Metrische Quantifizierung des weiblichen Genitalprolapses: Eine sinnvolle Neuerung in der Prolapsdiagnostik?

Abstract

Clinical applicability :To date no binding staging system exists for the quantification of genital prolapse, allowing a clear differentiation between the individual compartments with descension potential (anterior, posterior vaginal wall, vaginal vault and uterus). It is therefore difficult to assess the efficacy of the different surgical techniques applied for the correction of vaginal or uterine prolapse. The aim of this study was to determine, in a senior versus junior setting, the inter-observer reliability and acceptability by patients of the new classification system of genital prolapse as proposed by the International Continence Society comittee for Standardisation of Terminology at their Annual Conference in Prague in 1994: Applicability of a graphical grid for visual understanding of measure points. Women with varying degrees of genital prolapse were examined by two investigators in a half sitting position with prolapse to maximum extent. The examiners were blinded to the findings of their counterpart. The reproducibility of the nine site-specific measurements and the stages were analysed according to Bland and Altman and Kappa statistics. No single examination exceeded 5 minutes. In terms of discomfort it was comparable to a regular vaginal examination. Inter-rater reliability: The study population comprised 46 patients, mean age 69 ± 12, parity ± 2, weight 67 kg ± 10. The proposed international site-specific prolapse quantification and staging system yields a good inter-observer reliability (kappa: 0.67). In no patient did the stage vary by more than one, and in 83% of patients stages were identical. The study data show that the new classification system is highly reproducible. It is independent of examiner experience and is acceptable to the patient. The graphical grid is easily applicable and allows immediate visual understanding of measured points.