Genital prolapse Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):441-447
DOI 10.1590/S0100-72032004000600004
OBJECTIVE: to compare Baden and Walker's (BW) classification system to the International Continence Society (ICS) standardization of terminology of female pelvic organ prolapse. METHODS: information about urogynecological investigation on 101 women, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, was retrospectively analyzed. Only patients who had undergone the standard ICS exam which quantifies the pelvic prolapse were selected. According to ICS, the prolapse is analyzed through a standard reference system relating the hymen to the anatomic position of six vaginal points: two in the anterior vaginal wall, two in the vaginal apex and other two in the posterior vaginal wall. The maximum amount of pelvic organ prolapse was viewed and recorded during a Valsalva's maneuver. The measurement of the most distal point of the prolapse was performed and it was compared to the BW classification system. The data were analyzed by kappa statistics, to assess the concordance between the two terminologies. RESULTS: There was total correspondence only for the posterior vaginal prolapse stage IV (one patient) and for the uterus prolapse stage 0 (29 patients) with severe rectocele and absence of prolapse, respectively, according to BW. In the three types of prolapses evaluated, the values of kappa statistics were below 0.4, indicating a weak concordance between the two terminologies. There is an extensive variation in the measurement of the most distal point of prolapse when the BW classification is perfomed. CONCLUSIONS: there is a weak concordance between the BW classification system and the ICS standardization of terminology of female pelvic organ prolapse.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):441-447
DOI 10.1590/S0100-72032004000600004
OBJECTIVE: to compare Baden and Walker's (BW) classification system to the International Continence Society (ICS) standardization of terminology of female pelvic organ prolapse. METHODS: information about urogynecological investigation on 101 women, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, was retrospectively analyzed. Only patients who had undergone the standard ICS exam which quantifies the pelvic prolapse were selected. According to ICS, the prolapse is analyzed through a standard reference system relating the hymen to the anatomic position of six vaginal points: two in the anterior vaginal wall, two in the vaginal apex and other two in the posterior vaginal wall. The maximum amount of pelvic organ prolapse was viewed and recorded during a Valsalva's maneuver. The measurement of the most distal point of the prolapse was performed and it was compared to the BW classification system. The data were analyzed by kappa statistics, to assess the concordance between the two terminologies. RESULTS: There was total correspondence only for the posterior vaginal prolapse stage IV (one patient) and for the uterus prolapse stage 0 (29 patients) with severe rectocele and absence of prolapse, respectively, according to BW. In the three types of prolapses evaluated, the values of kappa statistics were below 0.4, indicating a weak concordance between the two terminologies. There is an extensive variation in the measurement of the most distal point of prolapse when the BW classification is perfomed. CONCLUSIONS: there is a weak concordance between the BW classification system and the ICS standardization of terminology of female pelvic organ prolapse.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):353-358
DOI 10.1590/S0100-72032003000500008
PURPOSE: to determine interobserver reliability of site-specific measurements and stages according to the proposed International Continence Society prolapse terminology document. METHODS: we analyzed 51 women during urogynecological investigation performed at the Urogynecology and Vaginal Surgery Sector of UNIFESP / EPM. We recorded the locations of point-specific measures proposed by the International Continence Society (ICS). They are: two in the anterior vaginal wall, two in the superior vagina, two in the posterior vaginal wall, genital hiatus, perineal body and total vaginal length. Then we recorded the stage of genital prolapse. Women underwent pelvic examinations by two investigators, each blinded to the results of the other's examination. The reproducibility of the nine site-specific measurements and the summary stage were analyzed using Pearson's correlation coefficient and the median measurements were compared by the paired-t test. RESULTS: there were substantial and highly significant correlations for each of the nine measurements. Correlation coefficient for point Aa was 0.89 (p<0.0001), point Ba 0.90 (p<0.0001), point C 0.97 (p<0.0001), point Ap de 0.72 (p<0.0001), point Bp 0.84 (p<0.0001), point D 0.91 (p<0.0001), genital hiatus 0.65 (p<0.0001), perineal body 0.66 (p<0.0001) e total vaginal length 0.73 (p<0.0001). We also did not note differences between the means of measurements by the two examiners. Staging was highly reproducible (r=0.81, p<0.0001). ln no subject did the stage vary by more than one; in 86,2%, stages were identical. CONCLUSIONS: there is a good reproducibility of measures using the system proposed by the International Continence Society prolapse terminology document.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):353-358
DOI 10.1590/S0100-72032003000500008
PURPOSE: to determine interobserver reliability of site-specific measurements and stages according to the proposed International Continence Society prolapse terminology document. METHODS: we analyzed 51 women during urogynecological investigation performed at the Urogynecology and Vaginal Surgery Sector of UNIFESP / EPM. We recorded the locations of point-specific measures proposed by the International Continence Society (ICS). They are: two in the anterior vaginal wall, two in the superior vagina, two in the posterior vaginal wall, genital hiatus, perineal body and total vaginal length. Then we recorded the stage of genital prolapse. Women underwent pelvic examinations by two investigators, each blinded to the results of the other's examination. The reproducibility of the nine site-specific measurements and the summary stage were analyzed using Pearson's correlation coefficient and the median measurements were compared by the paired-t test. RESULTS: there were substantial and highly significant correlations for each of the nine measurements. Correlation coefficient for point Aa was 0.89 (p<0.0001), point Ba 0.90 (p<0.0001), point C 0.97 (p<0.0001), point Ap de 0.72 (p<0.0001), point Bp 0.84 (p<0.0001), point D 0.91 (p<0.0001), genital hiatus 0.65 (p<0.0001), perineal body 0.66 (p<0.0001) e total vaginal length 0.73 (p<0.0001). We also did not note differences between the means of measurements by the two examiners. Staging was highly reproducible (r=0.81, p<0.0001). ln no subject did the stage vary by more than one; in 86,2%, stages were identical. CONCLUSIONS: there is a good reproducibility of measures using the system proposed by the International Continence Society prolapse terminology document.
