Have you tried Ultrasound Imaging to Evaluate Prolapse?

Today's post is written by faculty member Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC. You can join Allison in her Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics course, which takes place in Baltimore this year, June 12-14.

Since the mid 1990’s the POP-Q has been used to quantify, describe and stage pelvic organ prolapse. A series of 6 points are measured in the vagina in relation to the hymen. In a recent years, translabial ultrasound imaging has been used to look at the pelvic organs and the pelvic floor. A skilled practitioner can view pelvic floor muscle contractions, as well as Valsalva maneuvers and the effects each of these have on the pelvic organs. For example funneling of the urethral meatus, rotation of the urethra, opening of the retrovesical angle, and dropping of the bladder neck and uterus can be viewed using ultrasound imaging of the anterior compartment during Valsalva maneuvers. Pelvic organ descent seen on ultrasound imaging has been associated with symptoms of prolapse.

Until now the relationship between ultrasound and clinical findings has not been examined. A recent study by Dietz set out to see if there is an association between clinical prolapse findings and pelvic descent seen on ultrasound. Data was obtained on 825 women seeking treatment at a urogynecological center for symptoms of lower urinary tract or pelvic floor muscle dysfunction. Five coordinates of the POP-Q scale were measured and compared to ultrasound measures of descent. All data was blinded against other data obtained. Clinically, 78% of the women were found to have a POP-Q stage of 2 or greater. It was found that all coordinates were strongly associated with ultrasound measures of descent. The association was almost linear, particularly for the anterior compartment. This means that ultrasound measures can be used to quantify prolapse and be comparable to the POP-Q. Proposed cutoffs have been made for the bladder, uterus, and rectum in relation to the pubic symphysis.

It is exciting to see ultrasound use in the quantification and identification of more gynecological disorders. The use of translabial ultrasound imaging is growing and continuing to be researched. It is an exciting field to be a part of and I look forward to seeing where this research goes. I believe it will be used to help improve surgical procedures as well candidate selection for surgery. Join more for more discussion regarding translabial ultrasound imaging and learn how to view these images in Rehabilitative Ultrasound Imaging for the Pelvic Girdle and Pelvic Floor in Baltimore this June!

Dietz HP, Kamisan Atan I, Salita A. The association between ICS POPQ coordinates and translabial ultrasound findings: implications for the definition of ‘normal pelvic organ support’. Ultrasound Obstet Gynecol. 2015; April.