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P16.02: Ultrasonographic study on uterine hemodynamic changes following transcervical endometrial resection

Objective: Currently, no data exists that would help clinicians decide whether a certain degree of prolapse is relevant or not. This is an important issue as prolapse is generally considered an indication for surgery. We performed a retrospective study to define appropriate cutoffs for significant pelvic organ descent on the basis of prolapse symptoms. Methods: At a tertiary urogynecological centre, 735 women were seen for an interview, clinical examination, multichannel urodynamics and ultrasound imaging for prolapse quantification, supine and after voiding. Women in whom there was prolapse of several compartments, without one being clearly dominant, were excluded from the analysis. Receiver operator statistics were used to test pelvic organ descent as a predictor of prolapse symptoms. Results: Mean age was 55.1 (range 17.9–90.9), mean parity was 2.8 (0-12). Symptoms of prolapse were reported by 188 (25.8%). Seventy-four women showed a symptomatic multi-compartment prolapse and were excluded, leaving 56 cystoceles and 48 rectoceles. Symptomatic cystoceles descended on average to 23.8 mm below the symphysis pubis (SP), symptomatic rectoceles to 21.3 mm below the SP. Descent was strongly associated with symptoms of prolapse (both p < 0.001). Receiver operator curve statistics suggested a cutoff of,10 mm below the SP for cystocele, and 15 mm below the SP for rectocele. ROC characteristics were similar for both anterior and posterior compartment, although the relationship between descent and symptoms was stronger for the anterior compartment (c = 0.857 vs. c = 0.821). Conclusions: Descent of the bladder to > = 10 mm below the SP, and descent of the rectum to > = 15 mm below the SP are strongly associated with symptoms and are proposed as cutoffs for the diagnosis ‘significant prolapse’ on the basis of receiver operator curve characteristics.