Agreement of Ultrasound Measures with POP-Q in Patients with Pelvic Organ Prolapse

Ultrasound has emerged as a valuable complimentary tool for assessment of pelvic organ prolapse (POP). The present study aimed to evaluate the correlation between ultrasound measures and clinical staging in patients with suspected POP. Patients and Methods: Forty women with clinical suspicion of POP were enrolled in this cross-sectional study between November 2011 and April 2012. Pelvic organ prolapse quantification (POP-Q) system was used for clinical staging. Perineal ultrasound was performed both at rest and during Valsalva maneuver after proper preparation. On mid sagittal view, two reference lines were drawn; midpelvic line (MPL) was defined as the inferior horizontal tangent of symphysis pubis and H line was drawn from the most inferior part of symphysis pubis to the anorectal junction. Spearman’s correlation coefficient and Kappa coefficient of agreements were used for statistical analysis. Forty women with the mean age of 49.9 ± 10.07 years were enrolled. Excellent correlation was seen between MPL and H line (rho = 0.91, 0.93 and 0.88 in anterior, apical and posterior compartments, respectively). POP-Q had good-to-excellent correlation with ultrasound (rho = 0.84, 0.78 and 0.63 for H line and rho = 0.89, 0.82, 0.71 for MPL in anterior, apical and posterior compartments respectively). In anterior and apical compartments, high agreement was seen between clinical and ultrasound staging methods when grouping patients to no prolapse/mild vs. moderate/severe. In the posterior compartment, this agreement was significant when grouping was done based on the presence or absence of POP. Ultrasound has high correlation with POP-Q staging in all compartments for staging of pelvic organ prolapse. Ultrasound might be useful in the diagnosis of pop in those with negative clinical examination.