title: Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography.
abstract: The aim of the present study was to compare clinical and radiological findings when assessing posterior vaginal wall prolapse. Defecography can be used to complement the clinical evaluation in patients with posterior vaginal wall prolapse. Further development of the defecography technique, using contrast medium in the urinary bladder and intraperitoneally, have resulted in cystodefecoperitoneography (CDP). Thirty-eight women underwent clinical examination using the pelvic organ prolapse quantification system (POP-Q) followed by CDP. All patients answered a standardized bowel function questionnaire. Statistical analysis measuring correlation between POP-Q and CDP using Pearson's correlation coefficient (r) and Spearman's rank order correlation coefficient (rs) demonstrated a poor to moderate correlation, r=0.49 and rs=0.55. Although there was a strong association between large rectoceles (>3 cm) at CDP and symptoms of rectal emptying difficulties (p<0.001), severity and prevalence of bowel dysfunction showed poor coherence with clinical prolapse staging and findings at radiological imaging. Vaginal topography and POP-Q staging predict neither radiological size nor visceral involvement in posterior vaginal wall prolapse. Radiological evaluation may therefore be a useful complement in selected patients.
authors.affiliation: Pelvic Floor Center Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 182 88, Stockholm, Sweden. daniel.altman@ds.se
authors.forename: Daniel
authors.initials: D
authors.lastname: Altman
authors.forename: Annika
authors.initials: A
authors.lastname: López
authors.forename: Jonas
authors.initials: J
authors.lastname: Kierkegaard
authors.forename: Jan
authors.initials: J
authors.lastname: Zetterström
authors.forename: Christian
authors.initials: C
authors.lastname: Falconer
authors.forename: Johan
authors.initials: J
authors.lastname: Pollack
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
mesh_terms: D000328:Adult; D000368:Aged; D019841:Defecography; D005260:Female; D006547:Hernia / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010537:Peritoneum / Q000000981:diagnostic imaging*; D020047:Rectocele / Q000209:etiology; D015203:Reproducibility of Results; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014596:Uterine Prolapse / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D014621:Vagina / Q000000981:diagnostic imaging*