Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings

Anique T.M. Grob (Corresponding Author), Judith olde Heuvel, Jurgen J. Futterer, Diana Massop, Angelique L. Veenstra van Nieuwenhoven, Frank F.J. Simonis, Carl H. van der Vaart

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Abstract

Objective: Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.

Methods: This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.

Results: All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm2; SD ±14.8) than during the supine–strain position (mean 33.5 cm2; SD ±14.5), with a p value of 0.02.

Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.

Original languageEnglish
JournalInternational Urogynecology Journal
Early online date17 Jan 2019
DOIs
Publication statusE-pub ahead of print/First online - 17 Jan 2019

Fingerprint

Pelvic Organ Prolapse
Supine Position
Magnetic Resonance Imaging
Douglas' Pouch
Cervix Uteri
Urinary Bladder
Pelvic Floor
Prolapse
Gravitation
Prospective Studies

Keywords

  • Extent
  • Prolapse
  • Pubococcygeal line
  • Strain
  • Upright MRI

Cite this

@article{86b050a63f8249d8ad6ae3a78e917528,
title = "Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings",
abstract = "Objective: Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.Methods: This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.Results: All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm2; SD ±14.8) than during the supine–strain position (mean 33.5 cm2; SD ±14.5), with a p value of 0.02.Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.",
keywords = "Extent, Prolapse, Pubococcygeal line, Strain, Upright MRI",
author = "Grob, {Anique T.M.} and Heuvel, {Judith olde} and Futterer, {Jurgen J.} and Diana Massop and {Veenstra van Nieuwenhoven}, {Angelique L.} and Simonis, {Frank F.J.} and {van der Vaart}, {Carl H.}",
year = "2019",
month = "1",
day = "17",
doi = "10.1007/s00192-018-03862-0",
language = "English",
journal = "International Urogynecology Journal",
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publisher = "Springer",

}

Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings. / Grob, Anique T.M. (Corresponding Author); Heuvel, Judith olde; Futterer, Jurgen J.; Massop, Diana; Veenstra van Nieuwenhoven, Angelique L.; Simonis, Frank F.J.; van der Vaart, Carl H.

In: International Urogynecology Journal, 17.01.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings

AU - Grob, Anique T.M.

AU - Heuvel, Judith olde

AU - Futterer, Jurgen J.

AU - Massop, Diana

AU - Veenstra van Nieuwenhoven, Angelique L.

AU - Simonis, Frank F.J.

AU - van der Vaart, Carl H.

PY - 2019/1/17

Y1 - 2019/1/17

N2 - Objective: Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.Methods: This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.Results: All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm2; SD ±14.8) than during the supine–strain position (mean 33.5 cm2; SD ±14.5), with a p value of 0.02.Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.

AB - Objective: Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.Methods: This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.Results: All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm2; SD ±14.8) than during the supine–strain position (mean 33.5 cm2; SD ±14.5), with a p value of 0.02.Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.

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KW - Prolapse

KW - Pubococcygeal line

KW - Strain

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