Does patient posture affect the ultrasound evaluation of pelvic organ prolapse?

Meirav Braverman, Ixora Kamisan @ Atan, Friyan Turel, Talia Friedman, Hans Peter Dietz

Research output: Contribution to journalArticle

Abstract

Objectives-Translabial ultrasound (US) imaging is an emerging method for the evaluation of pelvic organ prolapse (POP). Normative data to date are limited to imaging in the supine position. The purpose of this study was to evaluate the effect of posture changes on US pelvic organ mobility. Methods-This work was a retrospective study of 175 women seen in a tertiary urogynecologic center for symptoms of lower urinary tract and pelvic floor dysfunction. All underwent a standardized interview, POP quantification prolapse assessment, and 4-dimensional translabial US examination in supine and standing positions. Offline measurement of organ descent on the Valsalva maneuver was undertaken at a later date and was blinded against all other data. Results-The mean age was 58 (SD, 13.5; range, 17 to 89) years, with a mean body mass index of 29 (SD, 6.1; range, 18 to 53) kg/m2. In total, 58.9% (n5103) presented with symptoms of prolapse. Clinically, 82.8% (n5145) had substantial prolapsed on the POP quantification assessment. On imaging, bladder, uterine, and rectal ampulla positions were significantly lower, and the hiatal area on the Valsalva maneuver was larger in the standing position (P<.03). On receiver operating characteristic statistics assessing correlations between POP symptoms and US pelvic organ descent, the area under the curve was higher in the standing position, but the difference was not statistically significant. Conclusions-Measurements of organ descent and hiatal dimensions are generally higher in the standing position. However, they are not reflected in a stronger association between symptoms and organ descent. Hence, imaging in the standing position can be limited to those patients in whom a false-negative assessment result is suspected.

LanguageEnglish
Pages233-238
Number of pages6
JournalJournal of Ultrasound in Medicine
Volume38
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Pelvic Organ Prolapse
Posture
Gynecology
Radiology
Valsalva Maneuver
Supine Position
Prolapse
Lower Urinary Tract Symptoms
Pelvic Floor
ROC Curve
Area Under Curve
Ultrasonography
Urinary Bladder
Body Mass Index
Retrospective Studies
Interviews

Keywords

  • Gynecology
  • Pelvic organ prolapse
  • Posture
  • Standing
  • Supine
  • Translabial ultrasound

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Does patient posture affect the ultrasound evaluation of pelvic organ prolapse? / Braverman, Meirav; Kamisan @ Atan, Ixora; Turel, Friyan; Friedman, Talia; Dietz, Hans Peter.

In: Journal of Ultrasound in Medicine, Vol. 38, No. 1, 01.01.2019, p. 233-238.

Research output: Contribution to journalArticle

Braverman, Meirav ; Kamisan @ Atan, Ixora ; Turel, Friyan ; Friedman, Talia ; Dietz, Hans Peter. / Does patient posture affect the ultrasound evaluation of pelvic organ prolapse?. In: Journal of Ultrasound in Medicine. 2019 ; Vol. 38, No. 1. pp. 233-238.
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abstract = "Objectives-Translabial ultrasound (US) imaging is an emerging method for the evaluation of pelvic organ prolapse (POP). Normative data to date are limited to imaging in the supine position. The purpose of this study was to evaluate the effect of posture changes on US pelvic organ mobility. Methods-This work was a retrospective study of 175 women seen in a tertiary urogynecologic center for symptoms of lower urinary tract and pelvic floor dysfunction. All underwent a standardized interview, POP quantification prolapse assessment, and 4-dimensional translabial US examination in supine and standing positions. Offline measurement of organ descent on the Valsalva maneuver was undertaken at a later date and was blinded against all other data. Results-The mean age was 58 (SD, 13.5; range, 17 to 89) years, with a mean body mass index of 29 (SD, 6.1; range, 18 to 53) kg/m2. In total, 58.9{\%} (n5103) presented with symptoms of prolapse. Clinically, 82.8{\%} (n5145) had substantial prolapsed on the POP quantification assessment. On imaging, bladder, uterine, and rectal ampulla positions were significantly lower, and the hiatal area on the Valsalva maneuver was larger in the standing position (P<.03). On receiver operating characteristic statistics assessing correlations between POP symptoms and US pelvic organ descent, the area under the curve was higher in the standing position, but the difference was not statistically significant. Conclusions-Measurements of organ descent and hiatal dimensions are generally higher in the standing position. However, they are not reflected in a stronger association between symptoms and organ descent. Hence, imaging in the standing position can be limited to those patients in whom a false-negative assessment result is suspected.",
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