Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

Robotic sacrocolpopexy

Pelvic organ prolapse (POP) is a common cause of gynecological disease in elderly women. The prevalence of POP has increased with an aging society. Abdominal sacrocolpopexy (ASC) is safer and more effective than the vaginal approach in patients with apical compartment POP because it has a higher anatomical cure rate, a lower recurrence rate, less dyspareunia, and improved sexual function. Laparoscopic sacrocolpopexy (LSC) has replaced ASC. Robotic sacrocolpopexy (RSC) also helps overcome the challenges of LSC by facilitating deep pelvic dissection and multiple intracorporeal suturing. The RSC is technically easy to apply, has a steep learning curve, and offers many advantages over the LSC. However, insufficient data led us to conclude that the LSC is superior overall, especially in terms of costeffectiveness. The present review provides insights into different aspects of RSC, highlighting the most common benefits and concerns of this procedure. We searched for eligible articles discussing this issue from January 2019 to March 2022 to reveal the outcomes of RSC.

Prevalence of Pelvic Floor Disorders in Parous Women from the Tibet Autonomous Region: A Cross-Sectional Study

Purpose

Pelvic floor disorder (PFD) seriously affects the everyday life of women. This cross-sectional study aimed to evaluate the prevalence and risk factors for postpartum PFD in women living in the Tibet Autonomous Region (TAR).

Methods

Parous women who attended the outpatient gynaecology clinic at our hospital between June 2022 and August 2022 were screened in this study. The demographic and clinical data of these women were collected. Their pelvic floor functions were evaluated via a pelvic organ prolapse (POP) quantification examination, the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) and the Overactive Bladder Symptom Score (OABSS).

Results

A total of 201 women were included in this study, of whom 81.09% (163/201) were Tibetan. Twenty-seven women (13.43%) were diagnosed with POP stage ≥2 and 27 women (13.43%) with an OABSS score ≥3. The median PFDI-20 total score was 4.17 (range 0-43.75). Han women (n = 38) in the TAR had much lower PFDI-20 total scores, compared with Tibetan women (n = 163) (p < 0.05). The results of the multiple linear regression models showed that the PFDI-20 scores obtained from women living in the TAR were closely related to parity, history of heavy weight lifting, age, history of instrumental deliveries, ethnicity and number of caesarean sections.

Conclusion

Pelvic floor disorder is common among parous women living in the TAR. Ethnicity, parity, history of heavy weight lifting, age, history of instrumental deliveries and number of caesarean sections are the factors closely related to the PFDI-20 scores.

Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification

BACKGROUND

Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points.

METHODS

A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements.

RESULTS

Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse.

CONCLUSION

POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.

Translabial ultrasound for pelvic organ prolapse

Pelvic organ prolapse (POP) is a significant public health concern in women and a common cause of gynecological surgery in elderly women. The prevalence of POP has increased with an increase in the aging population. POP is usually diagnosed based on pelvic examination. However, an imaging study may be necessary for more accurate diagnosis. Translabial ultrasound (TLUS) was used to assess diverse types of POP, particularly posterior-compartment POP. It is beneficial to distinguish between true and false rectocele, and detect the rectocele as clinically apparent. TLUS can also establish whether the underlying cause is a problem of the rectovaginal septum, perineal hypermobility, or isolated enterocele. TLUS also plays a role in differentiating POP from conditions that mimic POP. It is a simple, inexpensive, and non-harmful diagnostic modality that is appropriate for most gynecologic clinics.

Translabial ultrasound evaluation after tension-free transobturator tape technique: Outcomes based on the tape's position

OBJECTIVE

The purpose of this study was to evaluate the feasibility and accuracy of postoperative translabial ultrasound to assess the position of the tape implanted with the tension-free transobturator tape technique.

METHODS

We enrolled women with clinically and urodynamically proven type I or II stress urinary incontinence who were referred for transobturator tape treatment.

RESULTS

A total of 50 women underwent a transobturator tape procedure and were included in the analysis. We divided the patients into two study groups (group A and group B), characterized by normal and obstructed flow at least 30 days after the surgical procedure visit, respectively. We performed a translabial ultrasound evaluation to assess the suburethral localization of the sling. On the longitudinal scan, the distance between the bladder neck and the suburethral sling was >10 mm in all patients in group A (16.7 ± 1.6). On the contrary, the values in group B were ≤10 mm (5.3 ± 4.8).

CONCLUSION

Our findings highlight the role of a skilled sonographic operator performing translabial ultrasound as a first-line method for evaluating postoperative transobturator tape procedure and sling positioning. Moreover, translabial ultrasound could be helpful to determine a "cutoff" of the bladder neck to sling distance, as this is related to the onset of the obstruction.

A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.