Pop-q after pessary removal: what is the best time?
Annemarie van der Steen (TNW-M3i), Kim Jochem (TNW-M3i), Esther Consten (Meander Medisch Centrum), Frank Simonis (TNW-MD&I), Anique Grob (TNW-M3i)
Abstract
Introduction and hypothesis
The gold standard for quantifying pelvic organ prolapse is the pelvic organ prolapse quantification (POP-Q) system
[1]
, however upright Magnetic Resonance Imaging (MRI) is a promising new method. The objective of this study was to determine the correlation between POP-Q and MRI-PICS measurements of bladder and cervix.
Methods
This prospective study included prolapse patients of whom POP-Q points Aa or Ba and C were measured as standard care. MRI scans in upright position were performed, and distances of the lowest points of bladder and cervix to the Pelvic Inclination Correction System (PICS) were calculated. Correlations between POP-Q and MRI-PICS measurements were determined using the Pearson correlation coefficient for normally distributed data and the Spearman’s rank correlation coefficient for non-normally distributed data.
Results
63 patients were suitable for analysis. There was a moderate positive correlation between the POP-Q and MRI-PICS measurements for bladder (r(61)=.480, p<0.001) and uterus (r(61)=.527, p<0.001). Measurement differences between POP-Q and MRI-PICS of the bladder and uterus vary from -3.2 cm to 7.1 cm, and from -2.1 cm to 8.5 cm respectively. In 71.4% of patients more descent was seen on upright MRI than with POP-Q measurement for both bladder and uterus. For patients with similar POP-Q measurements, a high variety in MRI measurements of bladder and uterus was found.
Conclusion
Despite a moderate positive correlation upright MRI shows a larger POP extent in 71.4% of the patients than POP-Q. A high variety in MRI measurements for patients with the same POP-Q measurement was seen.
1. Bump RC, Mattiasson A, Brubaker LP, et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction