Pelvic Organ Prolapse Stage and the Relationship to Genital Hiatus and Perineal Body Measurements

Dunivan, Gena C.; Lyons, Katherine E.; Jeppson, Peter C.; Ninivaggio, Cara; Komesu, Yuko M.; Alba, Frances; Rogers, Rebecca G.

doi:10.1097/spv.0000000000000323

Cited by 31 publications

(37 citation statements)

References 12 publications

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“…The height of the perineal body in adult nulliparous women, according to the definition of the POP-Q system, ranges between 3.1-4.1 cm. 198,199 We therefore chose to include women with a perineal body height of <2cm in order to maximize the likelihood of the study subjects having anatomic defects of the perineum (34% had a perineal body height <1 cm and 66% less than 2 cm). The lack of nonblinded outcome assessment may have caused measurement bias.…”

Section: Selection Bias and Misclassificationmentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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Section: Selection Bias and Misclassificationmentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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“…Other studies correlating POP-Q PB and POP-Q GH with the presence of prolapse have also shown similarly that increasing stages of prolapse are associated with POP-Q GH, but not with POP-Q PB [16]. POPQ PB + GH have been shown to improve the prediction of levator injuries in women with incontinence and prolapse [17].…”

Section: Discussionmentioning

confidence: 86%

Ultrasound imaging of the perineal body: a useful clinical tool

et al. 2019

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Introduction and hypothesis The perineal body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transperineal ultrasound to measure the perineal body and assess whether there is an association with prolapse. Methods An observational, cross-sectional study was carried out in a tertiary level Urogynaecology department and included prolapse patients and healthy nulliparous volunteers (control group). This was a clinical assessment, including POP-Q and transperineal 2D ultrasound measurement of the perineal body height, length, perimeter, and area. Parametric tests were used, as the data were normally distributed. Results are reported as mean and 95% confidence interval (±95% CI). Results A total of 101 participants were recruited of which 22 were nulliparous healthy volunteers. Mean perineal body measurements in controls were height 22.5 ± 3.3 mm, length 17.4 ± 2.7 mm, perimeter 7.5 ± 0.9 mm, and area 2.8 ± 0.38 cm 2. Perineal body measurements in 79 prolapse patients: height 16.9 ± 1.7 mm, length 16.0 ± 1.4 mm, perimeter 6.5 ± 0.5 mm and area 2.1 ± 0.5 cm 2. A small perineal body was strongly associated with posterior compartment prolapse (paired t test, p < 0.0001) and wider POP-Q GH (paired t test, p = 0.0003). Surprisingly, Pelvic Organ Prolapse Quantification Perineal Body (POP-Q PB) of the two groups was not significantly different. A perineal body mid-sagittal area of less than 2.4 cm 2 has been shown to be associated strongly with posterior compartment prolapse. Conclusions It is possible to measure the perineal body on 2D ultrasound. This technique facilitates the objective diagnosis of perineal deficiency. POP-Q PB does not predict the length or area of the perineal body.

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“…There is no consensus regarding the clinical role of these landmarks in the management of pelvic organ prolapse (POP). PB has poor association with prolapse stage, whereas larger GH seems to be linked with prolapse greater than stage three, possibly due to pelvic muscle injury . A GH of 3.75 cm or more appears to be associated with apical support loss .…”

Section: Introductionmentioning

confidence: 86%

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

Durnea

Basu

Dadhwal

et al. 2019

Intl J Gynecology & Obste

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Objectives To evaluate the values of perineal body (PB) and genital hiatus (GH) before and after posterior repair. We also evaluated the introital surface area (ISA)—a sum of transverse and longitudinal GH measurements. Methods This secondary analysis of a prospective case series included 94 women undergoing posterior vaginal prolapse surgery at a consultant urogynecology clinic between October 3, 2011, and October 2, 2014. Patients were examined in clinic using the pelvic organ prolapse quantification system with Valsalva maneuver, and in theatre pre‐ and postoperatively with traction. Results Immediately postoperatively, a statistically significant change (all P<0.001) was noted for GH (mean difference −0.59 cm), PB (−0.56 cm), and ISA (−0.87 cm) compared with preoperative measurement. This effect was maintained for GH (−0.42 cm) and PB (−0.40 cm) at 2 months’ follow‐up (both P<0.001), and for PB alone (−0.43 cm; P=0.04) at 8 months. ISA had a moderate correlation with GH (r=0.55). Conclusions Posterior repair significantly improved PB length at months 2 and 8, and GH length at month 2. ISA did not correlate with prolapse stage. Changes in GH were not maintained beyond postoperative month 2.

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Pelvic Organ Prolapse Stage and the Relationship to Genital Hiatus and Perineal Body Measurements

Cited by 31 publications

References 12 publications

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Ultrasound imaging of the perineal body: a useful clinical tool

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

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