IMPACT OF PELVIC ORGAN PROLAPSE ON THE SIZE OF UROGENITAL HIATUS - A COMPARATIVE STUDY OF WOMEN WITH AND WITHOUT PROLAPSE
PURWAR1, R. CARTWRIGHT 2, A. A. FORD 3, R. BRAY 4, N. VEIT-RUBIN 2, A. DIGESU 5, R. FERNANDO 6, V. KHULLAR 2;
1Imperial Coll. Hosp. NHS Trust, London, United Kingdom, 2Imperial Coll. London, London, United Kingdom, 3St. Marys Hosp., London, United Kingdom, 4St Marys Hosp., london, United Kingdom, 5Imperial Coll. NHS Trust, London, United Kingdom, 6Imperial Coll. Hlth.care NHS Trust, London, United Kingdom.
Introduction: Pelvic organ prolapse (POP) is defined by the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina(1). It causes a range of symptoms, including the sensation of a bulge in the vagina, urinary tract symptoms, dyspareunia, and obstructed defecation.
Objective: We conducted a cross-sectional study with the aim to establish differences in the introital parameters associated with vaginal prolapse comparing the controls and the women with prolapse using the POP-Q classification.
Methods: Patients were recruited from clinics within the gynaecology department in a tertiary care hospital. Ethical approval was granted from Research Ethics Committee. The size of hiatus was measured with a wooden, calibrated ruler in the antero-posterior diameter (AP diameter- distance from lower border of pubic symphysis to palpable margin of firm, dense connective tissue of perineal body) in the sagittal plane and in the maximum transverse diameter of the levator ani (Transverse diameter - distance between medial borders of levator ani). We took measurements at the fourchette of the distance between loose skin and firm dense connective tissue of the perineal body (SM), and of the distance between hymeneal remnants (HH). The statistical analysis was done with SPSS V24.
Results: In total 257 women were recruited into the study. The general demographics of the patients in respective groups were comparable. 175 women with POP stage≥2 were found to have a statistically significant larger mean AP diameter, mean transverse diameter and mean area as compared to women with POP stage≤1 (N=82). We also noticed increased distance between hymeneal remnants (in the cases as compared to controls).
Table 1: Outcome measures *Independent sample t-test
The increase in hiatal area was more strongly correlated to the changes in AP diameter (r=0.831, p=0.000 with r2=0.691) than Transverse diameter (r=0.691,p=0.000 with r2=0.478). Analysis of Variance test with Welch test was used to compare the area/size of hiatus between different POP-Q stages, which showed that the size of urogenital hiatus increases with increase in the stages of prolapse. However, there was no statistically difference between stage 0 and stage1 and similarly no statistically difference between stage 3 and stage 4.
Table 2: POP- Q stage wise parameters.
Conclusions: There may be a causal relationship between these measurements, but further work is needed to identify the temporal sequence and prognostic significance. Identification of a wider hiatus provides an opportunity to risk stratify women, and may in future help in counselling regarding the treatment for POP.
References: 1. American journal of obstetrics and gynecology;175(1):10-7.