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Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography

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Abstract

The aim of the present study was to compare clinical and radiological findings when assessing posterior vaginal wall prolapse. Defecography can be used to complement the clinical evaluation in patients with posterior vaginal wall prolapse. Further development of the defecography technique, using contrast medium in the urinary bladder and intraperitoneally, have resulted in cystodefecoperitoneography (CDP). Thirty-eight women underwent clinical examination using the pelvic organ prolapse quantification system (POP-Q) followed by CDP. All patients answered a standardized bowel function questionnaire. Statistical analysis measuring correlation between POP-Q and CDP using Pearson’s correlation coefficient (r) and Spearman’s rank order correlation coefficient (rs) demonstrated a poor to moderate correlation, r=0.49 and rs=0.55. Although there was a strong association between large rectoceles (>3 cm) at CDP and symptoms of rectal emptying difficulties (p<0.001), severity and prevalence of bowel dysfunction showed poor coherence with clinical prolapse staging and findings at radiological imaging. Vaginal topography and POP-Q staging predict neither radiological size nor visceral involvement in posterior vaginal wall prolapse. Radiological evaluation may therefore be a useful complement in selected patients.

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Authors and Affiliations

  1. Pelvic Floor Center Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 182 88, Stockholm, Sweden

    Daniel Altman, Annika López, Jan Zetterström & Christian Falconer

  2. Division of Radiology, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden

    Jonas Kierkegaard

  3. Division of Surgery, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden

    Johan Pollack

  4. Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA

    Anders Mellgren

Authors
  1. Daniel Altman
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  2. Annika López
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  3. Jonas Kierkegaard
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  4. Jan Zetterström
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  5. Christian Falconer
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  6. Johan Pollack
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  7. Anders Mellgren
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Corresponding author

Correspondence to Daniel Altman.

Additional information

Presented in part at the 10th European Symposium on Urogenital Radiology, Uppsala, Sweden, 4–7 September 2003

Editorial Comment: This is an interesting study looking at a new radiographic technique for evaluating pelvic organ support defects. This technique is basically cystodefecography with the addition of an intraperitoneal contrast. The technique itself, while it currently cannot be recommended as standard care, certainly holds interesting possibilities particularly in the detection of complicated enteroceles and high sigmoidoceles. We wish that the authors will continue to look at this technique and determine its eventual role in the evaluation of pelvic organ support defects

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Altman, D., López, A., Kierkegaard, J. et al. Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography. Int Urogynecol J 16, 96–103 (2005). https://doi.org/10.1007/s00192-004-1220-2

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  • DOI: https://doi.org/10.1007/s00192-004-1220-2

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