title: Association between ICS POP-Q coordinates and translabial ultrasound findings: implications for definition of 'normal pelvic organ support'.
abstract: OBJECTIVE
  Female pelvic organ prolapse is quantified on clinical examination using the pelvic organ prolapse quantification system of the International Continence Society (ICS POP-Q). Pelvic organ descent on ultrasound is strongly associated with symptoms of prolapse, but associations between clinical and ultrasound findings remain unclear. This study was designed to compare clinical examination and imaging findings, especially regarding cut-offs for the distinction between normal pelvic organ support and prolapse.
  
  
  METHODS
  This was a retrospective study using 839 archived datasets of women referred to a tertiary urogynecological center for symptoms of lower urinary tract and pelvic floor dysfunction between June 2011 and May 2013. The main outcome measures were the maximum downward displacement of the anterior vaginal wall (point Ba), the cervix (point C) and the posterior vaginal wall (point Bp), the length of the genital hiatus (Gh) and the length of the perineal body (Pb), as defined by the ICS POP-Q; explanatory parameters were measures of pelvic organ descent on translabial ultrasound, ascertained by offline volume data analysis at a later date, by an operator blinded to all other data.
  
  
  RESULTS
  Full datasets were available for 825 women. On clinical examination, 646 (78.3%) were found to have prolapse of at least POP-Q Stage 2. All coordinates on clinical examination were strongly associated with the ultrasound measurements of pelvic organ descent (P < 0.001). These relationships were almost linear, especially for the anterior compartment.
  
  
  CONCLUSIONS
  There is a near linear relationship between sonographic and clinical measures of prolapse. Previously proposed cut-offs to define 'significant prolapse' on ultrasound and POP-Q (Ba ≥ -0.5 and cystocele ≥ 10 mm below the symphysis pubis, C ≥ -5 and uterine position of 15 mm above the symphysis pubis, Bp ≥ -0.5 and rectocele ≥ 15 mm below the symphysis pubis) are plausible and mutually consistent. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors: Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
authors: H P
authors: HP
authors: Dietz
authors: Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
authors: I
authors: I
authors: Kamisan Atan
authors: Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
authors: A
authors: A
authors: Salita
mesh_terms: D000328:Adult; D000368:Aged; D052858:Cystocele / Q000000981:diagnostic imaging; D005260:Female; D052776:Female Urogenital Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000473:pathology; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging* / Q000473:pathology*; D020047:Rectocele / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014599:Uterus / Q000000981:diagnostic imaging
keywords: cystocele; female pelvic organ prolapse; rectocele; ultrasound; uterine prolapse