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Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations

IMPORTANCE: Despite recognition of the critical role of the apex in vaginal support, there is no consensus on the anatomic criteria for clinically relevant apical prolapse. OBJECTIVE: The aim of this study was to define an optimal anatomic criterion for clinically relevant apical prolapse. STUDY DES...

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Autores principales: Oh, Sumin, Shin, E. Kyung, Lee, So Yeon, Kim, Min Ju, Lee, Youjoung, Jeon, Myung Jae
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637301/
https://www.ncbi.nlm.nih.gov/pubmed/37493249
http://dx.doi.org/10.1097/SPV.0000000000001383
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author Oh, Sumin
Shin, E. Kyung
Lee, So Yeon
Kim, Min Ju
Lee, Youjoung
Jeon, Myung Jae
author_facet Oh, Sumin
Shin, E. Kyung
Lee, So Yeon
Kim, Min Ju
Lee, Youjoung
Jeon, Myung Jae
author_sort Oh, Sumin
collection PubMed
description IMPORTANCE: Despite recognition of the critical role of the apex in vaginal support, there is no consensus on the anatomic criteria for clinically relevant apical prolapse. OBJECTIVE: The aim of this study was to define an optimal anatomic criterion for clinically relevant apical prolapse. STUDY DESIGN: This retrospective cohort study included 3,690 patients who had visited a tertiary hospital for ambulatory urogynecologic care. Vaginal bulge symptom was defined as a response of “somewhat,” “moderately,” or “quite a bit” to Question 3 on the Pelvic Floor Distress Inventory-20. Receiver operating characteristic curves were generated for a vaginal bulge symptom and apical support (Pelvic Organ Prolapse Quantification point C and C/total vaginal length [TVL]). RESULTS: Both point C and the C-to-TVL ratio (C/TVL) had excellent performance for predicting vaginal bulge symptoms (area under the curve, 0.917 and 0.927, respectively). The optimal cutoffs were −3.0 for C and −0.50 for C/TVL. When we analyzed the data set according to the TVL, there was a significant difference in the cutoffs for C, whereas those for C/TVL had little difference. There was no difference in the cutoffs of C and C/TVL according to hysterectomy status. CONCLUSIONS: The C/TVL is more appropriate than point C as a measure to define an anatomic criterion for clinically relevant apical prolapse. Descent of the vaginal apex beyond the halfway point of the vagina could be considered as an anatomic threshold for clinically relevant apical prolapse. This finding needs to be validated in nonurogynecology populations.
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spelling pubmed-106373012023-11-15 Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations Oh, Sumin Shin, E. Kyung Lee, So Yeon Kim, Min Ju Lee, Youjoung Jeon, Myung Jae Urogynecology (Phila) Original Research IMPORTANCE: Despite recognition of the critical role of the apex in vaginal support, there is no consensus on the anatomic criteria for clinically relevant apical prolapse. OBJECTIVE: The aim of this study was to define an optimal anatomic criterion for clinically relevant apical prolapse. STUDY DESIGN: This retrospective cohort study included 3,690 patients who had visited a tertiary hospital for ambulatory urogynecologic care. Vaginal bulge symptom was defined as a response of “somewhat,” “moderately,” or “quite a bit” to Question 3 on the Pelvic Floor Distress Inventory-20. Receiver operating characteristic curves were generated for a vaginal bulge symptom and apical support (Pelvic Organ Prolapse Quantification point C and C/total vaginal length [TVL]). RESULTS: Both point C and the C-to-TVL ratio (C/TVL) had excellent performance for predicting vaginal bulge symptoms (area under the curve, 0.917 and 0.927, respectively). The optimal cutoffs were −3.0 for C and −0.50 for C/TVL. When we analyzed the data set according to the TVL, there was a significant difference in the cutoffs for C, whereas those for C/TVL had little difference. There was no difference in the cutoffs of C and C/TVL according to hysterectomy status. CONCLUSIONS: The C/TVL is more appropriate than point C as a measure to define an anatomic criterion for clinically relevant apical prolapse. Descent of the vaginal apex beyond the halfway point of the vagina could be considered as an anatomic threshold for clinically relevant apical prolapse. This finding needs to be validated in nonurogynecology populations. Lippincott Williams & Wilkins 2023-11 2023-07-26 /pmc/articles/PMC10637301/ /pubmed/37493249 http://dx.doi.org/10.1097/SPV.0000000000001383 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Research
Oh, Sumin
Shin, E. Kyung
Lee, So Yeon
Kim, Min Ju
Lee, Youjoung
Jeon, Myung Jae
Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title_full Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title_fullStr Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title_full_unstemmed Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title_short Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
title_sort anatomic criterion for clinically relevant apical prolapse in urogynecology populations
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637301/
https://www.ncbi.nlm.nih.gov/pubmed/37493249
http://dx.doi.org/10.1097/SPV.0000000000001383
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