Advertisement

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

Published:August 23, 2010DOI:https://doi.org/10.1016/j.ajog.2010.06.071

      Objective

      This analysis compared 3 continuous variables as summary support loss (SL) scores with pelvic organ prolapse (POP) quantification (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 SL measures. The relative responsiveness was assessed using the standardized response mean of 2-year outcome data from the CARE trial.

      Results

      Each SL 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 POP Distress Inventory (r = 0.17–0.24; P < .01 for each) but not with changes in POP Impact Questionnaire for all measures of SL or POPQ stage.

      Conclusion

      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.

      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

        • Nygaard I.
        • Barber M.D.
        • Burgio K.L.
        • et al.
        Prevalence of symptomatic pelvic floor disorders in US women.
        JAMA. 2008; 300: 1311-1316
        • Wu J.M.
        • Hundley A.F.
        • Fulton R.G.
        • Myers E.R.
        Forecasting the prevalence of pelvic floor disorders in US women: 2010 to 2050.
        Obstet Gynecol. 2009; 114: 1278-1283
        • Bump R.
        • 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
        • Barber M.D.
        • Kuchibhatla M.N.
        • Pieper C.F.
        • Bump R.C.
        Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders.
        Am J Obstet Gynecol. 2001; 185: 1388-1395
        • Brubaker L.
        • Cundiff G.W.
        • Fine P.
        • et al.
        Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence.
        N Engl J Med. 2006; 354: 1557-1566
        • Brubaker L.
        • Nygaard I.
        • Richter H.
        • et al.
        • Pelvic Floor Disorders Network
        Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence: a randomized controlled trial.
        Obstet Gynecol. 2008; 112: 49-55
        • Wei J.
        • Nygaard I.
        • Richter H.
        • et al.
        Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial–design and methods.
        Clin Trials. 2009; 6: 162-171
        • Richter H.E.
        • Burgio K.L.
        • Goode P.S.
        • et al.
        Non-surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress incontinence (ATLAS) trial.
        Clin Trials. 2007; 4: 92-101
        • Weber A.M.
        • Abrams P.
        • Brubaker L.
        • et al.
        The standardization of terminology for researchers in female pelvic floor disorders.
        Int Urogynecol J. 2001; 12: 178-186
        • Brubaker L.
        • Nygaard I.
        • Richter H.E.
        • et al.
        Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence.
        Obstet Gynecol. 2008; 112: 49-55
        • Crosby R.D.
        • Kolotkin R.L.
        • Williams G.R.
        Defining clinically meaningful change in health-related quality of life.
        J Clin Epidemiol. 2003; 56: 395-407
        • Swift S.E.
        • Tate S.B.
        • Nicholas J.
        Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?.
        Am J Obstet Gynecol. 2003; 189: 372-379
        • Bradley C.S.
        • Nygaard I.E.
        Vaginal wall descensus and pelvic floor symptoms in older women.
        Obstet Gynecol. 2005; 106: 759-766
        • 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: 1332-1338
        • 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
        • Barber M.D.
        Symptoms and outcome measures of pelvic organ prolapse.
        Clin Obstet Gynecol. 2005; 48: 648-661
        • de Barros Moreira Lemos N.L.
        • Flores Auge A.P.
        • Lunardelli J.L.
        • et al.
        Optimizing pelvic organ prolapse research.
        Int Urogynecol J. 2007; 18: 609-611