Department of Obstetrics and Gynecology, CHU de Poitiers, Poitiers, France.
Université de Poitiers, CIC-Inserm, DECLAN, Poitiers, France.
Int J Gynaecol Obstet. 2024 Nov;167(2):573-597. doi: 10.1002/ijgo.15697. Epub 2024 May 22.
Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.
The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse-associated symptoms in terms of diagnosis and predictability of treatment success.
The databases were queried similarly using Medical Subject Headings (MeSH) and non-MeSH terms broadly related to pelvic examination and POP management.
We included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery.
We assessed peer-reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS-E or RoB2 tools.
In all, 67 studies were retained for the review. Prolapse-associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements.
In women complaining of prolapse-associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion-discernible on pelvic examination-are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.
法国健康高级管理局最近发布的关于盆腔器官脱垂（POP）管理的建议强调了盆腔检查的价值。
本文旨在分析文献，确定在诊断和预测治疗成功方面，针对出现脱垂相关症状的女性，有关盆腔检查的最佳证据。
使用与盆腔检查和 POP 管理广泛相关的医学主题词（MeSH）和非 MeSH 术语，对数据库进行类似的查询。
我们纳入了评估盆腔检查（与症状的相关性）对诊断的贡献及其在评估阴道器械失败或重建手术后复发风险的价值的研究。
我们在 PubMed、Embase 和 Cochrane 数据库中评估了同行评议的文章，截止日期为 2023 年 5 月。使用 ROBINS-E 或 RoB2 工具评估所有纳入研究的方法学质量。
共纳入 67 项研究进行综述。脱垂相关症状与 POP 诊断相关性差。与 POP 分期相关性最好的症状是阴道膨出（中度至高度相关性）。与手术后或阴道器械失败后复发风险最密切相关的因素是临床因素：主要是手术前 POP 分期更高、肛提肌撕裂以及阴道和生殖器测量。
在出现脱垂相关症状的女性中，盆腔检查（阴道窥器和阴道指诊）可以确认 POP 的存在，并识别手术管理或阴道器械放置后治疗失败或复发的风险因素。盆腔检查中可识别的 POP 分期更高和肛提肌撕裂是 POP 复发或治疗失败的主要危险因素。这些特征必须在治疗选择中考虑，并与患者讨论。
