A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse.

Sa-Ra Lee,Gina Nam,Jae-Yen Song

doi:10.3390/diagnostics12010098

Sa-Ra Lee, Gina Nam + Show 1 more

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https://doi.org/10.3390/diagnostics12010098

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Abstract

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

Highlights

Pelvic organ prolapse (POP) is a common disease among older women, wherein the organs in the female pelvis, including the uterus, bladder, and rectum, descend through the vagina
We observed that the clinical staging and angle measurement were correlated with the prolapse quantification (POP-Q) and translabial ultrasound (TLUS) findings
Weak but significant correlations were observed between the POP-Q stage and the angle measurements for the Ap parameter

Summary

Introduction

Pelvic organ prolapse (POP) is a common disease among older women, wherein the organs in the female pelvis, including the uterus, bladder, and rectum, descend through the vagina. The lifetime risk of POP surgery is 12–19%, and more than 300,000 surgeries are performed annually in the United States [1]. Gynecologists examine the patient’s pelvis and measure the degree of prolapse of the anterior wall, posterior wall, and cervix of the vagina or vaginal vault. This method can be subjective, depending on the examiner and the patient’s ability to perform the maximal Valsalva maneuver, and it can be inconvenient and unpleasant for the patient during the pelvic examination. A vaginal mass mimicking prolapse can be misdiagnosed as POP [4,5,6]

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