POMEGRANATE Trial: Comparing Reia Pessary Versus Standard of Care Pessary for Pelvic Organ Prolapse Treatment

Not Applicable

Recruiting

• Conditions: Pelvic Organ Prolapse; Prolapse
• Interventions: Device: Reia System; Device: Standard of Care Pessary

• Registration Number: NCT06634459
• Lead Sponsor: Medstar Health Research Institute

Brief Summary

This multi-centered, randomized controlled trial will evaluate the safety and efficacy of home use of the novel Reia System (RS), which includes the Reia pessary and applicator, compared to standard pessary care (Gellhorn or ring with/without support without knob) among women with stage II-IV pelvic organ prolapse (POP). A total of 182 participants will be recruited among pessary naïve patients who are symptomatic and choose a vaginal pessary for management of their POP from study sites specializing in Urogynecology and Reconstructive Pelvic Surgery (URPS). Participants will be assigned via 1:1 randomization using computer generated numbers in permutated groups of variable block sizes to either the intervention (the Reia System, RS) or standard pessary care (SPC) stratified by site. Participation in this trial will involve a total of four visits over six months. The primary outcome measure will be satisfaction measured at the six-month time point. Secondary outcomes will include validated surveys to assess quality of life, number of self-management events, ease/difficulty of pessary insertion/removal, importance of ability to self-manage pessary, and adverse events.

Specific Aims

Aim 1: To compare satisfaction with pessary use and management between subjects randomized to the Reia System and those randomized to standard of care pessary.

Aim 2: To assess successful fitting, number of refitting visits, number of self-management events and continued pessary use over a 6-month period between subjects randomized to the Reia System and those randomized to standard of care pessary.

Aim 3: To compare ease/difficulty of pessary use and importance of ability to self-manage, as well as quality of life over a 6-month period between subjects randomized to the Reia System and those randomized to standard of care pessary.

Aim 4: To measure rates of adverse events and risk factors for adverse events over a 6-month period between subjects randomized to the Reia System and those randomized to standard of care pessary.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2024-10-02
• Study First Submitted QC: 2024-10-08
• Study First Posted: 2024-10-10
• Status Verified: 2024-11
• Study Start: 2024-11-01
• Last Update Submitted: 2025-05-04
• Last Update Posted: 2025-05-07
• Primary Completion: 2025-10
• Study Completion: 2026-10-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: Female
• Target Recruitment: 182

Inclusion Criteria

• English-speaking natal females ≥ 18 years of age
• Willing to self-maintain (insert/remove) pessary
• Pessary naïve with Stage II-IV POP desiring conservative management with a pessary
• Primary indication for use of pessary is treatment of pelvic organ prolapse

Exclusion Criteria

• Primary indication for pessary use is for management of stress urinary incontinence

• Prior mesh-augmented prolapse repair (i.e. transvaginal mesh, sacrocolpopexy)

• Short vaginal length (TVL < 8cm) or subjective vaginal narrowing

• Vaginal fistula (e.g. rectovaginal, vesicovaginal or any type of fistula involving the vagina)

• Vaginal, rectal or bladder malignancy

• Genitourinary infection requiring treatment (See below 1)

• Ongoing treatment for vaginal infections (e.g., chronic bacterial vaginosis) (See below 2)

• Inflammatory bowel disease (Crohn's or ulcerative colitis)

• Pelvic or anorectal chronic pain

• Pelvic floor surgery within the past 6 months or planning to undergo pelvic floor surgery

• Congenital malformation of the bladder, rectum or vagina

• Pregnant or planning pregnancy in the next 6 months

• Prior failure of pessary for POP

• History of hydroureter, hydronephrosis, or impaired renal function secondary to prolapse

  1. Patients with acute vaginal infections will be eligible for enrollment 2 weeks after completing treatment with resolution of symptoms
  2. OK to be on prophylactic/suppressive therapy for HSV

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Reia System	Reia System	Participants receiving the commercially available RS will be fit with one of three available pessary sizes and will receive an applicator corresponding to their pessary size.
Standard Pessary Care	Standard of Care Pessary	Participants receiving SPC will be fit with a Gellhorn pessary or ring with/without support without knob pessary per standard clinical protocol.

