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Effects of a Full Bladder and Patient Positioning on Pelvic Organ Prolapse Assessment

W Andre Silva, MD^*, Steven Kleeman, MD^*, Jeffrey Segal, MD^*, Rachel Pauls, MD^*, Scott E. Woods, MD, MPH and Mickey M. Karram, MD^*

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Good Samaritan Hospital, and Bethesda Family Medicine Residency Program, Cincinnati, Ohio.

OBJECTIVE: To evaluate the effect of bladder filling and patient position on the degree of pelvic organ prolapse (of the maximally prolapsed segment).

METHODS: Fifty consecutive patients with symptomatic pelvic organ prolapse were evaluated between February 2003 and August 2003. Patients were examined in the supine lithotomy and standing position at maximal bladder capacity and then in the supine lithotomy and standing position with an empty bladder. The International Continence Society's Pelvic Organ Prolapse Quantification system was used.

RESULTS: The mean descent of prolapse beyond the hymen was 0.39 cm in the full/supine setting, 1.3 cm, full/standing, 1.9 cm, empty/supine, and 2.7 cm, empty/standing. All mean paired differences in the six examination pairs (empty/standing compared with empty/supine, full/standing compared with full/supine, full/standing compared with empty/standing, full/supine compared with empty/supine, full/standing compared with empty/supine, and full/supine compared with empty/standing) were statistically significantly different. The largest mean paired difference was noted in the full/supine compared with empty/standing pair (–2.3, 95% confidence interval –2.8 to –1.8, P < .001). Age and parity were not associated with differences in measurements taken in the different examination conditions. Using a linear regression model to control for body mass index, maximal bladder capacity, and Pelvic Organ Prolapse Quantification system stage, it was found that the values were still statistically significant. Full/supine compared with empty/standing pairs were significantly more likely to be upstaged by 1 stage (P < .001), or by 2 stages (P = .049), but not by 3 stages (P = .061).

CONCLUSION: Unless a patient is examined in the standing position with an empty bladder, the full extent of the prolapse may not be appreciated.

LEVEL OF EVIDENCE: II-3

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				A. M. Weber and H. E. Richter Pelvic Organ Prolapse Obstet. Gynecol., September 1, 2005; 106(3): 615 - 634. [Abstract] [Full Text] [PDF]