Accuracy of clinical evaluation of patients with site-specific vaginal wall prolapse and its corelation to surgical diagnosis

Abstract

Introduction: Pelvic organ prolapse (POP) is a defect of a specific vaginal segment characterized by descent of the vagina and associated pelvic organ. An understanding of normal pelvic support structures provides the basis for the identification of the defect and anatomic approach to repair. Aims and objectives: • To clinically evaluate the patients of uterovaginal prolapse for site-specific defects and levels of damage. • To corelate the clinical evaluation with evaluation during surgery. • To perform the site-specific repair of the defects. Materials and methods: A prospective observational study was conducted on 45 women admitted to the gynecological ward of King Edward Memorial (KEM) Hospital, Mumbai, India with symptoms of POP during a period of 13 months after seeking ethical clearance. After obtaining written informed consent, patients were subjected to detailed clinical evaluation for the type of prolapse, degree, and the site-specific defect. Patients were taken for surgery. Identification of the site-specific defect followed by restoration of the anatomic relationships by either repairing connective tissue supports or by creating a compensatory support mechanism was done. Results: On analysis of our study, it was observed that there is mild agreement (0.4–0.6) between the clinical and operative diagnosis of transverse defect and unilateral paravaginal defect of anterior compartment. However, there is good agreement (0.6–0.8) between the clinical and operative diagnosis of bilateral paravaginal defects of anterior compartment. The clinical diagnosis for transverse defect of posterior compartment has accuracy of 88.2%. Conclusion: The intraoperative diagnosis of site-specific defects remains the gold standard for detection of these defects.