Quantification of vaginal support: are continuous summary scores better than POPQ stage?

Abstract

Objectives-This analysis compared 3 continuous variables as summary support loss scores with POPQ ordinal stages.Study Design-We used pooled baseline data from 1141 subjects in 3 randomized trials (CARE, n=322; OPUS, n = 380; ATLAS, n =439) to test 3 support loss measures. The relative responsiveness was assessed using the standardized response mean of 2-year outcome data from the CARE trial.Results-Each support loss measure was strongly correlated with POPQ ordinal staging; the single most distal POPQ point had the strongest correlation. Improvements in anatomic support were weakly correlated with improvements in POPDI (r = .17-.24, p <.01 for each) but not with changes in POPIQ for all measures of support loss or POPQ stage.Conclusions-While continuous, single number summary measures compared favorably to ordinal POPQ staging system, the single most distal POPQ point may be preferable to POPQ ordinal stages to summarize or compare group data.

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

“…It is also appreciated that the present clinical methods do not sufficiently predict the outcome of specific operative approaches [25,26] particularly where there is no consensus regarding what represents a surgical success. Future prospective work will be required to define whether symptoms relate more readily to the measurable ordinal POP-Q values rather than to a particular POP stage with the most distal point more closely reflecting an anatomical (as opposed to a stage) correction [27].…”

Symptom and Anatomical Phenotypes Provide Insights Into Interactions of Prolapse Symptoms and Anatomy

“…Similarly, we defined 128 theoretical symptom phenotypes (SxPhen) combining symptoms from condition-specific questionnaires; the Pelvic Floor Disorders Inventory (PFDI-20) and for sexual function, the Short Form of the Personal Experience Questionnaire (SPEQ) 8,9 . We defined a positive symptom as bother of “moderately” and “quite a bit.” Previous work demonstrated that the PFDI-20 domain scores correlate poorly with symptom improvements 4 . Recognizing that worsening prolapse could increase the severity of some domain symptoms while decreasing others, we avoided domains, and organized symptoms into symptom composites, including protrusion (PRO: PFDI-Q2,3), stress urinary incontinence (SUI: PFDI-Q17,18), obstructed voiding (OV: PFDI-Q5,6,19), fecal incontinence (FI: PFDI-Q9,10), obstructed defecation (OD: PFDI-Q4,8), and rectal prolapse (RP: PFDI-Q14).…”

“…Previous work to quantify POP by using a single continuous variable were also unsuccessful in correlating anatomy to symptom improvements based on questionnaire scores. 4 Our hypothesis is that within the population of women with POP, there are different phenotypes that can be described anatomically using the Pelvic Organ Prolapse Quantification (POP-Q) measurements, and these phenotypes will correlate better with specific symptom complexes. The objective of this study was to develop a more nuanced understanding of anatomical defects of POP and associated symptoms through constructing theoretical symptom and anatomic phenotypes and investigating their prevalence and associations in a cohort of women with pelvic floor disorders.…”

“…The weak correlations may reflect overly simplistic representations of anatomic variation limited to the vaginal apex, anterior and posterior vaginal walls. Previous work to quantify POP by using a single continuous variable were also unsuccessful in correlating anatomy to symptom improvements based on questionnaire scores 4 …”

Measuring outcomes in urogynecological surgery: “perspective is everything”

“…Similar to POPQ stage, improvements in anatomic support only weakly correlated with prolapse symptoms and had no correlation with the impact of prolapse on quality of life. [26]…”