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Clinical-decision taking in primary pelvic organ prolapse; the effects of diagnostic tests on treatment selection in comparison with a consensus meeting

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Abstract

Introduction and hypothesis

The objective of the study was to establish the effects of additional diagnostic tests compared to a consensus outcome on treatment selection in primary pelvic organ prolapse.

Methods

Three expert gynecologists individually defined a management plan in 53 patients after magnetic resonance imaging, defecography, urodynamic, and anorectal function test information was provided. These management plans were compared with basic treatment advices in the absence of any test and with consensus advices (opinion-based references). The experts assigned a subjective score (assigned diagnostic value [ADV], 0–100%) to rate the test's relative importance.

Results

On average, additional diagnostic testing resulted in a revised initial management plan in 38% of the cases; 24% of the individual management plans did not meet the consensus reference. Overall defecography was regarded most valuable (ADV range 19–65%) vs. magnetic resonance imaging rated least (ADV range 0–37%).

Conclusions

Although additional diagnostic tests frequently led to adaptations of basic treatment proposals, consensus was not reached in a fourth of the cases.

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References

  1. Samuelsson EC, Victor FT, Tibbling G, Svärdsudd KF (1999) Signs of genital prolapse in a Swedisch population of women 20–59 years of and possible related factors. Am J Obstet Gynecol 180:299–305

    Article  PubMed  CAS  Google Scholar 

  2. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women´s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166

    Article  PubMed  Google Scholar 

  3. Brubaker L (1998) Initial assessment: the history in women with pelvic floor problems. Clin Obstet Gynecol 41:657–662

    Article  PubMed  CAS  Google Scholar 

  4. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  5. Jelovsek JE, Maher C, Barber MD (2007) Pelvic Organ Prolapse. Lancet 369:1027–1038

    Article  PubMed  Google Scholar 

  6. Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR, Fisher J, Hull T, Nygaard I, Weidner AC (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J 12:178–186

    Article  CAS  Google Scholar 

  7. Weber AM, Buchsbaum GM, Chen B, Clark AL, Damaser MS, Daneshgari F, Davis G, DeLancey J, Kenton K, Weidner AC, Word RA (2004) Basic science and translation research in female pelvic floor disorders: proceedings of an NIH-sponsored meeting. Neurourol Urodyn 23:288–301

    Article  PubMed  Google Scholar 

  8. Van der Vaart CH, De Leeuw JR, Roovers JP, Heintz AP (2003) Measuring health related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22:97–104

    Article  PubMed  Google Scholar 

  9. Van Brummen HJ, Bruinse HW, Van der Pol, Heintz AP, Van der Vaart CH (2006) Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J 17:224–230

    Article  Google Scholar 

  10. Da Silva GM, Gurland B, Sleemi A, Levy G (2006) Posterior vaginal wall prolapse does not correlate with fecal symptoms or objectivbe measures of anorectal function. Am J Obstetric Gynecol 195:1742–1747

    Article  Google Scholar 

  11. Stoker J, Rociu E, Bosch JL, Messelink EJ, Van der Hulst VP, Groenendijk AG, Eykemans MJ, Laméris JS (2003) High-resolution endovaginal MR imaging at stress urinary incontinence. Eur Radiol 13:2031–2037

    Article  PubMed  Google Scholar 

  12. Groenendijk AG, Van der Hulst VP, Birnie E, Bonsel GJ (2008) Correlation between posterior vaginal wall defects assessed by clinical examination and by defecography. Int Urogynecol J 19:1291–1297

    Article  Google Scholar 

  13. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Am J Obstet Gynecol 187:116–126

    Article  PubMed  Google Scholar 

  14. Groenendijk AG, Birnie E, Boeckxstaens GE, Roovers JP, Bonsel GJ (2009) Anorectal function testing and anal endosonography in the diagnostic work-up of patients with primary pelvic organ prolapse. Gynecol Obstet Invest 67:187–194. [Epub ahead off print]

    Article  PubMed  Google Scholar 

  15. Segal JL, Karram MM (2002) Evaluation and management of rectoceles. Cur Opin Urolog 12:345–352

    Article  Google Scholar 

  16. Bradley CS, Nygaard IE, Brown MB, Gutman RE, Kenton KS, Whitehead WE, Goode PS, Wren PA, Ghetti C, Weber AM, Pelvic Floor Disorders Network (2007) Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol 197:642.e1–642.e8

    Article  Google Scholar 

  17. Harvey CJ, Halligan S, Bartram CI, Holings N, Sahdev A, Kingston K (1999) Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology 211:223–227

    PubMed  CAS  Google Scholar 

  18. Hetzer FH, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D (2006) MR defecography in patients with fecal incontinence and their effect on surgical management. Radiology 240:449–457

