A new modification of the POPQ system--its effectiveness in the diagnosis of supravaginal elongation of the uterine cervix in cases with genital prolapse.
BACKGROUND
The evaluation of a genital prolapse has to include the POPQ-pelvic organ position quantification as a descriptive system.


OBJECTIVE
Effectiveness of our modification of the POPQ in the diagnosis of supravaginal cervical elongation.


METHODS
We evaluated our modification: Bal (midpoint of distance Aa/Va); Vas (most proximal point of anterior vaginal wall); Va (attachment of anterior vaginal wall to cervix); Vp (attachment of posterior vaginal wall to cervix); Vps (most proximal point of posterior vaginal wall); SU (attachment of sacrouterine ligaments to cervix); Bp1 (midpoint of distance Ap/Vp); as well as some level distances: (Vas-Va), (Vp-SU), (Vps-Vp), (Aa-Ba1) in 358 patients, divided into: group A-stage I/II prolapse; group B-stage I/II prolapse and cervical elongation; group C-stage III/IV prolapse; group D-stage III/IV prolapse and cervical elongation; group E-stage 0 prolapse and stress incontinence during Valsalva maneuver (Vm) and Pozzy maneuver (Pm).


RESULTS
In cases with a genital prolapse without cervical elongation, with presence of uterosacral ligaments/ upper paracolpium deterioration, the points, such as: Ba1, Vas, Va, Vp, Vps, SU, D, Bp1 came down during Pm. In cases with cervical elongation, without upper paracolpium deterioration and strong uterosacral ligaments, points: SU, D, Bp1 were higher, and level distances: (Vas-Va), (Vp-SU), (Vps-Vp), (Aa-Ba1), (Ap-Bp) greater. In cases with stage 0 prolapse and USI, with only urethrovesical junction deterioration, we found a higher position of Vas, Va, Vp and SU, reflecting the absence of upper paracolpium deterioration.


CONCLUSIONS
Our modification seems to be effective in the diagnosis of cervical elongation (Tab. 4, Fig. 3, Ref. 6).
Antovska
S V
SV
Department for Urogynaecology and Pelvic Floor Disorders, University Clinic for Gynaecology and Obstetrics, Medical Faculty University Saint Cyril and Methodius, Skopje, Republic of Macedonia. vantovska@yahoo.com
D000886:Anthropometry; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D014550:Urinary Incontinence, Stress / Q000150:complications; D014596:Uterine Prolapse / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014621:Vagina / Q000473:pathology; D014636:Valsalva Maneuver