Clinical assessment of pelvic organ prolapse by consecutive cough maneuver.

INTRODUCTION AND HYPOTHESIS: Staging of pelvic organ prolapse (POP) is important in clinical practice and research. Pelvic organ descent on Valsalva can be confounded by levator co-activation, which may be avoided by assessment on coughing. We evaluated the performance of a three consecutive coughs maneuver in the assessment of POP compared with standardised 6-second Valsalva. METHODS: This was a retrospective observational study carried out in women attending a tertiary urogynaecological service in 2017-2019. Patients underwent a standardised interview and clinical examination. Clinical assessment was performed twice, with both 6-s Valsalva and three consecutive coughs performed in random order. Main outcomes were Ba, C and Bp as defined by Pelvic Organ Prolapse-Quantification (POP-Q). Association between coordinates and prolapse symptoms was investigated with receiver-operating characteristic (ROC) statistics. RESULTS: Datasets of 855 women were analysed. POP symptoms were reported by 447 patients (52%) with a mean bother of 6.1 (SD 3.0). On clinical assessment, relevant prolapse was found in 716 (84%) patients on Valsalva and in 730 (85%) on coughing (p=0.109). Clinically relevant prolapse in the apical compartment was more likely to be detected on Valsalva (p<0.0001). Mean POP-Q measurements were not significantly different between maneuvers, except for Ba (p=0.004). ROC curve analysis yielded an area under the curve of 0.74 (95% CI, 0.70-0.77) for maximum POP-Q stage on Valsalva and 0.72 (95% CI, 0.69-0.75) after three consecutive coughs, with a similar performance of both maneuvers in predicting prolapse symptoms (p=0.95). CONCLUSIONS: Clinical assessment of POP by consecutive coughing seems complementary to standardised Valsalva, especially if Valsalva performance is poor.

Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification.

BACKGROUND: Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. METHODS: A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. RESULTS: Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. CONCLUSION: POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.

Study of the Relationship Between Pelvic Organ Prolapse Quantification (POP-Q) Staging and Decubitus Ulcer in Pelvic Organ Prolapse.

Introduction The protrusion of pelvic organs and their associated vaginal segments into or through the vagina is called pelvic organ prolapse (POP). One of the worrisome complications of POP is decubitus ulcer.It is a feature of old, long-standing prolapse. The standardized pelvic organ prolapse quantification (POP-Q) system of classification was proposed by the International Incontinence Society (ICS) for staging pelvic organ prolapse in 1996. This system is a clear and reproducible quantification method and has more inter-observer and intra-observer reliability. This study was designed to determine the relationship of the POP-Q stage with the presence and size of decubitus ulcer. Methods A total of 92 cases with pelvic organ prolapse were included in the study. We examined our patients by the POP-Q method and measured the dimension of the decubitus ulcer if present. Results Out of the 92 patients included in the study, 32 cases had a decubitus ulcer. As the POP-Q stage increased, the number of patients with a decubitus ulcer also increased. We also observed that larger dimension (>6 cm2) decubitus ulcers are present in stage 3 and stage 4 POP. A statistically significant correlation was observed between the POP-Q stage and the size of the decubitus ulcer, rs=0.607, p<0.001. Conclusion A decubitus ulcer becomes more common as the POP-Q stage increases. The size of the ulcer also increases with the advancing stage of POP-Q.