POPQ system and dynamic MRI in assessment of female genital prolapse

EL-Gharib, Mohamed Nabih; Farahat, Manal A.; Daoud, Mahmoud

doi:10.4236/ojog.2013.32045

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…El-Gharib et al reported that on functional MRI, considering anterior compartment, the best correlation of findings with POP-Q clinical results was obtained using PCL as the main reference line (21). They also found out that dynamic MRI is really helpful in defining nature, degree and quantitative measurements of visceral prolapses, while the solely use of POP-Q may be inadequate (21) (Figures 5 -7).…”

Section: Discussionmentioning

confidence: 99%

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Agreement of Manual Exam (POP-Q) with Pelvic MRI in Assessment of Anterior Pelvic Organ Prolapse

et al. 2016

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Background: Pelvic floor dysfunction (PFD) refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, lower back, coccyx, or hip joints. PFD and pelvic organ prolapse (POP) affect about 50% of women past middle age. Symptoms include pelvic pain, pressure, dyspareunia, incontinence, incomplete emptying, and gross organ protrusion. Nowadays, there are novel diagnostic tools and therapies proposed for pelvic floor weakness and organ prolapse. Pelvic organ prolapse quantification system (POP-Q) examination and complementary magnetic resonance imaging (MRI) are two methods of diagnosis. Objectives: The goal of our study was to assess the agreement between POP-Q examination and MRI in detecting anterior pelvic prolapses. In addition, we evaluated the additive role of MRI adjunct to POP-Q examination in detecting anterior pelvic organ prolapse. Patients and Methods: An experimental study was carried out on 61 patients having clinical manifestations suggesting pelvic floor weakness. The medical history and physical examination were obtained from all patients. POP-Q examination and dynamic MR imaging was performed. POP-Q results were compared with dynamic MRI findings thereafter. Results: Considering pubococcygeal line (PCL) and H line as reference lines, comparison of MRI and POP-Q findings for detecting bladder neck and urethra prolapses revealed a moderate to good agreement (49% -80%) rate between MRI and POP-Q examination. This corresponds to a weak to moderate agreement between these two methods. Conclusion: Agreement of MRI and POP-Q is moderate to good for detecting anterior pelvic organs prolapses. MRI could be regarded as a complementary method to POP-Q examination. A combination diagnostic approach, including MRI and POP-Q, for high stage pelvic prolapse is highly recommended.

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Section: Discussionmentioning

confidence: 99%

“…They also found out that dynamic MRI is really helpful in defining nature, degree and quantitative measurements of visceral prolapses, while the solely use of POP-Q may be inadequate (21) (Figures 5 -7).…”

Section: Discussionmentioning

confidence: 99%

Agreement of Manual Exam (POP-Q) with Pelvic MRI in Assessment of Anterior Pelvic Organ Prolapse

et al. 2016

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“…Meanwhile, The POPQ evaluation did not find the lateral cystocele to be related to the prolapse score. 8 On surgery, a total of 35 cases of Uterine prolapsed were diagnosed either solitary, or in combination with other compartment prolapse. While on clinical examination 28 patients were diagnosed to have uterine prolapsed with sensitivity, specificity, PPV, NPV and diagnostic accuracy of 77.1%, 80%, 96.4%, 33.3% and 77.5% respectively.…”

Section: Discussionmentioning

confidence: 99%

MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique

Dave

Joshi

Goel

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: MRI is the newest technique used to evaluate patients with pelvic floor disorders. It allows relatively non-invasive, dynamic evaluation of all pelvic organs in multiple planes and can directly visualize the muscular and ligamentous pelvic floor support structures. Using MRI to evaluate pelvic floor disorders may be most helpful in patients with multicompartment findings or symptoms, posterior compartment abnormalities, severe prolapse, or recurrent pelvic floor symptoms after prior surgical repair. MRI is often able to reveal more extensive organ prolapse than physical examination alone.Methods: The present study was carried out in the Department of Radiodiagnosis and Obstetrics and Gynecology of Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh from November 2014 to October 2015. A total of 43 patients who had symptoms of pelvic floor dysfunction like uterine prolapse, urinary or rectal dysfunction were evaluated by high resolution USG. Patients with low lying uterus on USG were subjected to MRI. Before MRI, these patients were assessed by a Gynecologist, and a clinical diagnosis in form of the organ/organs prolapsed and the grade of individual prolapse was assigned and tabled in the prefixed format.Results: Prolapse is more common in patients with greater than 50 years age (63% patients). MRI picked up more lesions compared to clinical examination, 90% as compared to 82.5% on clinical examination. MRI has good correlation with surgery in diagnosing prolapse. Concomitant prolapse of the Anterior and Middle compartment is the most common clinical entity diagnosed on 52.5% patients in our set up. MRI has poor sensitivity in identifying posterior compartment prolapse. There is good agreement between the clinical grading and MRI grading (81.8% correlation).Conclusions: T MRI offers a novel approach of simultaneous imaging of all compartments of the female pelvis at a single setting. With lesser intraobserver variation and better visualization of the pelvic anatomy MRI would help in accurate staging and hence better outcomes in patients in terms of symptom relief.

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“…Urethral axis (Ur) > 30° with vertical line resembles positive Q-tip test. A great vertical descent (DZ = 38.79 mm) of the anal orifice is observed in a dynamic MRI in a SUI patient [ 76 ]. The vertical displacement of the anal orifice in the SUI calculation ( Figure 6(b) ) is 40.83 mm.…”

Section: Figurementioning

confidence: 99%

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

Bhattarai

Staat

2018

Computational and Mathematical Methods in Medicine

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After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.

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POPQ system and dynamic MRI in assessment of female genital prolapse

Cited by 3 publications

References 12 publications

Agreement of Manual Exam (POP-Q) with Pelvic MRI in Assessment of Anterior Pelvic Organ Prolapse

Agreement of Manual Exam (POP-Q) with Pelvic MRI in Assessment of Anterior Pelvic Organ Prolapse

MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

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