Agreement of manual exam (POP-Q) with pelvic MRI in assessment of anterior pelvic organ prolapse

Abstract

Background: Pelvic floor dysfunction (PFD) refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, lower back, coccyx, or hip joints. PFD and pelvic organ prolapse (POP) affect about 50% of women past middle age. Symptoms include pelvic pain, pressure, dyspareunia, incontinence, incomplete emptying, and gross organ protrusion. Nowadays, there are novel diagnostic tools and therapies proposed for pelvic floor weakness and organ prolapse. Pelvic organ prolapse quantification system (POP-Q) examination and complementary magnetic resonance imaging (MRI) are two methods of diagnosis. Objectives: The goal of our study was to assess the agreement between POP-Q examination and MRI in detecting anterior pelvic prolapses. In addition, we evaluated the additive role of MRI adjunct to POP-Q examination in detecting anterior pelvic organ prolapse. Patients and Methods: An experimental study was carried out on 61 patients having clinical manifestations suggesting pelvic floor weakness. The medical history and physical examination were obtained from all patients. POP-Q examination and dynamic MR imaging was performed. POP-Q results were compared with dynamic MRI findings thereafter. Results: Considering pubococcygeal line (PCL) and H line as reference lines, comparison of MRI and POP-Q findings for detecting bladder neck and urethra prolapses revealed a moderate to good agreement (49% - 80%) rate between MRI and POP-Q examination. This corresponds to a weak to moderate agreement between these two methods. Conclusion: Agreement of MRI and POP-Q is moderate to good for detecting anterior pelvic organs prolapses. MRI could be regarded as a complementary method to POP-Q examination. A combination diagnostic approach, including MRI and POP-Q, for high stage pelvic prolapse is highly recommended.