Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia.
PLoS One. 2019 Mar 15;14(3):e0213617. doi: 10.1371/journal.pone.0213617. eCollection 2019.
While normal pelvic organ support has been defined for women with intact uterus, this is not the case for post- hysterectomy vault descent. A recent systematic review found that definitions of apical prolapse are highly variable.
To investigate the relationship between prolapse symptoms and apical POP-Q measurements and establish cutoffs for 'significant apical descent using receiver-operator characteristics (ROC) statistics.
Retrospective analysis of patients seen at a tertiary urogynecological unit. Evaluation included a standardized interview and clinical assessment using the Pelvic Organ Prolapse Quantification (POP-Q) system. ROC curves were prepared for the relationship between prolapse symptoms and POP-Q measure "C".
The records of 3010 women were available for analysis. Prolapse symptoms were reported by 52.3% (n = 1573), with a mean bother of 5.9 (SD 3.0, range 0-10). POP-Q point "C" was associated with symptoms of prolapse (p <0.0001) and prolapse bother (p <0.0001) on both univariate and multivariate analysis. ROC curves for women with and without uterus were similar, although the relationship between apical descent and symptoms of prolapse was stronger for women with uterus (AUC 0.728 versus 0.678). After controlling for multi-compartment prolapse, the models improved, resulting in AUCs of 0.782 and 0.720. For prediction of prolapse symptoms, cutoffs were set at C = -5 (sensitivity 0.73, specificity 0.67 with uterus in situ, sensitivity 0.59, specificity, 0.73 after hysterectomy).
A cut- off for 'significant central compartment descent' of 5 cm above the hymen on Valsalva seems valid regardless of previous hysterectomy.
虽然对于子宫完整的女性，正常的盆腔器官支持已经有了定义，但对于子宫切除术后的阴道穹隆下降，这种情况并不适用。最近的一项系统评价发现， apical prolapse 的定义差异很大。
探讨脱垂症状与 apical POP-Q 测量之间的关系，并利用接受者操作特征（ROC）统计数据确定“显著 apical 下降”的截断值。
回顾性分析在三级泌尿妇科单位就诊的患者。评估包括使用盆腔器官脱垂量化（POP-Q）系统进行标准化访谈和临床评估。为 prolapse 症状与 POP-Q 测量“C”之间的关系准备了 ROC 曲线。
可分析的患者记录有 3010 份。脱垂症状报告率为 52.3%（n=1573），平均困扰程度为 5.9（SD 3.0，范围 0-10）。POP-Q 点“C”与脱垂症状（p<0.0001）和脱垂困扰（p<0.0001）相关，无论是在单变量还是多变量分析中。有子宫和无子宫的妇女的 ROC 曲线相似，尽管子宫存在时， apical 下降与脱垂症状之间的关系更强（AUC 为 0.728 与 0.678）。在控制多部位脱垂后，模型得到了改善，导致 AUC 分别为 0.782 和 0.720。对于预测脱垂症状，设定的截断值为 C=-5（有子宫时的敏感性为 0.73，特异性为 0.67，子宫切除后敏感性为 0.59，特异性为 0.73）。
对于子宫切除术后的阴道穹隆下降，在 Valsalva 时处女膜上方 5cm 的“中央隔显著下降”的截断值似乎是有效的，无论之前是否进行了子宫切除术。
