Do patient characteristics impact the relationship between anatomic prolapse and vaginal bulge symptoms?
OBJECTIVE
Seeing or feeling a vaginal bulge is the most specific symptom for identifying prolapse. Bulge symptoms are becoming increasingly important as a surgical outcome measure. Our objectives were to identify patient characteristics associated with the symptom of a vaginal bulge and to determine whether those characteristics impact the relationship between symptoms and anatomic prolapse.


METHODS
A cross-sectional analysis of new urogynecology patients was performed. Standardized history and examination forms were used. Patient characteristics associated with vaginal bulge at p ≤0.10 were entered in logistic regression models. Interactions between patient characteristics and prolapse were tested to determine whether patient factors modified the association between anatomic prolapse and symptoms.


RESULTS
We evaluated 685 patients with mean age of 58.5 years. Patients reporting a vaginal bulge were slightly older, more likely postmenopausal, and had greater parity and body mass index (BMI). They were more likely to report prior prolapse surgery (p <0.05) and more often previously underwent hysterectomy (p = 0.10). In multivariable analysis, prolapse, age group, and vaginal parity were associated with the bulge symptom. Receiver operating characteristic (ROC) area under the curve (AUC) was 0.87 [95 % confidence interval (CI) 0.84-0.90], suggesting good predictive value of maximum vaginal descent for a vaginal bulge symptom. The AUC for the youngest women was lower than for middle and older age groups (p < 0.01). The optimal cutoff for defining prolapse associated with a vaginal bulge symptom was the hymen.


CONCLUSIONS
Age and vaginal parity were independently associated with the vaginal bulge symptom. The level of vaginal descent did not predict a bulge symptom as accurately in younger patients.
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1080, USA. joseph-kowalski@uiowa.edu.
Joseph T
http://orcid.org/0000-0002-7775-106X
JT
Kowalski
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1080, USA.
Gerardo Heredia
GH
Melero
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1080, USA.
Amandeep
A
Mahal
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1080, USA.
Rene
R
Genadry
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1080, USA.
Catherine S
CS
Bradley
D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000473:pathology; D014621:Vagina; D014623:Vaginal Diseases / Q000209:etiology
POP-Q; Prolapse; Vaginal bulge
Clin Obstet Gynecol. 2005 Sep;48(3):648-61
16012232
Obstet Gynecol. 2005 Oct;106(4):759-66
16199633
Int Urogynecol J. 2014 Apr;25(4):451-5
24504066
Am J Obstet Gynecol. 1996 Jul;175(1):10-7
8694033
Int Urogynecol J Pelvic Floor Dysfunct. 2005 May-Jun;16(3):203-9; discussion 209
15875236
Obstet Gynecol. 2009 Sep;114(3):600-9
19701041
Eur J Obstet Gynecol Reprod Biol. 2014 Jun;177:141-5
24784712
Biometrics. 1988 Sep;44(3):837-45
3203132
Neurourol Urodyn. 2016 Aug;35(6):724-7
25919311
Am J Obstet Gynecol. 2005 Jul;193(1):103-13
16021067
Maturitas. 1992 Jan;14(2):103-15
1565019