Pacquée S, Dietz H P
Department of Obstetrics, Gynaecology & Neonatology, Sydney Medical School Nepean, University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
Int Urogynecol J. 2023 Jan;34(1):185-190. doi: 10.1007/s00192-022-05208-3. Epub 2022 May 2.
Staging of pelvic organ prolapse (POP) is important in clinical practice and research. Pelvic organ descent on Valsalva can be confounded by levator co-activation, which may be avoided by assessment on coughing. We evaluated the performance of a three consecutive coughs maneuver in the assessment of POP compared with standardised 6-second Valsalva.
This was a retrospective observational study carried out in women attending a tertiary urogynaecological service in 2017-2019. Patients underwent a standardised interview and clinical examination. Clinical assessment was performed twice, with both 6-s Valsalva and three consecutive coughs performed in random order. Main outcomes were Ba, C and Bp as defined by Pelvic Organ Prolapse-Quantification (POP-Q). Association between coordinates and prolapse symptoms was investigated with receiver-operating characteristic (ROC) statistics.
Datasets of 855 women were analysed. POP symptoms were reported by 447 patients (52%) with a mean bother of 6.1 (SD 3.0). On clinical assessment, relevant prolapse was found in 716 (84%) patients on Valsalva and in 730 (85%) on coughing (p=0.109). Clinically relevant prolapse in the apical compartment was more likely to be detected on Valsalva (p<0.0001). Mean POP-Q measurements were not significantly different between maneuvers, except for Ba (p=0.004). ROC curve analysis yielded an area under the curve of 0.74 (95% CI, 0.70-0.77) for maximum POP-Q stage on Valsalva and 0.72 (95% CI, 0.69-0.75) after three consecutive coughs, with a similar performance of both maneuvers in predicting prolapse symptoms (p=0.95).
Clinical assessment of POP by consecutive coughing seems complementary to standardised Valsalva, especially if Valsalva performance is poor.
盆腔器官脱垂（POP）的分期在临床实践和研究中很重要。用力屏气时盆腔器官下降可能会因提肛肌共同激活而混淆，通过咳嗽评估可避免这种情况。我们评估了连续三次咳嗽动作在POP评估中的表现，并与标准化的6秒用力屏气进行比较。
这是一项回顾性观察研究，于2017 - 2019年在一家三级泌尿妇科服务机构就诊的女性中开展。患者接受了标准化访谈和临床检查。临床评估进行了两次，6秒用力屏气和连续三次咳嗽以随机顺序进行。主要结局指标为盆腔器官脱垂定量（POP-Q）定义的Ba、C和Bp。通过受试者操作特征（ROC）统计分析坐标与脱垂症状之间的关联。
分析了855名女性的数据集。447例患者（52%）报告有POP症状，平均困扰程度为6.1（标准差3.0）。临床评估时，用力屏气时716例（84%）患者发现有相关脱垂，咳嗽时730例（85%）患者发现有相关脱垂（p = 0.109）。在顶端区域，临床上相关的脱垂在用力屏气时更易被检测到（p < 0.0001）。除Ba外，各动作间平均POP-Q测量值无显著差异（p = 0.004）。ROC曲线分析显示，用力屏气时最大POP-Q分期的曲线下面积为0.74（95%可信区间，0.70 - 0.77），连续三次咳嗽后为0.72（95%可信区间，0.69 - 0.75），两种动作在预测脱垂症状方面表现相似（p = 0.95）。
通过连续咳嗽对POP进行临床评估似乎是对标准化用力屏气的补充，尤其是在用力屏气表现不佳时。
