UsingZ-scores to evaluate levator hiatal dimensions with four-dimensional translabial ultrasound

International Urogynecological Consultation Chapter 2.2: Imaging in the Diagnosis of Pelvic Organ Prolapse

INTRODUCTION AND HYPOTHESIS

This section of Chapter 2.2 of the International Urogynecology Consultation on Pelvic Organ Prolapse (POP), reviews the literature on the role of imaging in the diagnosis of POP.

METHODS

An international group of nine urogynecologists and one university-based medical librarian adhered to the framework of the scoping review. The group performed a search of the literature using pre-specified search terms in Scopus, OVID Medline, and PubMed. Publications were eliminated if not relevant to the diagnostic value of POP imaging. The remaining articles were evaluated for quality using the Joanna Briggs Institute Checklist for Diagnostic Test Accuracy Studies. The resulting list of articles was used to perform a comprehensive narrative review of the diagnostic value of imaging modalities for the diagnosis of POP.

RESULTS

The original search yielded 3,289 references, 135 of which were used by the writing group.

CONCLUSIONS

Most imaging studies utilized in the diagnoses of POP lacked standardization in the definition of POP. Most imaging studies lack standardization in the protocols used to diagnose POP within each imaging technique. Ultrasound- and MRI-related studies are most represented in the literature, compared with fewer CT- and X-ray-/fluoroscopy-related studies. Therefore, radiographic imaging is of limited value in the diagnosis of POP.

Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

BACKGROUND AND HYPOTHESIS

Pelvic organ prolapse (POP) is a very common and distressing problem that affects women's quality of life. This systematic review aimed to investigate the association of the dimensions of the genital hiatus and levator hiatus at rest and Valsalva with POP.

METHODS

The Cochrane Library, PubMed, Scopus, Embase and Web of Science were searched on 25 April 2020. All data were analyzed using Review Manager 5.3.

RESULTS

Of the 1288 papers reviewed, 21 (n = 5145: 2909 women with POP and 2236 controls) were considered for meta-analysis. Compared with the normal pelvic floor group, the urogenital hiatus size in the POP group was significantly higher at rest (mean difference: 0.49; 95% CI: [0.43, 0.55], P < 0.00001) and at Valsalva (mean difference: 0.79; 95% CI: [0.70, 0.89], P < 0.00001). Also, the levator ani hiatus size in the POP group was significantly higher at rest (mean difference: 0.52, 95% CI: [0.25, 0.78], P < 0.0001) and at Valsalva (mean difference: 1.01; 95% CI: [0.73,1.28], P < 0.00001) compared with that in the normal pelvic floor group.

CONCLUSION

This systematic review showed that the sizes of the urogenital hiatus and levator ani hiatus and area of the levator hiatus in the POP group were significantly higher than those in the normal pelvic floor groups in both positions (rest or Valsalva maneuver). Also, in the POP group, the levator hiatus length at rest was significantly lower than that in the Valsalva maneuver.