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

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.

scholarly journals Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound

2021 ◽  
Author(s):  
José Antonio García-Mejido ◽  
Zenaida Ramos-Vega ◽  
Alberto Armijo-Sánchez ◽  
Ana Fernández-Palacín ◽  
Rocío García-Jimenez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transperineal Ultrasound ◽  
Middle Compartment

Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?

2012 ◽  
Vol 53 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Bronwyn P. Andrew ◽  
Ka L. Shek ◽  
Varisara Chantarasorn ◽  
Hans P. Dietz
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Levator Hiatus ◽  
Female Pelvic Organ Prolapse

scholarly journals Minimal important difference and patient acceptable symptom state for PFDI-20 and POPDI-6 in POP surgery

2020 ◽  
Author(s):  
Päivi K. Karjalainen ◽  
Nina K. Mattsson ◽  
Jyrki T. Jalkanen ◽  
Kari Nieminen ◽  
Anna-Maija Tolppanen
Keyword(s):  
Pelvic Organ Prolapse ◽  
Roc Curve ◽  
Minimal Important Difference ◽  
Patient Reported Outcome Measures ◽  
Pelvic Organ ◽  
Population Based ◽  
Patient Reported Outcome ◽  
Pop Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State

Abstract Introduction and hypothesis Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as important. The Patient Acceptable Symptom State (PASS) represents the value of score beyond which patients consider themselves well. We aimed to determine the MID and PASS for Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) in pelvic organ prolapse (POP) surgery. Methods We used data from 2704 POP surgeries from a prospective, population-based cohort. MID was determined with three anchor-based and one distribution-based method. PASS was defined using two different methods. Medians of the estimates were identified. Results The MID estimates with (1) mean change, (2) receiver-operating characteristic (ROC) curve, (3) 75th percentile, and (4) distribution-based method varied between 22.9–25.0 (median 24.2) points for PFDI-20 and 9.0–12.5 (median 11.3) for POPDI-6. The PASS cutoffs with (1) 75th percentile and (2) ROC curve method varied between 57.7–62.5 (median 60.0) for PFDI-20 and 16.7–17.7 (median 17.2) for POPDI-6. Conclusion A mean difference of 24 points in the PFDI-20 or 11 points in the POPDI-6 can be used as a clinically relevant difference between groups. Postoperative scores ≤ 60 for PFDI-20 and ≤ 17 for POPDI-6 signify acceptable symptom state.

scholarly journals Transperineal ultrasound to estimate the appropriate ring pessary size for women with pelvic organ prolapse

2021 ◽  
Author(s):  
Claudia Manzini ◽  
Mariëlla I. J. Withagen ◽  
Frieda van den Noort ◽  
Anique T. M. Grob ◽  
Carl H van der Vaart
Keyword(s):  
Pelvic Organ Prolapse ◽  
Operating Characteristic ◽  
Pelvic Organ ◽  
Transperineal Ultrasound ◽  
Small Ring ◽  
Receiver Operating Characteristic Curves ◽  
Ring Pessary ◽  
Hiatal Area ◽  
Significant Difference ◽  
Control Study

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.

scholarly journals The Degree of Cystocele and Rectocele with Hiatal Area Levator Ani

2017 ◽  
pp. 225
Author(s):  
Fernandi Moegni ◽  
Hari Santoso
Keyword(s):  
Pelvic Organ Prolapse ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Stage I ◽  
Stage Iii ◽  
Cut Point ◽  
Hiatal Area ◽  
4D Ultrasound ◽  
Significant Difference ◽  
Sensitivity Specificity

