Abstract
The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.
Highlights
Introduction iationsPelvic organ prolapse (POP) is a condition in which the pelvic organs such as the bladder, uterus, rectum, and sometimes the small bowel descend from their normal position through the vagina
The prevalence of POP is higher in older women, with a lifetime risk factor of 30% and 180 per 100,000 women aged 50 or older based on a database maintained by the Korea National Health Insurance [1]
We aimed to evaluate the prevalence of rectocele and enterocele on translabial ultrasound (TLUS) and the main
Summary
Pelvic organ prolapse (POP) is a condition in which the pelvic organs such as the bladder, uterus, rectum, and sometimes the small bowel descend from their normal position through the vagina. The prevalence of POP is higher in older women, with a lifetime risk factor of 30% and 180 per 100,000 women aged 50 or older based on a database maintained by the Korea National Health Insurance [1]. Symptoms of POP include a sensation of vaginal bulge, overflow urinary incontinence, urinary retention, voiding difficulty, constipation, and splint behavior during urination or defecation [2]. Aging and parity are independent risk factors for POP [3]. The lifetime risk of surgery for POP in women is 19% [4]. The surgical repair of POP is the most common inpatient procedure performed in women aged 70 or older [5] and 1012 million USD is estimated as the economic burden of POP in our aging society [6]
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