Does Dominant Prolapse in Other Compartments Affect the Assessment of
Bladder Prolapse on Translabial Ultrasound?
Abstract
Objective: To explore the impact of dominant prolapse in other
compartments in assessing bladder prolapse, and to establish cutoffs for
staging bladder prolapse among Chinese women using translabial
ultrasound. Design: Prospective multicentre observational study.
Setting: Tertiary referral urogynaecology unit. Population: A total of
741 women with symptoms of lower urinary tract dysfunction and/or pelvic
floor dysfunction were included. Methods: Women underwent interview,
pelvic organ prolapse quantification (POP-Q) examinations and 4D
translabial ultrasounds. Main outcome measures: The ROC statistic was
used to assess accuracy and define the optimal cutoffs. Results: The
mean patient age was 42.7 years (range, 18-82). There were 456 women
without dominant prolapse in the apical/posterior compartments and 285
women with dominant prolapse in the apical/posterior compartments. Among
patients without and with dominant prolapse, similar cutoffs (-10.9 mm
vs. -9.1 mm) were determined for predicting POP-Q stage ≥ 2 in the
anterior compartment, with AUCs of 0.87 and 0.79, respectively. In
contrast, significantly different cutoffs (-5.7 mm vs. +3.5 mm) were
determined for predicting POP-Q stage ≥ 1 among patients with and
without dominant prolapse, with AUCs of 0.85 and 0.77, respectively.
Conclusion: Dominant prolapse in the apical/posterior compartments
affected the accuracy and cutoffs of translabial ultrasound for staging
bladder prolapse. Thus, competition of various organs in women with
multi-compartment prolapse should be considered as a potential
complicating factor in assessing pelvic organ prolapse. Funding: The
study is supported by grants from the National Natural Science
Foundation of China (No. 91859115). Key words: Bladder prolapse;
translabial ultrasound.