Pelvic organ prolapse in women: Diagnostic evaluation
- Tola B Fashokun, MD, FACOG
Tola B Fashokun, MD, FACOG
- Assistant Professor
- Johns Hopkins University School of Medicine
- Rebecca G Rogers, MD
Rebecca G Rogers, MD
- Professor of Obstetrics and Gynecology, Urogynecology
- Associate Professor of Surgery
- The University of New Mexico
Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, in women is diagnosed using pelvic examination. A medical history is also important to elicit prolapse-associated symptoms, since treatment is generally indicated only for symptomatic prolapse. (See "Pelvic organ prolapse in women: Choosing a primary surgical procedure", section on 'Women with symptomatic prolapse'.)
Historically, the severity of prolapse was graded using a variety of imprecise classification systems that were not easily reproduced or communicated in a standard way among clinicians . The Pelvic Organ Prolapse Quantitation system (POPQ), introduced in 1996, has become the standard classification system .
Diagnostic evaluation of women with POP is reviewed here. An overview of POP, general principles of the pelvic examination and additional aspects of evaluation of women with POP are discussed separately. (See "An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women" and "The gynecologic history and pelvic examination".)
CLASSIFICATION OF PELVIC ORGAN PROLAPSE
POPQ system — The POPQ system is an objective, site-specific system for describing and staging POP in women . The POPQ system involves quantitative measurements of various points representing anterior, apical, and posterior vaginal prolapse to create a "topographic" map of the vagina. These anatomic points can then be used to determine the stage of the prolapse (figure 1 and figure 2 and table 1) [1,3].
The POPQ has proven interobserver and intraobserver reliability . Intraoperative POPQ measurements correlate well with preoperative findings, with slightly more prolapse under anesthesia when traction is placed on the POPQ points .
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- CLASSIFICATION OF PELVIC ORGAN PROLAPSE
- POPQ system
- Other classification systems
- MEDICAL HISTORY
- APPROACH TO THE EXAMINATION
- Examination components
- Patient positioning
- VISUAL INSPECTION
- SPECULUM AND BIMANUAL EXAMINATION
- Using the POPQ system
- - POPQ measurements
- - POPQ staging
- - Modifications of the POPQ system and reporting POPQ results
- Simplified POPQ
- Additional examination techniques
- - Simulated apical support
- - Inspection for paravaginal defects
- RECTOVAGINAL EXAMINATION
- NEUROMUSCULAR EXAMINATION
- Neurologic evaluation
- Pelvic floor muscle testing
- ANCILLARY STUDIES
- Evaluation of prolapse
- - Photography
- - Imaging
- Urinary tract evaluation
- - Urinary incontinence
- - Urinary retention
- Bowel function evaluation
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS