Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

Abstract

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen's kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

Keywords: enterocele; pelvic organ prolapse; pelvic organ prolapse quantification (POP-Q); rectocele; translabial ultrasound.

Figure 1

Conditions mimicking pelvic organ prolapse (POP) and true POP. (A,B) anterior vaginal wall leiomyoma mimicking anterior compartment POP. (C) Urethral diverticulum mimicking anterior compartment POP. (D) Rectocele and (E) enterocele revealed by translabial ultrasonography.

Figure 2

Translabial ultrasonography (A) in resting phase. Rectovaginal septum (arrowheads). AC, anal canal; B, bladder; PS, pubis symphysis; RA, rectal ampulla; U, urethra; V, vagina. Translabial ultrasonography in patients with (B) rectocele and (C) enterocele in maximal Valsalva phase. Rectocele filled with stool and air, resulting in hyperechogenicity, and the defect of the rectovaginal septum is observed in the maximal Valsalva maneuver (B). The contents of an enterocele appear generally iso- to hyperechogenic compared with a rectocele and bowel peristalsis is usually observed in the enterocele sac (C). R, rectocele; E, enterocele.