Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound

Abstract Introduction and hypothesis The objective was to predict the successful ring pessary size based on the levator hiatal area (HA). Methods This is a prospective case–control study. Women with symptomatic pelvic organ prolapse (POP) choosing pessary treatment were included. All women underwent an interview, clinical examination, and 3D/4D transperineal ultrasound (TPUS). The ring pessary size used in each trial and the reason for unsuccessful trials were recorded. In addition, levator hiatal area divided by ring pessary size (HARP ratio) was measured at rest, maximum contraction, and maximum Valsalva. The HARP ratios of successful and unsuccessful trials were compared, receiver operating characteristic curves in the prediction of successful trials were constructed, and the cut-off optimizing sensitivity and specificity was identified. Results A total of 162 women were assessed and 106 were included with 77 successful trials, 49 unsuccessful trials owing to dislodgment or failure to relieve POP symptoms, and 20 unsuccessful trials owing to pain/discomfort. Rest HARP ratio and Valsalva HARP ratio were significantly smaller in the successful trials versus dislodgment/failure to relieve POP symptoms trials (mean rest HARP ratio [SD]: 2.93 [0.59] vs 3.24 [0.67], p = 0.021; median Valsalva HARP ratio (IQR): 4.65 (1.56) vs 5.32 (2.08), p = 0.004). No significant difference was observed between pain/discomfort trials and successful trials. The best cut-off for the prediction of successful trials was Valsalva HARP ratio ≤ 5.00. Conclusions Unsuccessful fitting trials due to dislodgment/failure to relieve POP symptoms are associated with a small ring pessary with respect to the levator HA. A ring pessary that produces a Valsalva HARP ratio > 5.00 has a higher risk of dislodgment/failure to relieve POP symptoms.

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Changes of the quality of sexual life following pelvic organ prolapse surgery

Česká gynekologie ◽

10.48095/cccg2021167 ◽

2021 ◽

Vol 86 (3) ◽

pp. 167-174

Author(s):

Vladimír Velický ◽

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Sexual Life ◽

Advanced Stage ◽

Sexually Active ◽

Middle Compartment

Summary Objective: The aim of the study was to determine the percentage of sexually active women with a higher degree of descent in the anterior and middle compartment (in one compartment at least ≥ III degree) and how the surgical solution affects the quality of sexual life and overall quality of life in women who underwent surgery. Methods: Patients who underwent prolapse surgery were included in the study. Before the operation, a complete urogynecological examination was performed, including ultrasound examination, history and POP-Q (pelvic organ prolapse quantification system) evaluation, and quality of life questionnaires were completed. We compared the quality of sexual life in sexually active women before and after surgery to ascertain the effect of surgery in this respect. Results: The study included 128 patients who underwent pelvic organ descent surgery from January 2018 to April 2019. Depending on the type of operation, they were divided into three groups: reconstruction with anterior vaginal implant fixed to the sacrospinous ligament, laparoscopic sacrocolpopexy and sacrospinous vaginofixation according to Amreich-Richter. The differences between the groups in the results of the surgical solution were not statistically significant due to the size of the monitored group. Sexual activity of the patients even in the advanced stage of pelvic organ setup was reported preoperatively by 45.9% of women and postoperatively – after 1 year – by 44.8% of women. Comparing the quality of life preoperatively and postoperatively, there was a very significant improvement in 58.0% of respondents, a significant improvement in 36.0% and a slight improvement in 2.0%: only in 3.0% of women, there was a deterioration (ranging from mild to very significant). Surgical treatment of the descent slightly worsened the quality of sexual life in 20.8% of women, did not change it in 33.3% and significantly improved it in 45.8% of them. Conclusion: A high percentage of patients are sexually active even at an advanced stage of descent. Comparing the quality of life preoperatively and postoperatively, there was a significant improvement or even complete resolution of the problems associated with descent in most women. For some women, the surgical treatment of the descent may slightly worsen the quality of sexual life; in others, its quality remains at the same level, but the largest section of the studied group feels a significant improvement in the perception of sexual activities.

