Pelvic organ prolapse quantification system: to valsalva or not to valsalva while measuring genital hiatus (GH) and perineal body (PB)

Abstract

INTRODUCTIONIt is significant that Pelvic organ prolapse and its associated disorders, although were never life threatening, continued to have a major impact on QOL. Even though there were different systems proposed for its staging, none has proved itself to respond to all the requirements of the medical community, so the vast majority were short lived, failing to become the single most useful system for POP staging. POPQ is currently the most quantitative and site specific system of staging and has received the recognition of TNM system in oncology.1 The original description of POPQ doesn't specify as to whether GH and PB measurements should be done in resting or during straining position. Hence methodology adopted by various practioners vary.2 Visco et al observed significant increase in GH and PB during valsalva, but it's not clear this is a normal phenomenon or an evidence of pelvic floor dysfunction. Reviewing the literature, the major risk factors associated with prolapse are unassisted vaginal delivery and increasing parity.3,4 Decrease in sexual hormones after menopause, straining (constipation, chronic cough, occupational physical stress or obesity) associated with increased intra-abdominal pressure is also shown by various studies to be strong risk factors. 5-15As shown by a study, hiatal ballooning can be predicted by GH and PB measurements, with their sum (GH+PB>7) being a stronger predictor than individual measurements. 16This study aims to support the idea of measuring hiatal diameters while valsalva. It further aims to determine ABSTRACT Background: It is a study to determine whether or not, the widening of GH and PB with valsalva is evidence of pelvic floor dysfunction, and by the logic should the values in POPQ staging, be taken at valsalva or at rest. Methods: Prospective 2 arm cohort study. However, the analysis of various risk factors for prolapse was done in a case control study manner. Results: As compared to women without prolapse, in patients with POP, the dimensions of GH and PB are higher. Also, the increase in their dimensions with valsalva is more in prolapse cases. So valsalving while measurement of GH and PB would give a better idea of pelvic floor dysfunction. Conclusions:The study shows association between the severity of urinary problems and degree of prolapse. Measurements of POPQ when taken during valsalva, tend to give a better picture of levator dysfunction in prolapse patients.