Nam Gina, Lee Sa-Ra, Kim Sung-Hoon, Chae Hee-Dong
Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Korea.
Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
J Clin Med. 2021 Sep 20;10(18):4267. doi: 10.3390/jcm10184267.
The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen's kappa (κ). values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.
在我们这个老龄化社会中，盆腔器官脱垂（POP）的发病率正在上升。我们旨在通过比较晚期POP患者的POP-Q检查结果和经阴唇超声检查（TLUS）结果，评估TLUS的临床实用性，同时我们还旨在评估TLUS检查中直肠膨出和肠膨出的患病率。我们分析了2019年3月至2021年4月期间到我们诊所就诊的363例有症状的POP患者的TLUS和POP-Q检查结果。我们排除了3例经TLUS检查发现有类似POP情况的患者。最常见的POP类型是前盆腔POP（68.61%），其次是顶端盆腔（38.61%）和后盆腔（16.11%）POP。使用Cohen's kappa（κ）检验POP-Q检查和TLUS之间的一致性。κ值<0.05被认为具有统计学意义。直肠膨出或肠膨出的发生率仅为1.67%（6/360），当POP-Q检查显示后盆腔POP时，大多数患者（246/252，96.63%）没有直肠膨出或肠膨出，这表明他们只有阴道后壁松弛。POP-Q检查检测直肠膨出或肠膨出（如TLUS所示）的阳性预测值仅为2.38%，而阴性预测值为100%。总之，TLUS的应用在POP的诊断中是有用的，特别是用于区分真正的POP和类似POP的情况。POP-Q检查和TLUS之间的相关性较低，尤其是在后盆腔POP中，因此，POP-Q检查结果提示后盆腔POP的患者应接受TLUS检查以排查直肠膨出或肠膨出。在POP患者的诊断中使用TLUS可以结合POP-Q检查提高POP患者诊断的准确性。
