Predictive value of prolapse symptoms: a large database study

Abstract

We sought to describe the relationship between patient symptoms and pelvic organ prolapse (POP) and report the sensitivity, specificity, and positive and negative predictive value of these POP symptoms. Two urologists and four urogynecologists developed a standardized pelvic floor questionnaire based on face validation for use at three female pelvic floor disorder clinics. Specific questions related to prolapse included questions on urinary splinting, digital assistance for defecation, and a bulge per vagina. Prolapse was assessed with the standardized Pelvic Organ Prolapse Quantitative (POP-Q) terminology. The analysis included 1912 women. Urinary splinting was uncommon (< 10%) when Ba < 0, but ranged between 23 and 36% for stage III and IV Ba prolapse. Digital assistance was equally common in stage II Bp prolapse (21-38%) and stage III-IV Bp prolapse (26-29%). Only 6-11% of women with stage 0 or I POP reported symptoms of bulge, but with stage II it increased to 77%. Urinary splinting is 97% specific for anterior prolapse. The report of a bulge has an 81% positive predictive value and a 76% negative predictive value. Very few patients without anterior prolapse will report urinary splinting. Digital assistance for fecal evacuation is no more common with massive posterior prolapse than with moderate posterior prolapse. Patient report of a bulge is a valuable screening tool for POP and should prompt a careful exam.

Long-term follow-up after vaginal sacrospinous fixation: patient satisfaction, anatomical results and quality of life

“…The explanation probably is that the displacement of the vaginal axis changes the dynamic architecture of the pelvic floor We recognize that every definition of recurrence has its limitations. On one hand, patients in general are not bothered by protrusion of the vaginal wall or vaginal apex inside the vagina-i.e., to the level of the hymenal ring [12]. On the other hand, even with the use of the POP-Q classification, the extent of an anatomical recurrence often is variable and not fully reproducible in the same patient at different times.…”

Perbandingan Kerapatan Kolagen Ligamentum Sakrouterina pada Pasien dengan dan tanpa Prolaps Uteri

“…Karakteristik paritas pada kedua kelompok secara statistik bermakna (p<0,05), yaitu ditemukan bahwa semakin tinggi paritas (paritas >5) maka risiko prolaps uteri sebesar 10 kali bila dibanding dengan paritas 3. Hal ini sesuai dengan penelitian Tan dkk., 7 Weber dan Waltres, 8 dan Hendrix dkk. 9 yang menyatakan bahwa cedera saat melahirkan terutama bila wanita tersebut mempunyai banyak anak atau mempunyai riwayat melahirkan bayi besar (lebih dari 9 pon).…”

“…9 yang menyatakan bahwa cedera saat melahirkan terutama bila wanita tersebut mempunyai banyak anak atau mempunyai riwayat melahirkan bayi besar (lebih dari 9 pon). Dikatakan pula oleh Tan dkk., 7 Weber dan Waltres, 8 dan Hendrix dkk.…”

If you could see what we see, would it bother you?

“…Pelvic organ prolapse and surgical success after reconstructive surgery have evolved from a physician centered to a patient centered diagnosis based on clinical data from welldesigned epidemiologic studies [1][2][3][4]. Two of the more commonly used classification systems;…”

“…Nonetheless, vaginal symptoms including the feeling of a vaginal bulge are the most reliable symptom of pelvic organ prolapse when the leading edge descends to or beyond the hymen [9]. Health outcomes researchers in female pelvic medicine and reconstructive surgery have redefined pelvic organ prolapse using this symptomatic threshold [1][2][3] rather than the previously established anatomic one. This new symptomatic threshold was used to retrospectively reclassify previously published surgical outcomes following vaginal reconstructive surgery Kassis 5 resulting in an unprecedented improvement in success rates from 30-46% to 88% for the surgical team [10].…”