Paper 39: Are Anterior and Apical Compartment Support at Maximal Valsalva Related?

Abstract

OBJECTIVE: To determine whether the distances below normal of the anterior compartment (bladder) and apical compartments (cervix) are correlated at maximal Valsalva. METHODS: Women were recruited with varying stages of prolapse and normal support. Sagittal dynamic cine magnetic resonance (MR) scans were recorded during maximal Valsalva effort. Women were excluded if they had undergone hysterectomy or if their MR scan was inadequate for analysis. Scans of 156 women with a mean age of 53.2 ± 12.5 (SD) years were analyzed. The most caudal bladder point (B) and the external cervical os (Cx) were used to reflect the locations of the anterior and apical compartments respectively. The locations of B and Cx of each woman at maximum Valsalva were plotted on a Cartesian coordinate system with the inferior pubic point as the origin, the SCIPP (sacrococcygeal inferior pubic point) line as the x-axis, and a line through the inferior pubic point as the y-axis. The normal positions (shown in Figure 1) of B and Cx were determined by the average locations at rest in 20 individuals without pelvic organ prolapse. The distances from the normal position of B and Cx to the location of both points at maximum Valsalva were calculated for each woman. (The distance below normal was selected rather than the distance moved because some large prolapses did not show much movement.) Pearson correlation coefficient of the relationship of the distances was calculated.FigureRESULTS: The locations of B and Cx for each woman at maximum Valsalva are shown in Figure 1. On average the bladder was 3.7 ± 2.4 cm below the normal position (range 0.4 cm-15.0 cm) and the cervix was 3.4 ± 2.3 cm below normal (range 0.2-13.7 cm). The relationship between these distances is seen in Figure 2. The correlation coefficient of this relationship is R=0.7 indicating that about half of the variability (r2=0.49) in bladder position is explained by cervix position.FigureCONCLUSION: In women with a spectrum of uterine and bladder support, half of the observed variation in anterior compartment support is explained by apical support and vice versa.