Characterizing and Reporting Pelvic Floor Defects: the Revised New York Classification System

Abstract

The authors have devised a conceptual model and reporting system for characterizing, grading and staging pelvic floor defects. The system is user friendly and simple to learn and apply. It is based on commonly known anatomic landmarks and can be performed without memorizing or referring to a separate characterization and reporting plan. Completing the accompanying forms is self-explanatory and provides the information needed for proper comprehension and recording of anatomic defects. The model and reporting format have been used at our institutions for 5 years by medical students, residents, fellows and attendings. It has several advantages over the Pelvic Organ Prolapse Quantitation (POPQ) system: (1) it uses known anatomic landmarks rather than alphabetic labels; (2) it grades lateral wall defects which the POPQ system omits; (3) it recognizes and reports isolated defects or tears which present as bulges in the vaginal walls without downward linear descent (prolapse); (4) it uses a one-page reporting form and a one-page checklist and vaginal profile; (5) it can be done easily in both the supine and the standing positions; (6) it requires simple instruments and a disposable measuring tape available in most office settings; (7) it includes urethral hypermobility in its reporting scheme; (8) it includes cervical length, perineal descent and other measurements in its reporting scheme; and (9) it is similar enough to the POPQ system that easy conversion to, and integration with, the POPQ reporting form and vaginal profile is possible. Prospective trials testing the validity of this system and comparing it with the POPQ system for validity, reliability, reproducibility, test-retest analysis, and interobserver and intraobserver variance are warranted.

POP-Q Point C May Not Be Equal to Point D After Hysterectomy

“…The standardization of terminology for female pelvic organ prolapse (POPQ system) has allowed evaluation of uterovaginal prolapse by a standard system relative to clearly defined points [6]. However, it does not identify the specific defects in the lateral vaginal walls and nor does it determine parameters for successful repair [9,10]. An ICS and AUGS survey showed that the acceptance rate for POPQ was low with 40 % of practitioners routinely using the system and 33.5% of the members never using it [11].…”

Pessary use in advanced pelvic organ prolapse

“…All patients had a focused urogynecologic history, a pelvic defect evaluation using the Revised New York Classification System [9], pelvic defect staging using the International Continence Society criteria [10], Q-tip [11], and catheterized post-void residual determinations, urinalysis with culture, and multichannel urodynamic testing and/or office cystoscopy, as indicated. Additionally, filling provocative cystometry, and urethral pressure profilometry with the prolapse extended and reduced were also obtained.…”

Pessary reduction and postoperative cure of retention in women with anterior vaginal wall prolapse

“…The inclusion criteria for this study were symptomatic anterior vaginal wall prolapse with preoperative presence of urinary retention [5] defined as PVR ‡100 cc, the absence of any neurological disorders and ability to use and retain a pessary without difficulty. All patients underwent a detailed urogynecologic history and physical examination including urethral axis determination by cotton swab (Q tip), site-specific prolapse grading by the International Continence Society (POPQ) [6] and New York Classification (NYC) [7] Systems, spontaneous uroflowmetry, PVR urine determination, urine analysis and urine culture. All studied patients with elevated PVR ( ‡100 ml) had repeated PVR determinations and confirmation of abnormally elevated residual volume at each voiding trial along with complex uroflowmetry.…”

“…At the time of surgery a suprapubic catheter was placed in all patients and was discontinued when voiding resumed spontaneously and the PVR was <100 cc. At 3 months following surgery, all patients underwent a detailed sitespecific evaluation in the supine position during maximal Valsalva and empty bladder using the site-specific prolapse grading proposed by the International Continence Society (POPQ) [6] and New York Classification (NYC) [7] Systems, along with Q-tip testing, uroflowmetry and PVR measurement. Cure of urinary retention was defined as a PVR <100 cc at 3 months postoperatively.…”