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

Abstract

Measurements of six POP-Q points obtained with traction showed a higher grade of POP than those assessed with Valsalva maneuver. On this basis, surgeons might decide on the extent of surgical procedure after examination under anesthesia; however, preoperative patient counselling would be essential to obtain consent for this approach. The clinical significance of the findings requires further evaluation.

Correlation of preoperative and intraoperative assessment of pelvic organ prolapse by pelvic organ prolapse quantification system

“…Among the three measurements of POP‐Q length, there was a significant change in Gh measurements and no changes in measurements of Tvl and Pb between the two examination methods, which is in agreement with other studies 5 5 …”

“…It has been suggested that the development of POP may be due to the neuromuscular blockade and denervation of pelvic floor muscles. The relaxation of levator ani muscles under anesthesia might contribute to an increased degree of descent measured in the operating theatre 5 …”

“…The findings of our study are in agreement with the observations made in other studies that descent of POP seen during maximal Valsalva in the clinic is not as pronounced as seen in the operating room under traction of the cervix under anesthesia. 4,5 This difference in preoperative and intraoperative POP-Q measurements may be explained partially by different environmental and loading factors to which the supports of pelvic organs are subjected, such as, force applied during traction, leg position, apical support stiffness, inadequate Valsalva, or levator ani muscle paralysis due to anesthesia. 3,5 The amount of displacement of POP seen on maximal Valsalva maneuver can be achieved by a small traction force of 85 g or the weight of a chicken egg (0.8 N).…”

Perioperative changes in superficial pelvic organ prolapse quantification system measurements after prolapse surgery

“…This was a secondary analysis of data from a prospective case series, which was registered with the local audit department (audit registration 1511). The primary analysis compared the assessment of POP using the POP‐Q system with Valsalva maneuver and intraoperative measurements with mechanical traction . No ethics committee approval or informed consent was required for this study, since it represented an audit of our standard practice.…”

“…The primary analysis compared the assessment of POP using the POP-Q system with Valsalva maneuver and intraoperative measurements with mechanical traction. 8 P<0.05 was considered statistically significant. Table 1 shows demographic characteristics of included women and the surgical procedures performed.…”