    Article  PubMed  Google Scholar 

  19. Roovers JP, Van der Bom JG, Van der Vaart CH, Heintz AP (2005) Prediction of findings at defecography in patients with genital prolapse. BJOG 112:1547–1553

    Article  PubMed  Google Scholar 

  20. Kaufman HS, Buller JL, Thompson JR, Pannu HK, DeMeester SL, Genadry RR, Bluemke DA, Jones B, Rychcik JL, Cundiff GW (2001) Dynamic pelvic magnetic resonance imaging and cytocolpoprotography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575–1584

    Article  PubMed  CAS  Google Scholar 

  21. Lienemann A, Sprenger D, Janßen U, Grosch E, Pellengahr C, Anthuber C (2004) Assessment of pelvic organ descent by use of functional Cine-MRI: which reference line should be used? Neurourol Urodyn 23:33–37

    Article  PubMed  Google Scholar 

  22. Fauconnier A, Zareski E, Abichedid J, Bader G, Falissard B, Fritel X (2008) Dynamic magnetic resonance imaging for grading pelvic organ prolapse according to the International Continence Society classification: which line should be used. Neurol Urodyn 27:191–197

    Article  Google Scholar 

  23. Roovers JP, Oelke M (2007) Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolaps: a literature review. Int Urogynecol J 18:455–460

    Article  Google Scholar 

  24. Klutke JJ, Ramos S (2000) Urodynamic outcome after surgery for severe prolapse and potential stress-incontinence. Am J Obstet Gynecol 182:1378–1381

    Article  PubMed  CAS  Google Scholar 

  25. Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D (2004) Tension free vaginal tape (TVT) for treatment of occult stress-incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases. Neurourol Urodyn 23:632–635

    Article  PubMed  Google Scholar 

  26. De Tayrac R, Gervaise A, Chauveaud-Lambling A, Fernandez H (2004) Combined genital prolapse repair with a polypropylene mesh and tension-free vaginal tape in women with genital stress urinary incontinence: a retrospective case-control study with short-term follow-up. Acta Obstet Gynecol Scand 83:950–954

    Article  PubMed  Google Scholar 

  27. American Gastroenterology Association, Diamant NE, Kamm MA, Wald A, Whitehead WE (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116:735–760

    Article  PubMed  CAS  Google Scholar 

  28. Davila GW, Ghoniem GM, Kapoor DS, Contreras-Ortiz O (2002) Pelvic floor dysfunction management practice patterns: a survey of members of the International Urogynecologic Association. Int Urogynecol J 13:319–325

    Article  CAS  Google Scholar 

  29. Griffiths JM, Black NA, Pope C, Stanley J, Bowling A, Abel PD (1998) London School of Hygiene and Tropical Medicine. What determines the choices of procedures in stress incontinence surgery? The use of multilevel modeling. Int J Technol Assess Health Care 14:431–434

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Jaap Stoker (professor of Radiology of the Academic Medical Center-University of Amsterdam) and Guy E. Boeckxstaens (professor of Gastro-Enterology of the Academic Medical Center—University Amsterdam), Egbert J. Messelink (urologist of the Onze Lieve Vrouwe Hospital, Academic Medical Center-University Groningen), George van Andel (urologist), and Victor P. van der Hulst (radiologist of the Onze Lieve Vrouwe Hospital) for the implementation and their supervision of the additional diagnostic tests in our patient group.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Onze Lieve Vrouwe Hospital, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands

    Annette G. Groenendijk & Sjoerd de Blok

  2. Department of Public Health Epidemiology, Academic Medical Center—University of Amsterdam, Amsterdam, The Netherlands

    Erwin Birnie & Gouke J. Bonsel

  3. Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands

    Erwin Birnie & Gouke J. Bonsel

  4. Department of Gynecology and Obstetrics, Medical Center Alkmaar, Alkmaar, The Netherlands

    Albert H. Adriaanse

  5. Department of Gynecology and Obstetrics, Academic Medical Center—University of Amsterdam, Amsterdam, The Netherlands

    Willem M. Ankum & Jan-Paul W. Roovers

Authors
  1. Annette G. Groenendijk
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  2. Erwin Birnie
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  3. Sjoerd de Blok
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  4. Albert H. Adriaanse
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  5. Willem M. Ankum
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  6. Jan-Paul W. Roovers
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  7. Gouke J. Bonsel
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Corresponding author

Correspondence to Annette G. Groenendijk.

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Groenendijk, A.G., Birnie, E., de Blok, S. et al. Clinical-decision taking in primary pelvic organ prolapse; the effects of diagnostic tests on treatment selection in comparison with a consensus meeting. Int Urogynecol J 20, 711–719 (2009). https://doi.org/10.1007/s00192-009-0846-5

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  • DOI: https://doi.org/10.1007/s00192-009-0846-5

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