Pelvic Organ Prolapse Quantification System

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Pelvic Organ Prolapse Quantification System
Purposeassessing the degree of prolapse of pelvic organs

The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings. [1] [2] This assessment is the most frequently used [3] [4] among research publications related to pelvic organ prolapse. [4]

Contents

When assessed using the POP-Q, the prevalence of pelvic organ prolapse is estimated to be up to 50% while diagnosis by symptoms has a prevalence of 3–6%. [2] Some advocate that the system of assessment be modified. [5]

The POP-Q was developed in 1996, it quantifies the descent of pelvic organs into the vagina. [3] [6] [2] The POP-Q provides reliable description of the support of the anterior, posterior and apical vaginal wall. It uses objective and precise distance measurements to the reference point, the hymen. Cystocele and prolapse of the vagina from other causes is staged using POP-Q criteria and can range from good support (no descent into the vagina) reported as a POP-Q stage 0 or I to a POP-Q score of IV, which includes prolapse beyond the hymen. It also used to quantify the movement of other structures into the vaginal lumen and their descent. [6] [2]

Stages

Pelvic Organ Prolapse Quantification System (POP-Q)
StageDescription
0No prolapse anterior and posterior points are all −3 cm, and C or D is between −TVL and −(TVL−2) cm.
1The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than −1 cm).
2The most distal prolapse is between 1 cm above and 1 cm below the hymen (at least one point is −1, 0, or +1).
3The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL.
4Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (TVL−2) cm.

The POP-Q assessment tool measures nine points in the vagina. The hymen is the reference point to which the other points are compared. The prolapsed organs are measured in centimeters to the hymen. The measurements are taken when the Valsalva maneuver is performed while The woman is in the dorsal lithotomy position. [3] [7] The anatomical landmarks used are anterior vaginal wall, cervix, hymen, perineal body, total vaginal length, posterior vaginal wall and posterior fornix. [8] A three-by-three centimeter grid is used to record the proximal and distal numbers. The information on the grid is translated to the appropriate stage of prolapse. [3]

This system of assessing pelvic organ prolapse is China's most commonly used grading system. [9]

Other assessments

Other assessment tools are abailable to determine the impact of pelvic floor prolapse. These are Pelvic Floor Impact Questionnaire (PFIQ), The Pelvic Floor Distress Inventory (PFDI) and the shorter forms PFIQ-7 and PFDI-20. [7]

The evaluation of pelvic organ prolapse includes other diagnostic tests in addition to the POP-Q. These can be: [3]

In the US, greater than 200,000 surgeries are performed each year for pelvic organ prolapse. Examples of pelvic organ prolapse are cystocele, rectocele, urethrocele, enterocele and sigmoidocele. Cystocele is the most common. [10] [2]

History

The Porges or Severity prolapse assessment system was proposed in 1963. [11] In 1972, the Baden–Walker Halfway Scoring System was developed and is the second most used system. [11] [1] In 1980, the Beecham system was developed. The POP was developed in 1996. [11]

See also

References

  1. 1 2 Persu, C; Chapple, CR; Cauni, V; Gutue, S; Geavlete, P (2011-02-15). "Pelvic Organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging". Journal of Medicine and Life. 4 (1): 75–81. ISSN   1844-122X. PMC   3056425 . PMID   21505577.
  2. 1 2 3 4 5 Barber, Matthew D.; Maher, Christopher (2013-11-01). "Epidemiology and outcome assessment of pelvic organ prolapse". International Urogynecology Journal. 24 (11): 1783–1790. doi:10.1007/s00192-013-2169-9. ISSN   0937-3462. PMID   24142054. S2CID   9305151.
  3. 1 2 3 4 5 Beckley, Ian; Harris, Neil (2013-03-26). "Pelvic organ prolapse: a urology perspective". Journal of Clinical Urology. 6 (2): 68–76. doi:10.1177/2051415812472675. S2CID   75886698.
  4. 1 2 Boyd, S. S.; O'Sullivan, D. M.; Tulikangas, P. (2017-03-01). "29: Implementation of the pelvic organ prolapse quantification system in peer-reviewed journals". American Journal of Obstetrics & Gynecology. 216 (3): S591. doi: 10.1016/j.ajog.2016.12.076 . ISSN   0002-9378.
  5. Oyama, Ian A.; Steinberg, Adam C.; Watai, Travis K.; Minaglia, Steven M. (2012). "Pelvic Organ Prolapse Quantification Use in the Literature". Female Pelvic Medicine & Reconstructive Surgery. 18 (1): 33–34. doi:10.1097/spv.0b013e31823bd1ab. PMID   22453265. S2CID   26251358.
  6. 1 2 Hoffman, Barbara L.; Williams, J. Whitridge (2012). Williams gynecology (2nd ed.). New York: McGraw-Hill Medical. pp. 647–653. ISBN   9780071716727. OCLC   779244257.
  7. 1 2 Sengupta, Niladri; Hilliard, Timothy (2013). "Urogynecological Risk Assessment in Postmenopausal Women". www.medscape.com. Retrieved 2017-12-29.
  8. Practitioners, The Royal Australian College of General. "RACGP – Pelvic organ prolapse – a review". www.racgp.org.au. Retrieved 2017-12-29.
  9. Wang, Yi-ting; Jiang, Jun-ying; Han, Jin-song (2016-02-01). "A review of the pelvic organ prolapse quantification system in China". International Urogynecology Journal. 27 (2): 287–290. doi:10.1007/s00192-015-2830-6. ISSN   0937-3462. PMID   26353847. S2CID   20771630.
  10. Halpern-Elenskaia, Ksenia; Umek, Wolfgang; Bodner-Adler, Barbara; Hanzal, Engelbert (2017-12-06). "Anterior colporrhaphy: a standard operation? Systematic review of the technical aspects of a common procedure in randomized controlled trials". International Urogynecology Journal. 29 (6): 781–788. doi:10.1007/s00192-017-3510-5. ISSN   0937-3462. PMC   5948274 . PMID   29214325.
  11. 1 2 3 Zimmern, Philippe E.; Haab, Francois; Chapple, Christopher R. (2007-12-09). Vaginal Surgery for Incontinence and Prolapse. Springer Science & Business Media. p. 40. ISBN   9781846283468.