Total vaginal length: Does it matter for assessing uterine prolapse?

Area of Science:

• Urogynecology
• Pelvic floor disorders
• Female pelvic medicine

Background:

• Pelvic Organ Prolapse Quantification (POP-Q) staging for uterine prolapse involves measuring total vaginal length (TVL).
• The role of TVL as a confounder in the relationship between uterine descent and prolapse symptoms requires clarification.

Purpose of the Study:

• To investigate whether total vaginal length (TVL) confounds the association between uterine descent and pelvic organ prolapse (POP) symptoms.
• To evaluate the impact of including TVL in predictive models for POP symptoms.

Main Methods:

• Retrospective analysis of 393 patients with complete data from a tertiary urogynaecological unit.
• Standardized physician-led questionnaire and POP-Q examination were used.
• Binary logistic regression and Receiver Operating Characteristic (ROC) analysis were employed to assess associations and predictive performance, with and without TVL.

Main Results:

• Prolapse symptoms were significantly associated with cervical station (C), menopausal status, and TVL (P < 0.03).
• ROC analysis showed an Area Under the Curve (AUC) of 0.75 with menopausal status and C. Adding TVL improved the AUC to 0.773 (P < 0.001).

Conclusions:

• Total vaginal length (TVL) significantly enhances the predictive accuracy of cervical station for uterine prolapse symptoms.
• The inclusion of TVL in staging is validated, improving the clinical assessment of uterine prolapse.