W. Allen Addison Professor and Chair, Department of Obstetrics and Gynecology, Duke University School of Medicine, 203 Baker House, Box 3084, Durham, NC, 27720, USA.
Int Urogynecol J. 2024 May;35(5):967-976. doi: 10.1007/s00192-024-05798-0. Epub 2024 May 10.
Advances in our understanding of pelvic organ prolapse (POP) have been made with the introduction of valid, reliable measures of anatomy and patient-reported outcome measures.
This review provides an overview of the evolution of POP measurement and its implications for clinical practice and research.
Since the introduction of the Pelvic Organ Prolapse Quantification (POPQ), studies have demonstrated that some degree of loss of anatomic support is normal, with as many as 40% of normal women having stage 2 prolapse. Vaginal support is dynamic and can wax and wane but is largely stable over time. Vaginal bulge symptoms are the most reliable and specific symptom for POP and the hymen is an important threshold for symptom development. Most pelvic floor symptoms have only weak to moderate correlation with the anatomic severity of POP. Treatment success rates are highly variable depending upon criteria used and definitions of anatomic success commonly used are too strict and often not clinically relevant. There is substantial discordance between subjective and anatomic measures of success, and both are dynamic, fluctuating between success and failure for many patients without intervening treatment.
Pelvic organ prolapse is multidimensional, dynamic, and has a complex impact on patients. Patients' symptoms are more clinically relevant than anatomic support. Symptomatic cure, particularly the absence of vaginal bulge symptoms, is more clinically relevant than anatomic cure and composite outcomes can be misleading and overestimate failure rates. Future studies should compare treatments using continuous variables along multiple dimensions rather than using composite outcomes or dichotomizing patients into success or failure.
随着对解剖结构和患者报告的结果测量的有效、可靠措施的引入，我们对盆腔器官脱垂（POP）的理解有了进展。
本综述概述了 POP 测量方法的发展及其对临床实践和研究的影响。
自从引入盆腔器官脱垂量化（POPQ）以来，研究表明，一定程度的解剖支持丧失是正常的，多达 40%的正常女性存在 2 期脱垂。阴道支持是动态的，可以增减，但随着时间的推移基本稳定。阴道膨出症状是 POP 最可靠和最特异的症状，处女膜是症状发展的重要阈值。大多数盆底症状与 POP 的解剖严重程度只有弱到中度的相关性。治疗成功率高度取决于所使用的标准和常用的解剖成功定义过于严格，通常与临床无关。主观和解剖成功的测量之间存在很大的差异，许多患者在没有干预治疗的情况下，两者都在成功和失败之间动态波动。
盆腔器官脱垂是多维度的、动态的，对患者有复杂的影响。患者的症状比解剖支持更具有临床相关性。症状治愈，特别是没有阴道膨出症状，比解剖治愈更具有临床相关性，而综合结果可能具有误导性并高估失败率。未来的研究应该使用多个维度的连续变量来比较治疗方法，而不是使用综合结果或将患者分为成功或失败。
