Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

Abstract

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

“…However, the five-level staging system of the current POP-Q system may be insufficient to describe POP accurately. In our cases, the POP-Q system revealed a posterior compartment prolapse, although it was a relaxation of the vaginal wall, not a rectocele or an enterocele by TLUS [ 3 ]. We also demonstrated a weak correlation between the POP-Q exam findings with the TLUS images for the presence of a rectocele and an enterocele [ 3 ].…”

“…In our cases, the POP-Q system revealed a posterior compartment prolapse, although it was a relaxation of the vaginal wall, not a rectocele or an enterocele by TLUS [ 3 ]. We also demonstrated a weak correlation between the POP-Q exam findings with the TLUS images for the presence of a rectocele and an enterocele [ 3 ]. The diagnosis of an anterior compartment prolapse can be aided with the addition of TLUS to a POP-Q exam.…”

“…However, this method can be subjective, depending on the examiner and the patient’s ability to perform the maximal Valsalva maneuver, and it can be inconvenient and unpleasant for the patient during the pelvic examination. In addition, the presence or absence of a rectocele and an enterocele is not clearly determined by the POP-Q stage [ 3 ]. Rarely, a vaginal mass mimicking prolapse can also be misdiagnosed as POP [ 4 , 5 , 6 ].…”

“…Although posterior vaginal prolapse has been considered a synonym of a rectocele, recent studies have shown that true rectoceles are only observed in 2.38–39% of women [ 3 , 4 , 5 , 6 , 7 ]. However, we cannot distinguish between simple posterior vaginal wall relaxation, a true rectocele, and an enterocele using only the POP-Q examination ( Figure 1 ).…”

Translabial ultrasound evaluation after tension‐free transobturator tape technique: Outcomes based on the tape's position

“…In the past years, many experiences on the application and utility of TL-US in different fields of obstetrics and gynecology were published, such as intrapartum evaluations, quantification of PVR, and grade of uterine descent. [26][27][28][29] Recently, Illiano et al 30 compared with continent women had the sling in a proximal or distal position, which moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (P < 0.0001). 30…”