If you could see what we see, would it bother you?

Abstract

Objective: The purpose of our study is to determine if the anatomic threshold for pelvic organ prolapse diagnosis and surgical success remains valid when the patient sees what we see on exam.Methods: 200 participants were assigned, by computer generated block randomization, to see one of 4 videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip.They were asked: "In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area". Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. Results:The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early Stage 2 prolapse (1 cm above the hymen), with 67% answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early Stage 2 prolapse (1 cm above the hymen), with 52% describing that outcome as "not at all" or "somewhat" successful. Conclusion:Early Stage 2 pelvic organ prolapse (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcomewhen they see what we see on examination.

The effect of the first vaginal birth on pelvic floor anatomy and dysfunction

“…For POP evaluation, we chose the more strict criteria because we lacked the subjectively reported outcome [13, 26]. Chances for POP(II+) increased by 8% for each additional year of age.…”

Increasing Anteroposterior Genital Hiatus Widening Does Not Limit Apical Descent for Prolapse Staging During Valsalva's Maneuver: Effect on Symptom Severity and Surgical Decision Making

“…This might inadvertently alter management decisions by health care providers for women with pelvic organ prolapse. For example, patients with a leading edge of 0 may be "inoperable 21 ", while a leading edge of +1 to +2 may receive a uterosacral ligament suspension, and a leading edge ≥ +3 may receive obliterative or mesh augmented apical suspension because preoperative prolapse stage is a predictor of symptomatic recurrence [22][23][24] .…”