Skip to main content
SpringerLink
Log in

Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The objective was to identify the best parameter (pubis–cervix measurement, pubis–uterine fundus measurement or pubis–pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP.

Methods

A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test.

Results

Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis–cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis–uterine fundus distance, the AUC was 0.81; and for the pubis–pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%).

Conclusion

A difference of ≥15 mm in the pubis–uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dietz HP, Lekskulchai O. Ultrasound assessment of prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol. 2007;29:688–91.

    Article  CAS  Google Scholar 

  2. Shek KL, Dietz HP. What is abnormal uterine descent on translabial ultrasound? Int Urogynecol J. 2015;26(12):1783–7.

    Article  Google Scholar 

  3. Eisenberg VH, Chantarasorn V, Shek KL, Dietz HP. Does levator ani injury affect cystocele type? Ultrasound Obstet Gynecol. 2010;36(5):618–23.

    Article  CAS  Google Scholar 

  4. Green TH Jr. Urinary stress incontinence: differential diagnosis, pathophysiology, and management. Am J Obstet Gynecol. 1975;122(3):368–400.

    Article  Google Scholar 

  5. Chantarasorn V, Dietz HP. Diagnosis of cystocele type by clinical examination and pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2012 Jun;39(6):710–4.

    Article  CAS  Google Scholar 

  6. Dietz HP, Steensma AB. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermotility and enterocele. Ultrasound Obstet Gynecol. 2005;26(1):73–7.

    Article  CAS  Google Scholar 

  7. Hsiao SM, Chang TC, Chen CH, Li YI, Shun CT, Lin HH. Risk factors for coexistence of cervical elongation in uterine prolapse. Eur J Obstet Gynecol Reprod Biol. 2018;229:94–7.

    Article  Google Scholar 

  8. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  Google Scholar 

  9. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodynam. 2002;21:167–78.

    Article  Google Scholar 

  10. Dietz HP, Mann K. What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J. 2014;25:451–5.

    Article  CAS  Google Scholar 

  11. Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115:979–84.

    Article  CAS  Google Scholar 

  12. Dietz HP, Shek KL. Tomographic ultrasound imaging of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol. 2009;33:698–703.

    Article  CAS  Google Scholar 

  13. Orejuela F, Shek KL, Dietz HP. The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J. 2012;23:175–8.

    Article  Google Scholar 

  14. García-Mejido JA, Bonomi-Barby MJ, Armijo-Sanchez A, Borrero-Fernández C, Castro-Portillo L, Vargas-Broquetas M, et al. Metodología para el estudio ecográfico transperineal del suelo pélvico. Clin Invest Ginecol Obstet. 2020;https://doi.org/10.1016/j.gine.2020.09.008.

    Article  Google Scholar 

  15. Dietz H. Ultrasound imaging of the pelvic floor. I. Two-dimensional aspects. Ultrasound Obstet Gynecol. 2004;23:80–92.

    Article  CAS  Google Scholar 

  16. Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18:511–4.

    Article  CAS  Google Scholar 

  17. Broekhuis SR, Kluivers KB, Hendriks JCM, Futterer JJ, Barentsz JO, Vierhout ME. POP-Q, dynamic MR imaging and perineal ultrasonography: do they agree in quantification of female pelvic organ prolapse? Int Urogynecol J. 2009;20:541–9.

    Article  Google Scholar 

  18. Kluivers KB, Jan CM, Shek HC, Dietz HP. Pelvic organ prolapse symptoms in relation to POP-Q, ordinal stages and ultrasound prolapse assessment. Int Urogynecol J. 2008;19:1299–302.

    Article  Google Scholar 

  19. Lone FW, Thakar R, Sultan AH, Stankiewicz A. Accuracy of assessing pelvic organ prolapse quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse. Int Urogynecol J. 2012;23(11):1555–60.

    Article  CAS  Google Scholar 

  20. Swenson CW, Smith TM, Luo J, Kolenic GE, Ashton-Miller JA, DeLancey JO. Intraoperative cervix location and apical support stiffness in women with and without pelvic organ prolapse. Am J Obstet Gynecol. 2017;216(2):155.e1–8.

    Article  Google Scholar 

  21. Chen L, Ashton-Miller JA, DeLancey JO. A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation. J Biomech. 2009;42:1371–7.

    Article  Google Scholar 

  22. Luo J, Betschart C, Chen L, Ashton-Miller JA, DeLancey JO. Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study. Int Urogynecol J. 2014;25:197–203.

    Article  Google Scholar 

  23. Rodríguez-Mias NL, Subramaniam N, Friedman T, Shek KL, Dietz HP. Prolapse assessment supine and standing: do we need different cutoffs for “significant prolapse”? Int Urogynecol J. 2018;29(5):685–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain

    José Antonio García-Mejido, Alberto Armijo-Sánchez, Rocío García-Jimenez & José Antonio Sainz

  2. Department of Obstetrics and Gynecology, University of Seville, Seville, Spain

    José Antonio García-Mejido & José Antonio Sainz

  3. Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, Seville, Spain

    Zenaida Ramos-Vega

  4. Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain

    Ana Fernández-Palacín

Authors
  1. José Antonio García-Mejido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zenaida Ramos-Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Armijo-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Fernández-Palacín
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rocío García-Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José Antonio Sainz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Antonio García-Mejido.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(MP4 7605 kb)

ESM 2

(GIF 9666 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

García-Mejido, J.A., Ramos-Vega, Z., Armijo-Sánchez, A. et al. Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound. Int Urogynecol J 32, 2219–2225 (2021). https://doi.org/10.1007/s00192-020-04646-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04646-1

Keywords

Search

Navigation