The retroverted uterus: ignored to date but core to prolapse

Abstract

The retroverted uterus has been largely ignored in urogynaecological research to date. The prevalence of the retroverted uterus is 79% more common in the urogynaecological patient population (34%) than in the general gynaecological population (19%). Its diagnosis requires the use of (a) transvaginal ultrasound with (b) an empty bladder. Recent data demonstrate that the prevalence of grade 2-4 uterine prolapse for a retroverted uterus is 4.5 times that for an anteverted uterus. Alternatively, 69% grade 2-4 uterine prolapse involves the retroverted uterus. The retroverted uterus, when diagnosed by transvaginal ultrasound (bladder empty), is far more common in urogynecology patients due to their higher incidence of prolapse.

A standardised ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients

“…1 There has been no standardisation to date of the technique for its ultrasonic diagnosis. There have been no systematic studies published and thus no accurate data on the prevalence of the retroverted uterus in general gynaecology patients.…”

The empty bladder

“…The empty bladder has been shown to be a pre-condition for the accurate diagnosis of uterine version [18,19]. The retroverted uterus has been shown to be of increasing relevance to an understanding of prolapse [20].…”

Urinary retention secondary to a uterine leiomyoma: is it nonpregnant incarceration of a retroverted uterus?

“…As suggested by the authors, symptoms of voiding difficulty can have a cyclical exacerbation [2]. I believe this is more the case in women with a retroverted uterus.…”

“…This would make all the above scenarios readily explicable. With retroversion, the uterine cervix is already generally anteriorized [2]. As the uterine fundus is progressively enlarged by the fibroid, especially a posterior fibroid (present in both cases), the increased volume (and weight) would tend to further displace it posteriorly.…”

“…This correspondent's recent review on the retroverted uterus [2] cited one [4] of 12 such papers he found in the literature on the obstetric scenario. While the pelvic MRI photo gives an excellent illustration for this case report, it is relevant to highlight to readers, as the authors do generically in the last paragraph, the importance of transvaginal ultrasound (with the bladder empty-perhaps here requiring catheterization) in diagnosing uterine version [2,5] in such circumstances.…”