The effect of bladder fullness on evaluation of pelvic organ prolapse.

OBJECTIVE: To investigate the effect of bladder fullness on pelvic organ prolapse (POP) staging via the Pelvic Organ Prolapse Quantification System (POP-Q). METHODS: Sixty women with advanced POP underwent pelvic examination with maximal Valsalva straining via POP-Q with an empty bladder and after transcatheter bladder filling to maximum cystometric capacity, with simultaneous intra-abdominal and intravesical pressure recordings. Main outcome measures included POP-Q values and staging with full versus empty bladder. RESULTS: An empty bladder was associated with a significantly higher POP-Q staging (median, 3 vs 2; P<0.0001); and a lower location of points Ba (4.51 vs 1.37; P<0.0001), Aa (2.58 vs 0.62; P<0.0001), Bp (-0.68 vs -1.10; P=0.01), Ap (0.83 vs -1.27; P=0.002), C (1.57 vs -1.07; P<0.0001), and D (0.14 vs -2.77; P<0.0001) compared with a full bladder. However, genital hiatus, perineal body, and total vaginal length values were not significantly affected by bladder fullness. No differences in intra-abdominal or detrusor pressures were noted between empty and full bladder states. CONCLUSION: POP-Q assessment with a full bladder is associated with underestimation of POP severity. Therefore, bladder emptying should be a standard requirement for POP-Q staging and reporting.