Mark D. Walters, M.D. Professor and Vice Chair of Gynecology Department of Obstetrics and Gynecology...
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Transcript of Mark D. Walters, M.D. Professor and Vice Chair of Gynecology Department of Obstetrics and Gynecology...
Mark D. Walters, M.D.
Professor and Vice Chair of Gynecology
Department of Obstetrics and Gynecology
Cleveland Clinic, USA
Evaluation of Pelvic Evaluation of Pelvic
Organ Prolapse Organ Prolapse
Disclosure of Financial Relationships
American Medical Systems and Boston
Scientific: paid consultant and lecturer
Learning ObjectivesLearning Objectives
At the conclusion of this lecture, At the conclusion of this lecture, participants should be able to:participants should be able to:
1.1. Review epidemiology of pelvic organ Review epidemiology of pelvic organ prolapseprolapse
2.2. Summarize office evaluation and POPQ Summarize office evaluation and POPQ techniques and appraise evidence of techniques and appraise evidence of their utilitytheir utility
Pelvic Organ Prolapse - Pelvic Organ Prolapse - BackgroundBackground
16% of women in US have prolapse 16% of women in US have prolapse Pannu et al. Radiographics 2000;20(6):1567-82Pannu et al. Radiographics 2000;20(6):1567-82
Lifetime prevalence 30-50%, of which 2% are Lifetime prevalence 30-50%, of which 2% are symptomaticsymptomatic Samuelsson EC et al, AJOG 1999;180:299-305Samuelsson EC et al, AJOG 1999;180:299-305
7% lifetime risk of surgery for prolapse7% lifetime risk of surgery for prolapse Olsen et al., Obstet Gynecol 1997;89:501Olsen et al., Obstet Gynecol 1997;89:501
29% of these patients require re-operation29% of these patients require re-operation Olsen et al., Obstet Gynecol 1997;89:501Olsen et al., Obstet Gynecol 1997;89:501
30-39 40-49 50-59 60-69 70-79
0.9%
2.8%
4.7%
7.5%
11.1%
00
22
44
66
88
1010
1212
Age GroupAge Group
Pe
rce
nt
Pe
rce
nt
Lifetime Risk of Single Operation for POP/UI
Olsen et al., Obstet Gynecol 1997;89:501Olsen et al., Obstet Gynecol 1997;89:501
Outcomes for Pelvic Organ Prolapse
Vaginal anatomy; bulge, pressure, mass
Visceral symptoms: Urinary and bowel symptoms
Sexual activity and expectations
Future surgical procedures or medicines to manage failures or complications
Vaginal Prolapse Exam
Vaginal apex
Enterocele
Anterior wall
Bladder neck
Posterior wall
Perineum
Uterine prolapseUterine prolapse Anterior vaginal Anterior vaginal prolapseprolapse
Vaginal vault Vaginal vault prolapseprolapse
Pelvic Organ Prolapse Quantification Pelvic Organ Prolapse Quantification System (POP-Q)System (POP-Q)
Adopted by ICS, AUGS and SGSAdopted by ICS, AUGS and SGS Objective, site-specific systemObjective, site-specific system
DocumentingDocumenting ComparingComparing CommunicatingCommunicating
Allows for:Allows for: Precise description of pelvic support without assigning Precise description of pelvic support without assigning
severity valueseverity value Accurate observation of stability or progression of Accurate observation of stability or progression of
prolapse over time by same or different observersprolapse over time by same or different observers
The POP-Q SystemThe POP-Q System
Fixed reference point: hymenFixed reference point: hymen
Two points of measurement eachTwo points of measurement each
Anterior wall (Aa, Ba)Anterior wall (Aa, Ba)
Posterior wall (Ap, Bp)Posterior wall (Ap, Bp)
Apex (C, D)Apex (C, D)
Also measure genital hiatus (gh), perineal Also measure genital hiatus (gh), perineal
body (pb), and total vaginal length (tvl)body (pb), and total vaginal length (tvl)
AaAa BaBa CC
GHGH PBPB TVLTVL
ApAp BpBp DD
Anterior wall
Posterior wall
Cervix or cuff
Posterior fornix
Genital hiatus Perineal body
Total vaginal length
POP-QPOP-Q
Evaluate maximum Evaluate maximum prolapseprolapse ValsalvaValsalva TractionTraction Confirmation by patientConfirmation by patient Standing examStanding exam
Describe other Describe other variablesvariables
Genital Genital HiatusHiatus
Perineal Perineal BodyBody
Midline of anterior vaginal wall 3cm from external urethral meatus
SLIDING POINT
Most distal position of any part of anterior vaginal wall
Anterior points (Aa, Ba)Anterior points (Aa, Ba)
Location of posterior fornix
Most distal edge of cervix or leading edge of vaginal cuff
SLIDING POINT
Most distal position of any part of posterior vaginal wall
Midline of posterior vaginal wall 3cm from hymen
POP-Q StagingPOP-Q Staging
Stage 0 normalStage 0 normal Stage IStage I
< -1 cm from (above) < -1 cm from (above) hymenhymen
Stage IIStage II ++1 cm from hymen1 cm from hymen
Stage III-IV Stage III-IV >+1 cm to complete >+1 cm to complete
prolapseprolapse
Thank you for your attention!