scholarly journals A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 98
Author(s):  
Gina Nam ◽  
Jae-Yen Song ◽  
Sa-Ra Lee
Keyword(s):  
Pelvic Organ Prolapse ◽  
Valsalva Maneuver ◽  
Pelvic Organ ◽  
Angle Measurement ◽  
Symphysis Pubis ◽  
Clinical Staging ◽  
Translabial Ultrasound ◽  
Inferior Margin ◽  
The Difference ◽  
Spearman’S Correlation

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

scholarly journals Rectal–vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheng Tan ◽  
Man Tan ◽  
Jing Geng ◽  
Jun Tang ◽  
Xin Yang
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pressure Gradient ◽  
Obstructed Defecation ◽  
Elevated Pressure ◽  
Pelvic Organ ◽  
Lower Grade ◽  
Translabial Ultrasound ◽  
Rectal Ampulla ◽  
The Relationship ◽  
Posterior Vaginal Prolapse

Abstract Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O, p < 0.001). Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.

scholarly journals Does Dominant Prolapse in Other Compartments Affect the Assessment of Bladder Prolapse on Translabial Ultrasound?

2021 ◽  
Author(s):  
Manli Wu ◽  
Xudong Wang ◽  
Zhijuan Zheng ◽  
Junyan Cao ◽  
Jing Xu ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Chinese Women ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Lower Urinary Tract Dysfunction ◽  
Translabial Ultrasound ◽  
Anterior Compartment ◽  
Stage 1 ◽  
The Impact ◽  
Bladder Prolapse

Objective: To explore the impact of dominant prolapse in other compartments in assessing bladder prolapse, and to establish cutoffs for staging bladder prolapse among Chinese women using translabial ultrasound. Design: Prospective multicentre observational study. Setting: Tertiary referral urogynaecology unit. Population: A total of 741 women with symptoms of lower urinary tract dysfunction and/or pelvic floor dysfunction were included. Methods: Women underwent interview, pelvic organ prolapse quantification (POP-Q) examinations and 4D translabial ultrasounds. Main outcome measures: The ROC statistic was used to assess accuracy and define the optimal cutoffs. Results: The mean patient age was 42.7 years (range, 18-82). There were 456 women without dominant prolapse in the apical/posterior compartments and 285 women with dominant prolapse in the apical/posterior compartments. Among patients without and with dominant prolapse, similar cutoffs (-10.9 mm vs. -9.1 mm) were determined for predicting POP-Q stage ≥ 2 in the anterior compartment, with AUCs of 0.87 and 0.79, respectively. In contrast, significantly different cutoffs (-5.7 mm vs. +3.5 mm) were determined for predicting POP-Q stage ≥ 1 among patients with and without dominant prolapse, with AUCs of 0.85 and 0.77, respectively. Conclusion: Dominant prolapse in the apical/posterior compartments affected the accuracy and cutoffs of translabial ultrasound for staging bladder prolapse. Thus, competition of various organs in women with multi-compartment prolapse should be considered as a potential complicating factor in assessing pelvic organ prolapse. Funding: The study is supported by grants from the National Natural Science Foundation of China (No. 91859115). Key words: Bladder prolapse; translabial ultrasound.

scholarly journals Comparison between the Valsalva maneuver and intraoperative traction measurements in pelvic organ prolapse assessment

2017 ◽  
Vol 139 (3) ◽  
pp. 358-362 ◽  
Author(s):  
Stergios K. Doumouchtsis ◽  
Nivedita Gauthaman ◽  
Azar Khunda ◽  
Maya Basu ◽  
Kiran Dadhwal ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Valsalva Maneuver ◽  
Pelvic Organ

scholarly journals Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

2021 ◽  
Author(s):  
Georgios Poutakidis ◽  
Anna Marsk ◽  
Daniel Altman ◽  
Christian Falconer ◽  
Edward Morcos
Keyword(s):  
Pelvic Organ Prolapse ◽  
Clinical Outcomes ◽  
Pelvic Organ ◽  
Horizontal Line ◽  
Midsagittal Plane ◽  
Inferior Margin ◽  
Bladder Emptying ◽  
Ultrasound Evaluation ◽  
Patient Reported ◽  
Mesh Length

Abstract Introduction and hypothesis Vaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes. Methods Seventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C ≥ stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain. Results Original mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 ± 5.2 to 29.2 ± 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r − 0.254 and − 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r − 0.245). Conclusions Five years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.

scholarly journals Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

2021 ◽  
Vol 10 (18) ◽  
pp. 4267
Author(s):  
Gina Nam ◽  
Sa-Ra Lee ◽  
Sung-Hoon Kim ◽  
Hee-Dong Chae
Keyword(s):  
Pelvic Organ Prolapse ◽  
Predictive Value ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Translabial Ultrasound ◽  
Posterior Compartment ◽  
P Values ◽  
Anterior Compartment ◽  
Aging Society ◽  
Apical Compartment

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.

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