Primary Outcome Measures

Name	Time	Method
Total Self-Mangement Events	6 months	Satisfaction with pessary use/management measured at six months

Secondary Outcome Measures

Name	Time	Method
Patient Global Impression of Improvement (PGI-I)	6 months	A single item questionnaire to assess a patient's impression of change. For purposes of this trial, the investigators have adapted the PGI-I to specifically ask about "prolapse symptoms." It will ask participants to "Check the one number that best describes how the participant's prolapse condition is now, compared with how it was before the participant began this study" on a 7-point Likert scale ranging from (1) very much better to (7) very much worse
Behavioral Outcomes	6 months	Will include a 5-point Likert scale ranging from (1) disagree strongly to (5) agree strongly about participants' ease of self-administered pessary insertion, ease of self-administered pessary removal, discomfort with self-administration of pessary insertion, and discomfort with self-administration of pessary removal
Pelvic Floor Distress Inventory-20 (PFDI-20)	6 months	A 20-item condition-specific quality-of-life instrument with three scales (6-item Urinary Distress Inventory, 6-item Pelvic Organ Prolapse Distress Inventory, and 8-item Colorectal-Anal Distress Inventory) used to evaluate the impact of pelvic floor disorders on quality of life with a response scale from 0 (not present) to 4 (quite a bit bothersome).
Pelvic Floor Impact Questionnaire-7 (PFIQ-7)	6 months	A 7-item condition-specific quality-of-life instrument with three scales (Urinary, Pelvic Organ Prolapse, and Colorectal-Anal). The PFIQ-7 is a validated instrument that is widely utilized in research in conjunction with the PFDI-20 to provide a comprehensive evaluation of the impact of pelvic floor disorders on quality of life, specifically how they affect activities, relationships, and feelings on a scale from not at all to quite a bit.
Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)	6 months	A validated instrument to evaluate sexual function in women with pelvic organ prolapse and/or urinary incontinence with 21 questions for sexually active women and 12 questions for non-sexually active women
Pessary outcomes	6 months	Will include continued use of pessary and number of unintentional pessary expulsions
Total self-management events	6 months	Defined as removing the pessary ≥ one time per 24-hour period over the six-month follow-up period, this outcome will be summed and divided by actual days of follow-up to accommodate minor variation across participants in the exact length of follow-up.
Patient Global Impression of Severity (PGI-S)	6 months	A single item questionnaire to assess the patient's impression of disease severity. For purposes of this trial, the investigators have adapted the PGI-I to specifically ask about "prolapse" severity. It will ask participants to "Check the one number that best describes how the participant's prolapse condition is now" on a 4-point Likert scale ranging from (1) normal to (4) severe
Patient Global Symptoms Control Rating Scale (PGSC)	6 months	A a single item adapted for purposes of this trial. It will state "My current treatment is giving me adequate control of my prolapse" and participants will be asked to select a response on a 5-point Likert scale ranging from (1) disagree strongly to (5) agree strongly
Participant view of importance of ability to self-maintain pessary	6 months	This outcome will be measured by the question "How important is it to you to be able to self-manage your pessary?" with response options on a 5-point Likert scale of 1-not at all important, 2-slightly important, 3-neutral, 4-moderately important, 5-very important.

Trial Locations

Locations (9)

Women & Infants Hospital in Rhode Island; 🇺🇸 Providence, Rhode Island, United States

University of Alabama at Birmingham; 🇺🇸 Birmingham, Alabama, United States

Stanford University; 🇺🇸 Palo Alto, California, United States

MedStar Health; 🇺🇸 Washington, District of Columbia, United States

The University of Chicago; 🇺🇸 Northbrook, Illinois, United States

Dartmouth-Hitchcock; 🇺🇸 Lebanon, New Hampshire, United States

University of New Mexico Health Sciences Center; 🇺🇸 Albuquerque, New Mexico, United States

Atrium Health Wake Forest Baptist; 🇺🇸 Winston-Salem, North Carolina, United States

University of Wisconsin; 🇺🇸 Madison, Wisconsin, United States