Cut-offs for defining uterine prolapse using transperineal ultrasound in Chinese women: prospective multicenter study

International Urogynecological Consultation Chapter 2.2: Imaging in the Diagnosis of Pelvic Organ Prolapse

INTRODUCTION AND HYPOTHESIS

This section of Chapter 2.2 of the International Urogynecology Consultation on Pelvic Organ Prolapse (POP), reviews the literature on the role of imaging in the diagnosis of POP.

METHODS

An international group of nine urogynecologists and one university-based medical librarian adhered to the framework of the scoping review. The group performed a search of the literature using pre-specified search terms in Scopus, OVID Medline, and PubMed. Publications were eliminated if not relevant to the diagnostic value of POP imaging. The remaining articles were evaluated for quality using the Joanna Briggs Institute Checklist for Diagnostic Test Accuracy Studies. The resulting list of articles was used to perform a comprehensive narrative review of the diagnostic value of imaging modalities for the diagnosis of POP.

RESULTS

The original search yielded 3,289 references, 135 of which were used by the writing group.

CONCLUSIONS

Most imaging studies utilized in the diagnoses of POP lacked standardization in the definition of POP. Most imaging studies lack standardization in the protocols used to diagnose POP within each imaging technique. Ultrasound- and MRI-related studies are most represented in the literature, compared with fewer CT- and X-ray-/fluoroscopy-related studies. Therefore, radiographic imaging is of limited value in the diagnosis of POP.

Ultrasound assessment of bladder descent and its correlation with prolapse severity in Chinese women: a prospective multicenter study

INTRODUCTION AND HYPOTHESIS

Translabial ultrasound is currently regarded as one of the most promising modalities in the evaluation of female pelvic organ prolapse. However, abnormal bladder descent on pelvic floor ultrasound has not been established among Chinese women. This study aimed to establish optimal cutoffs for defining bladder prolapse among Chinese women using translabial ultrasound.

METHODS

In this prospective multicenter study, 674 women with symptoms of lower urinary tract dysfunction and/or pelvic floor dysfunction were finally included and underwent interview, Pelvic Organ Prolapse Quantification (POP-Q) examinations and 4D translabial ultrasound. The receiver-operating characteristic (ROC) statistic was used to assess accuracy and define the optimal cutoffs.

RESULTS

The mean patient age was 42.6 (range, 19-82) years. Multivariable analysis showed that both POP-Q assessment and translabial ultrasound findings for anterior compartment were significantly associated with prolapse symptoms. The ROC statistics suggested an optimal cutoff value of 10 mm below the symphysis pubis of bladder position on Valsalva for predicting prolapse symptoms, with an area under the curve (AUC) of 0.73. Compared to translabial ultrasound, POP-Q stage showed similar accuracy for predicting prolapse symptoms (AUC: 0.74; P = 0.79), with an optimal cutoff of POP-Q stage ≥ 2.

CONCLUSIONS

This study proposed that the descent of the bladder to ≥ 10 mm below the symphysis pubis on Valsalva should be proposed as an optimal cutoff value for defining abnormal bladder prolapse on translabial ultrasound among the Chinese population. These cutoff values are nearly identical to those previously established in mainly Caucasian women.