Prolapse assessment supine and standing: do we need different cutoffs for "significant prolapse"?

Area of Science:

• Urogynecology
• Pelvic Floor Imaging
• Diagnostic Ultrasound

Background:

• Translabial ultrasound (TLUS) has established normal limits for pelvic organ support in the supine position.
• Normative data for TLUS in the standing position are lacking, necessitating investigation into position-specific diagnostic criteria.

Purpose of the Study:

• To test the hypothesis that different cutoff values for pelvic organ support are required for translabial ultrasound imaging in the standing position compared to the supine position.
• To establish optimal cutoff values for normal pelvic organ support using TLUS in both supine and standing positions.

Main Methods:

• Retrospective study of 243 women with lower urinary tract and pelvic floor dysfunction symptoms.
• Standardized interview, 4D TLUS, and Pelvic Organ Prolapse Quantification (POP-Q) assessment.
• Measurement of organ descent and levator hiatus dimensions in supine and standing positions during maximal Valsalva; Receiver Operator Characteristic (ROC) statistics used for cutoff determination.

Main Results:

• Similar cutoff values for organ descent were found between supine and standing positions using ROC statistics.
• Levator hiatus distention was significantly greater in the standing position compared to supine.
• A new optimal cutoff of 29 cm² was identified for hiatal distensibility in the standing position.

Conclusions:

• Established supine imaging cutoffs for organ descent are applicable to standing position assessments.
• A higher cutoff value of 29 cm² is recommended for evaluating hiatal distensibility in the standing position.