Objective: To investigate the degree of cystocele and rectocele with a maximum of levator hiatal area (AHL) during Valsava. Methods: Secondary data analysis of 90 patients with uterine prolapse January 2012 to November 2013 in the clinic Uroginekologi RSCM, Jakarta. 3D/4D ultrasound measurement and pelvic organ prolapse system Quantification (POP-Q) stage I-IV cystocele and rectocelestage I-IV. All statistical analyses were analyzed using Stata 20 for Windows. Results: Significant difference cystocele stage I-II (n = 25) with stage III-IV (n = 65), the maximum AHL with a difference of 4.33 cm2 (p = 0.040). In rectocele stage I-II (n = 64) and stage III-IV (n = 26) of 3.85 cm2 (p = 0.130). AUC values for stage I-II and III-IV cystocele was 0.607 (IK95% from 0.467 to 0.738), and the ROC for rectocele was 0.603 (IK95% from 0.472 to 0.734). The ROC optimal cut point for cystocele stage I-II with III-IV with the highestsensitivity and specificity is 29 cm2 (0.523 sensitivity, specificity 0.520), the rectocele is 30 cm2 (0.538 sensitivity, specificity 0.584). Conclusion: There is a significant relationship between the degree of cystocele and area of the levator ani muscles when Valsava, but there is no relationship at rectocele. The value of maximum area under the curve (AUC) hiatal area of the levatorani muscle in distinguishing stage I-II and III-IV cystocele are relatively similar to rectocele stage I-II and III-IV. Optimal cut point hiatal area of the levatorani muscle in distinguishing stage I-II and III-IV cystoceleis 29 cm2, while for rectocele is 30 cm2 with sensitivity and specificity values were quite good. Keywords: cystocele, levatorani hiatal area, pelvic organ prolapse, rectocele

scholarly journals Post void residue in women with pelvic organ prolapse: a prospective observational study

2019 ◽  
Vol 8 (4) ◽  
pp. 1520
Author(s):  
Nanthini Saravanan ◽  
Aruna N. Kekre ◽  
Mahasampath Gowri S.
Keyword(s):  
Quality Of Life ◽  
Urinary Tract ◽  
Pelvic Organ Prolapse ◽  
Lower Urinary Tract ◽  
Pelvic Organ ◽  
P Value ◽  
Residual Volume ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.

scholarly journals Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound

2020 ◽  
Author(s):  
Jose Antonio Garcia Mejido ◽  
Zenaida Ramos Vega ◽  
Alberto Armijo ◽  
Ana Fernandez Palacin ◽  
Rocio Garc a Jimenez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transperineal Ultrasound ◽  
Middle Compartment

scholarly journals Identification of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire—IUGA Revised (PISQ-IR) Cutoff Scores for Impaired Sexual Function in Women with Pelvic Floor Disorders

2019 ◽  
Vol 9 (1) ◽  
pp. 13 ◽  
Author(s):  
Magdalena Emilia Grzybowska ◽  
Konrad Futyma ◽  
Dariusz Wydra
Keyword(s):  
Pelvic Organ Prolapse ◽  
Sexual Dysfunction ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Roc Curve ◽  
Pelvic Floor Disorders ◽  
Pelvic Organ ◽  
Summary Score ◽  
Operating Characteristics ◽  
Cutoff Scores

The aim of this cross-sectional study was to determine the cutoff scores for sexual dysfunction in disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire—IUGA Revised (PISQ-IR) for women with pelvic floor disorders (PFD). Medical history and urogynecological data of 521 women with PFD were collected. The subjects provided information about their sexual activity and completed Female Sexual Function Index (FSFI) and PISQ-IR questionnaires. Sexually active (SA) women were further analyzed and categorized using their FSFI scores: <26.55—sexual dysfunction, >26.55—no sexual dysfunction. Receiver operating characteristics (ROC) curve tested how well PISQ-IR allowed to discriminate between patients with and without sexual disorders. Area under curve (AUC) was calculated to measure the PISQ-IR Summary Score efficiency in the prediction. The cutoff values which minimalize (1-specifity) and maximize sensitivity were selected. In the analyzed cohort, 250 (48%) women were SA and a total of 226 SA were recruited for the study: 143 (63.3%) with <26.55 FSFI and 83 (36.7%) with >26.55 FSFI (response rate: 90.4%). Using ROC curve analysis, PISQ-IR Summary Score of 2.68 was determined to be the optimal cutoff for distinguishing between dysfunctional and nondysfunctional women (AUC = 0.85), allowing to diagnose sexual dysfunction in SA women with PFD, with 90% sensitivity and 71% specificity.

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