How accurate is preoperative evaluation of pelvic organ prolapse in women undergoing vaginal reconstruction surgery?
OBJECTIVE
To evaluate the differences between the in-office and intraoperative techniques used to evaluate pelvic organ prolapse.


METHODS
A prospective study included 25 women undergoing vaginal reconstruction surgery including vaginal hysterectomy for pelvic organ prolapse. The outpatient pelvic and site-specific vaginal examination was performed in the lithotomy position with the Valsalva maneuver. Repeated intraoperative examination was performed under general anesthesia with standard mild cervical traction. The Pelvic Organ Prolapse Quantification system (POPQ) was used for both measurements and staging. The values found under the two conditions were compared.


RESULTS
The intraoperative POPQ-measurements values were significantly higher than the outpatient values for apical wall prolapse in 17/25 (68%) women and for anterior wall prolapse in 8/25 (32%) women. There was not a significant difference in the posterior wall where increase in staging was shown in 3/25 (12%) patients.


CONCLUSIONS
Clinicians and patients should be alert to the possibility that pelvic organ measurements performed under general anesthesia with mild traction may be different from preoperative evaluation.
Urogynecology Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel. haimkr@clalit.org.il
Haim
H
Krissi
Ram
R
Eitan
Edward
E
Ram
Yoav
Y
Peled
D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*; D011446:Prospective Studies; D014621:Vagina / Q000601:surgery*