Abstract
BackgroundWhile normal pelvic organ support has been defined for women with intact uterus, this is not the case for post- hysterectomy vault descent. A recent systematic review found that definitions of apical prolapse are highly variable.ObjectivesTo investigate the relationship between prolapse symptoms and apical POP-Q measurements and establish cutoffs for ‘significant apical descent using receiver–operator characteristics (ROC) statistics.Study designRetrospective analysis of patients seen at a tertiary urogynecological unit. Evaluation included a standardized interview and clinical assessment using the Pelvic Organ Prolapse Quantification (POP-Q) system. ROC curves were prepared for the relationship between prolapse symptoms and POP-Q measure “C”.ResultsThe records of 3010 women were available for analysis. Prolapse symptoms were reported by 52.3% (n = 1573), with a mean bother of 5.9 (SD 3.0, range 0–10). POP-Q point “C” was associated with symptoms of prolapse (p <0.0001) and prolapse bother (p <0.0001) on both univariate and multivariate analysis. ROC curves for women with and without uterus were similar, although the relationship between apical descent and symptoms of prolapse was stronger for women with uterus (AUC 0.728 versus 0.678). After controlling for multi-compartment prolapse, the models improved, resulting in AUCs of 0.782 and 0.720. For prediction of prolapse symptoms, cutoffs were set at C = -5 (sensitivity 0.73, specificity 0.67 with uterus in situ, sensitivity 0.59, specificity, 0.73 after hysterectomy).ConclusionA cut- off for ‘significant central compartment descent’ of 5 cm above the hymen on Valsalva seems valid regardless of previous hysterectomy.
Highlights
The prevalence of pelvic organ prolapse (POP) is increasing due to increasing life-expectancy and changing demographics [1, 2], and the lifetime risk for undergoing surgery for POP is between 12% and 19% in Western countries [3, 4]
The records of 3010 women were available for analysis
receiver–operator characteristics (ROC) curves for women with and without uterus were similar, the relationship between apical descent and symptoms of prolapse was stronger for women with uterus (AUC 0.728 versus 0.678)
Summary
The prevalence of pelvic organ prolapse (POP) is increasing due to increasing life-expectancy and changing demographics [1, 2], and the lifetime risk for undergoing surgery for POP is between 12% and 19% in Western countries [3, 4]. Anterior prolapse is commonly the most pronounced, apical descent is considered important for POP symptoms and sexual function and needs to be adequately addressed [10, 12, 13]. A recent systematic review found that definitions of clinically significant apical prolapse for study inclusion and outcome assessment are highly variable. There are no guidelines regarding the degree of apical support loss that should be considered ‘abnormal’, and further research is needed to develop evidence-based definitions for clinical practice and research [12]. While normal pelvic organ support has been defined for women with intact uterus, this is not the case for post- hysterectomy vault descent. A recent systematic review found that definitions of apical prolapse are highly variable.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
