Clinical-decision taking in primary pelvic organ prolapse; the effects of diagnostic tests on treatment selection in comparison with a consensus meeting.
OBJECTIVE
The objective of the study was to establish the effects of additional diagnostic tests compared to a consensus outcome on treatment selection in primary pelvic organ prolapse.


METHODS
Three expert gynecologists individually defined a management plan in 53 patients after magnetic resonance imaging, defecography, urodynamic, and anorectal function test information was provided. These management plans were compared with basic treatment advices in the absence of any test and with consensus advices (opinion-based references). The experts assigned a subjective score (assigned diagnostic value [ADV], 0-100%) to rate the test's relative importance.


RESULTS
On average, additional diagnostic testing resulted in a revised initial management plan in 38% of the cases; 24% of the individual management plans did not meet the consensus reference. Overall defecography was regarded most valuable (ADV range 19-65%) vs. magnetic resonance imaging rated least (ADV range 0-37%).


CONCLUSIONS
Although additional diagnostic tests frequently led to adaptations of basic treatment proposals, consensus was not reached in a fourth of the cases.
Department of Gynecology and Obstetrics, Onze Lieve Vrouwe Hospital, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands. A.G.Groenendijk@olvg.nl
Annette G
AG
Groenendijk
Erwin
E
Birnie
Sjoerd
S
de Blok
Albert H
AH
Adriaanse
Willem M
WM
Ankum
Jan-Paul W
JP
Roovers
Gouke J
GJ
Bonsel
D000368:Aged; D032921:Consensus; D003657:Decision Making; D019841:Defecography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014563:Urodynamics; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000628:therapy