Pelvic Organ Prolapse Quantification (POP-Q) system needs revision or abandonment: The anatomy study

Area of Science:

• Female pelvic anatomy
• Surgical anatomy
• Pelvic floor disorders

Background:

• The female urogenital hiatus (UGH) and perineal body (PB) are critical structures in pelvic floor support.
• Accurate anatomical assessment is essential for diagnosing and managing pelvic organ prolapse (POP).
• The Pelvic Organ Prolapse Quantification (POP-Q) system is widely used for POP evaluation.

Purpose of the Study:

• To investigate the gross and topographic anatomy of the female urogenital hiatus and perineal body.
• To evaluate the accuracy of the POP-Q system in assessing these structures.

Main Methods:

• Prospective case series involving fifteen fresh human adult female cadavers.
• Stratum-by-stratum, macro-, and micro-anatomical dissections of the UGH and PB.
• Analysis of existing medical literature on UGH and PB anatomy.
• Digital photography for documentation.

Main Results:

• The urogenital hiatus is an oval structure located in the Retzius space, extending from the inferior pubic bone to the posterior anal wall and PB.
• The POP-Q's recommended measurement for UGH from the middle urethral meatus to the posterior hymeneal ring is inaccurate.
• The perineal body is a horizontally oriented, oval muscular mass, not a part of the posterior perineum as suggested by POP-Q; its measurement should be horizontal (mean length 4.2 cm).

Conclusions:

• The current POP-Q system does not adequately assess the anatomical details of the female urogenital hiatus and perineal body.
• The POP-Q system requires significant revision to accurately quantify UGH and PB anatomy.