Phenotypes of Pelvic Organ Prolapse

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Female Pelvic Medicine

Background:

• The Pelvic Organ Prolapse Quantification (POP-Q) staging system is widely used but does not adequately correlate with patient symptoms or define distinct prolapse subtypes.
• There is a need for a more clinically relevant classification system to understand and manage pelvic organ prolapse (POP).

Purpose of the Study:

• To define clinically meaningful prolapse "phenotypes" using POP-Q measurements.
• To determine the frequency of these defined phenotypes.
• To compare demographic, medical characteristics, and symptom profiles across the identified phenotypes.

Main Methods:

• Retrospective categorization of 501 patients who underwent prolapse surgery into 8 distinct phenotypes based on anterior, posterior, and apical compartment involvement using POP-Q criteria.
• Comparison of demographics, medical characteristics, and Pelvic Floor Distress Inventory-20 (PFDI-20) scores between phenotypes using linear and logistic regression models.

Main Results:

• The anterior-predominant and apical (AC) phenotype was the most frequent (46.1%).
• Specific phenotypes (e.g., isolated posterior, posterior-apical) were associated with younger age, higher BMI, and distinct symptom profiles (e.g., colorectal-anal distress, bowel splinting).
• Isolated apical prolapse (C phenotype) showed lower overall PFDI-20 scores, while the AC phenotype served as a reference with no significant symptom differences in the APC group.

Conclusions:

• Defined prolapse phenotypes offer a more nuanced understanding of pelvic organ prolapse beyond traditional staging.
• These phenotypes may improve clinical communication, patient counseling, and treatment strategies for pelvic organ prolapse.
• Further research is warranted to validate and integrate these phenotypes into clinical practice.