A Comparison of Conventional Outpatient and Instrumental Intraoperative POP-Q Measurements in Patients Undergoing Vaginal Surgery for Pelvic Organ Prolapse
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Abstract
Objective: To compare the differences of Pelvic Organ Prolapse Quantification (POP-Q) measurements obtained preoperatively at the outpatient setting and intraoperatively with instrumental traction during full anesthetization in patients undergoing vaginal reconstructive surgery.
Materials and Methods: Retrospective chart review of 98 women having undergone vaginal POP repair for ≥stage II uterovaginal prolapse during September 2014 and March 2020 at Phramongkutklao Hospital was conducted. Patients’ baseline characteristics, history of POP and anti-incontinence surgery, clinical manifestations, POP stage, pessary use, and pre- and intra-operative POP-Q measurements were recorded. At preoperative outpatient setting, POP-Q examination was performed during maximal Valsalva. Intraoperatively, it was performed with instrumental cervical traction after full anesthetization. All POP-Q measurements were interpreted for prolapse location and severity according to the standardized POP-Q system.
Results: Mean age was 72.08 years, with 98% being postmenopausal. Mean BMI was 25.08 kg/m2. Most had vaginal deliveries with median parity of 3. All manifested with bulge symptom while 79.6% complained of voiding difficulty. 96 out of 98 presented with advanced stage prolapse. Among these, 20 patients were treated with vaginal pessary during the waiting period for POP surgical repair. POP-Q measurements (Ba, Ap, Bp, C, D, GH, and PB) obtained during intraoperative instrumental traction significantly demonstrated more prolapse severity when compared with those obtained during outpatient setting. No changes were found when evaluating point Aa.
Conclusion: POP-Q measurements obtained during conventional outpatient examination provides less prolapse severity when compared with those measured during intraoperative instrumental traction after full anesthetization.
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