Advertisement

Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms?

Published:October 02, 2008DOI:https://doi.org/10.1016/j.ajog.2008.07.028

      Objective

      The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms.

      Study Design

      We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom.

      Results

      Of 296 participants, age was 56.3 ± 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55-0.62 for other prolapse and urinary symptoms; and 0.48-0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered.

      Conclusion

      Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bump R.C.
        • Mattiasson A.
        • Bo K.
        • et al.
        The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.
        Am J Obstet Gynecol. 1996; 175: 10-17
        • Swift S.
        • Woodman P.
        • O'Boyle A.
        • et al.
        Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects.
        Am J Obstet Gynecol. 2005; 192: 795-806
        • Bradley C.S.
        • Nygaard I.E.
        Vaginal wall descensus and pelvic floor symptoms in older women.
        Obstet Gynecol. 2005; 106: 759-766
        • Tan J.S.
        • Lukacz E.S.
        • Menefee S.A.
        • Powell C.R.
        • Nager C.W.
        • San Diego Pelvic Floor Consortium
        Predictive value of prolapse symptoms: a large database study.
        Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 203-209
        • Ghetti C.
        • Gregory W.T.
        • Edwards S.R.
        • Otto L.N.
        • Clark A.L.
        Pelvic organ descent and symptoms of pelvic floor disorders.
        Am J Obstet Gynecol. 2005; 193: 53-57
        • Ellerkmann R.M.
        • Cundiff G.W.
        • Melick C.F.
        • Nihira M.A.
        • Leffler K.
        • Bent A.E.
        Correlation of symptoms with location and severity of pelvic organ prolapse.
        Am J Obstet Gynecol. 2001; 185: 1332-1337
        • Handa V.L.
        • Cundiff G.
        • Chang H.H.
        • Helzlsouer K.J.
        Female sexual function and pelvic floor disorders.
        Obstet Gynecol. 2008; 111: 1045-1052
        • Barber M.D.
        • Walters M.D.
        • Bump R.C.
        Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7).
        Am J Obstet Gynecol. 2005; 193: 103-113
        • Ware Jr, J.
        • Kosinski M.
        • Keller S.D.
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Weber A.M.
        • Walters M.D.
        • Ballard L.A.
        • Booher D.L.
        • Piedmonte M.R.
        Posterior vaginal prolapse and bowel function.
        Am J Obstet Gynecol. 1998; 179: 1446-1449
        • Burrows L.J.
        • Meyn L.A.
        • Walters M.D.
        • Weber A.M.
        Pelvic symptoms in women with pelvic organ prolapse.
        Obstet Gynecol. 2004; 104: 982-988
        • Nygaard I.
        • Bradley C.
        • Brandt D.
        • Women's Health Initiative
        Pelvic organ prolapse in older women: prevalence and risk factors.
        Obstet Gynecol. 2004; 104: 489-497