Does neuromuscular blockade affect the assessment of pelvic organ prolapse?

Brazell, Hema D.; Claydon, C Sage; Li, Janet; Moore, Carol; Dereska, Nina H; Hudson, Suzanne; Swift, Steven

doi:10.1007/s00192-012-1771-6

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…A recent study by Brazell et al examined the role of neuromuscular blockade and descent in the operating room and found that patients that had neuromuscular blockade had a larger difference in point C between the clinic and the operating room (3.4 cm with neuromuscular blockade and an endotracheal tube and 0.5 cm in those with a laryngeal mask airway) [8]. We did not find that use of a neuromuscular blockade agent affected the magnitude of the difference in point C in the office and the OR.…”

Section: Discussionmentioning

confidence: 99%

Apical Descent in the Office and the Operating Room

Crosby

Sharp²,

Gasperut

et al. 2013

Female Pelvic Medicine &Amp; Reconstructive Surgery

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Objectives The support of the uterine cervix assessed in the clinic with Valsalva or cough and operating room (OR) with traction often differs. The objective of this study is to test the null hypothesis that the difference between preoperative and intraoperative values of POP-Q (Pelvic Organ Prolapse Quantification) point C is not related to prolapse size, and to determine if other factors exist that predict this difference. Methods This is a retrospective review of women who had a vaginal hysterectomy in the FPMRS (Female Pelvic Medicine and Reconstructive Surgery) division between 2005 and 2011 and had preoperative and intraoperative POP-Q point C recorded. A difference of 5 cm was established by a panel of urogynecologists as clinically significant. Student t-tests and chi-squared analyses were used and a logistic regression performed. Results There were 206 subjects included. The mean difference in point C between the two clinical settings was 3.5 cm. A difference of ≥5 cm was present in 33%. The mean difference in point C was larger for women with lesser stages of prolapse (stage 1: 5.8 cm, stage 2: 3.0 cm, stage 3/4: 1.4 cm, p<.001). A difference of ≥5 cm in point C was more often present in women with lesser stages of prolapse–70.3% of women with stage 1, 9.3% for stage 2 and 8.5% for stage 3 (p<0.001). Conclusions We reject our null hypothesis. A difference of ≥5 cm between POP-Q point C in the clinic and the operating room occurred more frequently in women with lesser stages of prolapse.

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Section: Discussionmentioning

confidence: 99%

Apical Descent in the Office and the Operating Room

Crosby

Sharp²,

Gasperut

et al. 2013

Female Pelvic Medicine &Amp; Reconstructive Surgery

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“…GH and Pb measured on straining were consistently stronger predictors of prolapse symptoms and objective prolapse (by clinician examination and by ultrasound) than at Gh and Pb measured at rest. Anesthesia/neuromuscular blockade: the effect of neuromuscular blockade on POP staging was examined by one study [ 19 ]. It was found that neuromuscular blockade during anesthesia led to a significant increase in POP-Q measurements, especially in the apical compartment.…”

Section: Resultsmentioning

confidence: 99%

“…Anesthesia/neuromuscular blockade: the effect of neuromuscular blockade on POP staging was examined by one study [ 19 ]. It was found that neuromuscular blockade during anesthesia led to a significant increase in POP-Q measurements, especially in the apical compartment.…”

Section: Resultsmentioning

confidence: 99%

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Barbier,

Carberry,

Karjalainen

et al. 2023

Int Urogynecol J

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Introduction and hypothesis This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. Methods An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. Results The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. Conclusions The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.

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

Doumouchtsis

Gauthaman

Khunda

et al. 2017

Intl J Gynecology & Obste

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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.

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Does neuromuscular blockade affect the assessment of pelvic organ prolapse?

Abstract: Neuromuscular blockade leads to significantly greater increases in POP-Q examination measurements compared with the office measurements, and this increase is most pronounced apically.

Cited by 7 publications

References 6 publications

Apical Descent in the Office and the Operating Room

Apical Descent in the Office and the Operating Room

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

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

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