (84.6% vs 82.4%, p = 1.00) Nor was there a statistically significant difference in the composite complication rate between the Gellhorn and Marland groups (50.0% vs 52.9%, p = 1.00, respectively). The mean duration of use was greater in the Gellhorn group than Marland group (24.33 months ± 22.90 vs 11.54 months ± 16.41, p = 0.133). (Table 2: Primary Outcome: Success ( 3 months) and Secondary Outcomes (Duration of Pessary Use and Complications of Pessary Use) in Gellhorn and Marland Groups).

Conclusions: The use of Marland pessary as a second line pessary for management of POP has an equivalent success rate to a Gellhorn pessary. Therefore, providers should take into consideration other factors including potential complications, specific type of prolapse, and professional experience when proposing as second-line pessary for POP management. Though this study evaluated a small sample size, it demonstrates that Marland pessary can be taken into consideration for advanced POP management.