title: Perineal ultrasound as a complement to POP-Q in the assessment of cystoceles.
abstract: OBJECTIVE
  In the present study we want to propose a classification system to quantify cystoceles by perineal ultrasound (PUS).
  
  
  METHODS
  120 PUS data were analyzed measuring the distance between the lowest point of the bladder and the midpubic line (MPL) during rest and Valsalva. Results were classified into groups and compared to POP-Q using the κ-coefficient. Results for exact bladder position were checked for interrater reliability using ICC and Pearson's coefficient and results for classification were checked using the κ-coefficient. Bladder positions at rest and Valsalva were correlated with the distance between these points.
  
  
  RESULTS
  Highly significant differences concerning the position at rest and the distance between rest and Valsalva were found between the groups. For the interrater agreement, the Pearson correlation coefficient was ρ = 0.98, the ICC (A-1) = 0.98, and κ = 1.00. Comparing the classification results for POP-Q and PUS, the kappa-coefficient was κ = 0.65.
  
  
  CONCLUSIONS
  PUS using the MPL and the classification system is a highly reliable tool for the evaluation of cystoceles. PUS shows good correlation with POP-Q. Furthermore, PUS offers a doubtless identification of the descending organ. Further studies are needed to evaluate the clinical use of the classification system proposed here.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany.
authors.forename: Laila
authors.initials: L
authors.lastname: Najjari
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Hennemann
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany.
authors.forename: Pia
authors.identifier: 0000-0003-1844-8105
authors.initials: P
authors.lastname: Larscheid
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Papathemelis
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Maass
mesh_terms: D052858:Cystocele / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging* / Q000473:pathology; D014465:Ultrasonics; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging*