Comparative study to evaluate the intersystem association and reliability between standard pelvic organ prolapse quantification system and simplified pelvic organ prolapse scoring system

The Digital Rectal Examination: Appropriate Techniques for the Evaluation of Constipation and Fecal Incontinence

Disorders of defecation, including constipation and fecal incontinence, are very common. The digital rectal examination (DRE) is a key component in the early evaluation of patients with these complaints. Confident performance of a DRE requires dedicated training for the clinician and hands-on experience with the technique. DRE can yield a diagnostic accuracy comparable to specialized physiologic tests, including anorectal manometry. This review will describe in detail the steps required to perform a thorough DRE evaluation, as well as the proper interpretation of observations. Thereafter, the current evidence-based findings supporting the value of DRE in defecatory disorders will be summarized.

Comparison of Pelvic Organ Prolapse Quantification and Simplified Pelvic Organ Prolapse Quantification Systems in Clinical Staging of Iranian Women with Pelvic Organ Prolapse

Background

Pelvic organ prolapse is a common pelvic disorder among women. A standard staging system is needed to carefully evaluate the extent and severity of the disease, and initiate appropriate treatment. The aim of this study was to compare the two methods of standard and simplified pelvic organ prolapse quantification systems in clinical staging of Iranian women with pelvic organ prolapse.

Methods

This observational cross-sectional study was conducted on all women with complaints of seeing or feeling a vaginal lump or bulge and/or a dragging sensation who were presented to a pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran, Iran, from October 2018 to June 2019. All patients were evaluated in terms of pelvic organ prolapse severity and staging using both instruments. Also, length of time needed to complete the questionnaires were calculated. After data collection, the results of pelvic organ prolapse staging and degree of agreement between two examiners were evaluated.

Results

A total of 120 women with mean age of 50.92±13.12 years were evaluated. It was shown that there is an almost perfect agreement (kappa coefficient > 0.8) between standard and simplified pelvic organ prolapse quantification systems in all the 3 compartments. Also, there was almost a twofold increase in the time needed to perform standard pelvic organ prolapse quantification (4.16±1.01 minutes) compared to performing simplified pelvic organ prolapse quantification (2.12±1.14 minutes) (p=0.03).

Conclusion

According to the results of this study, there is a substantial and almost perfect agreement between standard and simplified pelvic organ prolapse quantification systems in clinical staging of Iranian women with pelvic organ prolapse. It seems that using simplified pelvic organ prolapse quantification system is more applicable in clinical practice for staging of pelvic organ prolapse, with high reliability coefficient.

Study of the Relationship Between Pelvic Organ Prolapse Quantification (POP-Q) Staging and Decubitus Ulcer in Pelvic Organ Prolapse

Introduction

The protrusion of pelvic organs and their associated vaginal segments into or through the vagina is called pelvic organ prolapse (POP). One of the worrisome complications of POP is decubitus ulcer.It is a feature of old, long-standing prolapse. The standardized pelvic organ prolapse quantification (POP-Q) system of classification was proposed by the International Incontinence Society (ICS) for staging pelvic organ prolapse in 1996. This system is a clear and reproducible quantification method and has more inter-observer and intra-observer reliability. This study was designed to determine the relationship of the POP-Q stage with the presence and size of decubitus ulcer.

Methods

A total of 92 cases with pelvic organ prolapse were included in the study. We examined our patients by the POP-Q method and measured the dimension of the decubitus ulcer if present.

Results

Out of the 92 patients included in the study, 32 cases had a decubitus ulcer. As the POP-Q stage increased, the number of patients with a decubitus ulcer also increased. We also observed that larger dimension (>6 cm²) decubitus ulcers are present in stage 3 and stage 4 POP. A statistically significant correlation was observed between the POP-Q stage and the size of the decubitus ulcer, r_s=0.607, p<0.001.

Conclusion

A decubitus ulcer becomes more common as the POP-Q stage increases. The size of the ulcer also increases with the advancing stage of POP-Q.

Relationship of Decubitus Ulcer on Cervix in Pelvic Organ Prolapse with POP-Q Staging

Aim

Utero vaginal prolapse is a very common complaint of patients in the OPD. It's an entity that existed since a very long time and hence many classifications were proposed; however, only one system was found to be a validated system for determining the degree of prolapse-POP-Q system.

Objective

To determine the relationship of decubitus ulcer with POP-Q staging.

Materials and Methods

A prospective study of 100 patients with complaints of prolapse (something coming out of vagina) was considered. The patients were staged in accordance with POP-Q system. The number of patients with decubitus ulcer were noted. The area of each decubitus ulcer was also noted, by measuring the radius. Statistical tests were applied to find out if the relationship of the presence of and the area of decubitus ulcer with stage of prolapse was significant.

Results

It was found that as the stage of prolapse increased, the number of patients with decubitus ulcer also increased. Also, as the Point C measurement increased, the area (small/medium/large size) of the decubitus ulcer also increased.

Conclusion

There is a definite correlation between the presence of decubitus ulcer along with its area and the POP-Q component. The study also indicated that POP-Q staging is the only method of classification available that allows accurate and standardized measurements, foregoing pitfalls of all previous classifications.

[Laparoscopic sacrocolpopexy for exteriorized pelvic organ prolapse: Mid-term functional results]

OBJECTIVES

To assess feasibility and postoperative outcomes associated with laparoscopic sacrocolpopexy in patients presenting with exteriorized pelvic organ prolapse (stage>3).

METHODS

Prospective study involving patients undergoing laparoscopic sacrocolpopexy for advanced stage pelvic organ prolapse. Symptoms and quality of life were evaluated at baseline and at 1, 4 and 18 months after surgery using validated questionnaires (PFDI-20 and PFIQ-7).

RESULTS

Sixty-three patients were included between September 2012 and January 2014. Sub-total hysterectomy and sub-urethral sling were performed at the time of surgery in 36% and 34% of patients, respectively. We observed 1 per-operative complication (bladder wound). De novo stress urinary incontinence and de novo dyspareunia persisting at 18 months occurred in 10% and 3% of cases, respectively. Recurrence rate was 1.6% at 18 months. The follow-up also revealed a significant and prolonged improvement in PFDI-20 and PFIQ-7 scores: from 98.8 at baseline to 33.9 at 18 months (P<0.01) and from 89.6 to 26.5 (P<0.001), respectively.

CONCLUSION

Laparoscopic sacrocolpopexy seems feasible and safe in patients suffering from exteriorized pelvic organ prolapse, leading to high anatomic success rate. It is also associated with a prolonged improvement in quality of life and a positive impact on symptoms related to prolapse.