Differential diagnosis of middle compartment pelvic organ prolapse with
transperineal ultrasound
Abstract
Objectives:To identify the best parameter(pubis-cervix measurement,
pubis-uterine fundus measurement or pubis-Douglas cul-de-sac
measurement) on transperineal ultrasound, based on the difference
between measurements taken at rest and with the Valsalva maneuver, for
differential diagnosis presurgical between uterine prolapse (UP) and
cervical elongation(CE) without UP. Design:Observational prospective
cohort study. Setting:Valme University Hospital, Seville, Spain.
Sample:60 consecutively recruited patients who underwent corrective
surgery of the middle compartment (UP or CE without UP). Methods: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, Douglas
cul-de-sac and the cervix. Main outcome measures:Difference between
measurements taken at rest and with the Valsalva for the uterine fundus,
Douglas cul-de-sac and the cervix maneuver. 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-Douglas cul-de-sac 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%). Conclusions:A difference ≥15 mm in the pubis-uterine fundus
distance at rest and with the Valsalva maneuver is useful to
differentiate UP from CE without UP by ultrasound.