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abstract

348 - ASSESSMENT OF VAULT PROLAPSE, IS VALSALVA GOOD ENOUGH?

348

ASSESSMENT OF VAULT PROLAPSE, ISVALSALVA GOOD ENOUGH?

S. BENNENBROEK, J. VEEN, M.BONGERS;
Gynaecology, Màxima Med. Ctr., Veldhoven, Netherlands.

Introduction: Assessment ofmaximum vaginal vault descent in women with pelvic organ prolapse(‘POP’) is needed for optimal surgical planning, i.e. thenecessity for restoration of level I support. Vault traction is oftenapplied under anaesthesia because it seems to allow for a moreclinically relevant assessment as compared with assessment of maximumdescent using the Valsalva maneuver.
Objective: In thisstudy, the effect of vaginal vault traction with a traction deviceduring pelvic examination under anesthesia in hysterectomized womenwas compared with the descent on Valsalva as assessed in theoutpatient clinic. We hypothesized that there was more descent of thevaginal vault with use of the traction device.
Methods: Weconducted a retrospective chart review of hysterectomized women whounderwent POP surgery at our institution between July 2013 and June2016. Subjects were included if the apical compartment Pelvic OrganQuantification (‘POP-Q point C’) was available from thepre-operative Valsalva maneuver and intra-operative examination undertraction using Allis forceps. The two examination techniques werecompared using a paired samples t-test, McNemar test andBland-Altman plot.
Results: 69 patients were included foranalysis. POP-Q point C was significantly higher (i.e. more descent)when examined under vault traction compared with Valsalva, with amean difference of 1.7 cm (95% CI 1.1 - 2.3 cm, p<.0001).In 33 women (54%), point C increased 2 cm or more. In 18 patients(26.1%) the POP-Q under traction increased 1 stage and in 2 patients(2.6%) even 2 stages compared with Valsalva. Among women with stage 0or I pre-operatively, 18 (40.9%) had at least stage II when applyingtraction. The Bland-Altman plot showed a clinically significantdifference between examination techniques (95% limits of agreement-2.9 - 6.3 cm). Since traction was consistently applied until maximumdescent was felt and Valsalva may not always have been performedadequately and consistently, wide levels of agreement may indicatethat traction allows for a more standardized and objectiveassessment.
Conclusions: 69 patients were included foranalysis. POP-Q point C was significantly higher (i.e. more descent)when examined under vault traction compared with Valsalva, with amean difference of 1.7 cm (95% CI 1.1 - 2.3 cm, p<.0001).In 33 women (54%), point C increased 2 cm or more. In 18 patients(26.1%) the POP-Q under traction increased 1 stage and in 2 patients(2.6%) even 2 stages compared with Valsalva. Among women with stage 0or I pre-operatively, 18 (40.9%) had at least stage II when applyingtraction. The Bland-Altman plot showed a clinically significantdifference between examination techniques (95% limits of agreement-2.9 - 6.3 cm). Since traction was consistently applied until maximumdescent was felt and Valsalva may not always have been performedadequately and consistently, wide levels of agreement may indicatethat traction allows for a more standardized and objectiveassessment.
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