Comparison of cervical length measured by POP-Q C-D and MRI: Why is POP-Q C-D not accurate?

Comparison of robot-assisted vs. traditional laparoscopic sacral colpopexy for pelvic organ prolapse: Outcomes and quality of life

BackgroundPelvic organ prolapse is a prevalent condition affecting women of varying ages and ethnicities globally. The prevalence of pelvic organ prolapse is substantial, with estimates suggesting that up to 50% of parous women may experience some degree of prolapse during their lifetime.ObjectiveThis retrospective evaluation aimed to compare the outcomes of robot-assisted sacral colpopexy (RASC) and traditional laparoscopic sacral colpopexy (LSC) in the treatment of pelvic organ prolapse, focusing on surgical outcomes, postoperative pain, quality of life, complications, and recurrence rates.MethodsA total of 138 patients treated for pelvic organ prolapse and undergoing sacral colpopexy from December 2021 to December 2023 were included in the study. The patients were categorized into two groups based on the procedure utilized: RASC or LSC. Demographic characteristics, surgical outcomes, postoperative pain scores, quality of life, complications, and recurrence rates were compared between the two groups.ResultsThe demographic characteristics of the study population demonstrated comparable baseline profiles for the RASC and LSC groups. RASC was associated with shorter surgery duration, lower intraoperative blood loss, shorter operative time for apical prolapse repair, and significantly lower postoperative pain scores at 24, 48, and 72 h postoperatively compared to LSC. Additionally, patients undergoing RASC demonstrated significantly better quality of life across various domains compared to those undergoing LSC. There were no statistically significant differences in the incidence of complications between the two groups. Furthermore, the RASC group demonstrated consistently lower recurrence rates at 1, 2, and 5 years postoperatively compared to the LSC group.ConclusionRobot-assisted sacral colpopexy offers potential advantages over traditional laparoscopic sacral colpopexy in the treatment of pelvic organ prolapse, with favorable surgical outcomes, reduced postoperative pain, improved quality of life, comparable complication rates, and lower recurrence rates. These findings support the consideration of RASC as a promising surgical approach for addressing pelvic organ prolapse and provide valuable insights for informing clinical decision-making and refining the approach to pelvic organ prolapse treatment.

Comparison of cervical length measured by pelvic organ prolapse quantification system and sonography

Background

Pelvic organ prolapse (POP) is associated with cervical elongation (CE). The presence of CE could affect the surgical approach for the patient. Cervical length measurement using the pelvic organ prolapse quantification system (POP‐Q) has poor accuracy in CE detection. We speculated that transvaginal sonography of the cervix could be an alternative method to assess the cervical length properly.

Aims

We aimed to compare cervical length based on POP‐Q examination with transvaginal sonography.

Methods

This was a prospective observational study of 99 patients with POP symptoms. POP‐Q staging was performed, and a gynaecologist determined cervical length. Moreover, all women underwent transvaginal sonography, and cervical length was reported. We used the inter‐class correlation coefficient and Bland–Altman plot to assess agreement. We used Spearman or Pearson correlation to determine the relationship between measurements difference and age, body mass index (BMI), total vaginal length, and parity.

Results

One‐sample t‐test showed a significant difference between cervical length measured by POP‐Q and sonography (mean difference 9.93, 95% CI 8.26–11.93, p value <.001). The inter‐class correlation coefficient was reported as 0.476 (95% CI 0.22–0.65). The Bland–Altman plot illustrated considerable disagreement. There was no statistically significant correlation between measurement discrepancy and age, BMI, total vaginal length, or parity.

Conclusions

There is a significant discrepancy between the POP‐Q system and sonography in cervical length measurement. Given the importance of CE detection in choosing an appropriate surgical approach, it seems reasonable to repeat the measurement using alternative methods like sonography.