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Association between pelvic organ prolapse types and levator‐urethra gap as measured by 3D transperineal ultrasound

Journal of Ultrasound in Medicine ◽

10.1002/jum.14644 ◽

2018 ◽

Vol 37 (12) ◽

pp. 2849-2854 ◽

Cited By ~ 3

Author(s):

Bence Kozma ◽

Kindra Larson ◽

Lauren Scott ◽

Tina D. Cunningham ◽

Alfred Abuhamad ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transperineal Ultrasound

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OP26.03: Transperineal ultrasound and clinical examination for pelvic organ prolapse correlate better if both are performed in a one stop clinic

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.8168 ◽

2010 ◽

Vol 36 (S1) ◽

pp. 128-128

Author(s):

M. L. Konstantinovic ◽

E. Werbrouck ◽

J. Veldman ◽

P. Lewi ◽

D. Timmerman ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Clinical Examination ◽

Pelvic Organ ◽

Transperineal Ultrasound ◽

One Stop

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Long-term efficacy of transvaginal high uterosacral ligament suspension for middle-compartment defect-based pelvic organ prolapse

Annals of Translational Medicine ◽

10.21037/atm-20-7296 ◽

2020 ◽

Vol 8 (24) ◽

pp. 1645-1645

Author(s):

Wenying Wang ◽

Yinghui Zhang ◽

Wenjie Shen ◽

Ke Niu ◽

Yongxian Lu

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Term Efficacy ◽

Middle Compartment

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Accuracy of assessing Pelvic Organ Prolapse Quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse

International Urogynecology Journal ◽

10.1007/s00192-012-1779-y ◽

2012 ◽

Vol 23 (11) ◽

pp. 1555-1560 ◽

Cited By ~ 16

Author(s):

F. W. Lone ◽

R. Thakar ◽

A. H. Sultan ◽

A. Stankiewicz

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transperineal Ultrasound ◽

Pelvic Organ Prolapse Quantification

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The Combined Measurement of Pelvic Organ Mobility and Hiatus Area Improves the Sensitivity of Transperineal Ultrasound When Detecting Pelvic Organ Prolapse

Frontiers in Medicine ◽

10.3389/fmed.2021.727711 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoduo Wen ◽

Haiyan Tian ◽

Xiaojing Yan ◽

Quiqing Sun ◽

Yuanyuan Du ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Roc Curve ◽

Pelvic Organ ◽

Transperineal Ultrasound ◽

Index Test ◽

Levator Hiatus ◽

Roc Curve Analysis ◽

Standardized Interview ◽

Sensitivity Specificity ◽

Lower Urinary

Objective: To evaluate whether the combined measurement of pelvic organ mobility and levator hiatus area improves the sensitivity of transperineal ultrasound (the index test) for diagnosing pelvic organ prolapse (POP).Methods: We retrospectively recruited women who had been examined in a tertiary gynecological center for symptoms of lower urinary tract incontinence and/or POP between January 2017 and June 2018. We excluded patients who had undergone hysterectomy previously or those who had received corrective surgery. All subjects underwent a standardized interview, POP quantification (POP-Q) examination (a reference standard for patients and controls), and ultrasound measurements of the levator hiatus area at rest (rHA), on contraction (cHA), and on Valsalva (vHA). We also determined the mobility of the bladder neck (BNM), cervix (CM), and rectum ampulla (RAM). Receiver operating characteristic (ROC) curve analyses were performed to determine cut-off values for diagnosis. Diagnostic performance was assessed by sensitivity, specificity, and area under curve (AUC).Results: A total of 343 women were eligible for analysis, including 247 POP patients (stage 2–3 by POP-Q) and 96 controls. Compared with controls, POP cases had significantly higher values for rHA, vHA, cHA, BNM, CM, and RAM. Each parameter was identified as a significant discriminator for POP and controls, as determined by ROC curve analysis, although the cut-off value varied slightly between different parameters. The combination of rHA, vHA, and cHA (with any HA that was ≥ the cut-off) improved the sensitivity from 64–89 to 89–93%. The combination of pelvic organ mobility with rHA, vHA, and cHA, further increased the sensitivity from 89–93 to 95–97%.Conclusion: The combination of levator hiatus area and pelvic organ mobility improved the sensitivity of transperineal ultrasound in the diagnosis of POP, whether used as a frontline test to assist POP-Q grading or to monitor the effect of pelvic floor exercise programs.

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