Clinical Evaluation and Diagnostic Tools in Women with Prolapse

  • Fabio Del Deo
  • Antonio Grimaldi
  • Marco Torella
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)


A complete evaluation of pelvic organ prolapse needs the investigation of general, gynecological, and obstetric history, the inquiry of the presence of concomitant lower urinary tract symptoms, and a careful physical and instrumental examination.
  1. 1.

    Family history

  2. 2.

    Past medical history

  3. 3.

    Present medical history

  4. 4.

    Physical examination and POP quantification

  5. 5.

    Imaging and instrumental examination



  1. 1.
    Lince SL, van Kempen LC, Vierhout ME, et al. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J. 2012;23(10):1327–36.CrossRefGoogle Scholar
  2. 2.
    Kerkhof MH, Hendriks L, Brölmann HA. Changes in connective tissue in patients with pelvic organ prolapse—a review of the currenst literature. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(4):461–74.CrossRefGoogle Scholar
  3. 3.
    Chen HY, Chung YW, Lin WY, et al. Collagen type 3 alpha 1 polymorphism and risk of pelvic organ prolapse. Int J Gynaecol Obstet. 2008;103(1):55–8.CrossRefGoogle Scholar
  4. 4.
    Kluivers KB, Dijkstra JR, Hendriks JC, et al. COL3A1 2209G>A is a predictor of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1113–8.CrossRefGoogle Scholar
  5. 5.
    Sun MJ, Cheng YS, Sun R, et al. Changes in mitochondrial DNA copy number and extracellular matrix (ECM) proteins in the uterosacral ligaments of premenopausal women with pelvic organ prolapse. Taiwan J Obstet Gynecol. 2016;55(1):9–15.CrossRefGoogle Scholar
  6. 6.
    Eser A, Unlubilgin E, Hizli F, et al. Is there a relationship between pelvic organ prolapse and tissue Fibrillin-1 levels? Int Neurourol J. 2015;19(3):164–70.CrossRefGoogle Scholar
  7. 7.
    Tetzschner T, Sørensen M, Jønsson L, et al. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand. 1997;76(4):324–31.CrossRefGoogle Scholar
  8. 8.
    Alperin M, Cook M, Tuttle LJ, et al. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles. Am J Obstet Gynecol. 2016. [Epub ahead of print];215:312.e1.CrossRefGoogle Scholar
  9. 9.
    Novellas S, Chassang M, Verger S, et al. MR features of the levator ani muscle in the immediate postpartum following cesarean delivery. Int Urogynecol J. 2010;21(5):563–8.CrossRefGoogle Scholar
  10. 10.
    Laterza RM, Schrutka L, Umek W, et al. Pelvic floor dysfunction after levator trauma 1-year postpartum: a prospective case-control study. Int Urogynecol J. 2015;26(1):41–7.CrossRefGoogle Scholar
  11. 11.
    Gyhagen M, Bullarbo M, Nielsen TF, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):152–60.CrossRefGoogle Scholar
  12. 12.
    Glazener C, Elders A, Macarthur C, et al. Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse. BJOG. 2013;120(2):161–8.CrossRefGoogle Scholar
  13. 13.
    Marchionni M, Bracco GL, Checcucci V, et al. True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med. 1999;44(8):679–84.PubMedGoogle Scholar
  14. 14.
    Srikrishna S, Robinson D, Cardozo L, et al. Can sex survive pelvic floor surgery? Int Urogynecol J. 2010;21(11):1313–9.CrossRefGoogle Scholar
  15. 15.
    Zielinski R, Miller J, Low LK, et al. The relationship between pelvic organ prolapse, genital body image, and sexual health. Neurourol Urodyn. 2012 Sep;31(7):1145–8.CrossRefGoogle Scholar
  16. 16.
    Glavind K, Larsen T, Lindquist AS. Sexual function in women before and after surgery for pelvic organ prolapse. Acta Obstet Gynecol Scand. 2015;94(1):80–5.CrossRefGoogle Scholar
  17. 17.
    Nichols DH, Randall CL. Vaginal surgery. 4th ed. Baltimore: Williams and Wilkins; 1996.Google Scholar
  18. 18.
    Baden WF, Walker TA. Physical diagnosis in the evaluation of vaginal relaxation. Clin Obstet Gynecol. 1972;15:1055–69.CrossRefGoogle Scholar
  19. 19.
    Beecham CT. Classification of vaginal relaxation. Am J Obstet Gynecol. 1980;136(7):957–8.CrossRefGoogle Scholar
  20. 20.
    Bump RC, Mattiasson A, Kari B, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.CrossRefGoogle Scholar
  21. 21.
    Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037–45.CrossRefGoogle Scholar
  22. 22.
    Haessler AL, Lin LL, Ho MH, et al. Reevaluating occult incontinence. Curr Opin Obstet Gynecol. 2005;17(5):535–40.CrossRefGoogle Scholar
  23. 23.
    Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2007;97(1):31–4.CrossRefGoogle Scholar
  24. 24.
    Sinha D, Arunkalaivanan AS. Prevalence of occult stress incontinence in continent women with severe genital prolapse. J Obstet Gynaecol. 2007;27(2):174–6.CrossRefGoogle Scholar
  25. 25.
    Migliorini GD, Glenning PP. Bonney’s test—fact or fiction? Br J Obstet Gynaecol. 1987;94:157–9.CrossRefGoogle Scholar
  26. 26.
    Ellström Engh AM, Ekeryd A, Magnusson A, et al. Can de novo stress incontinence after anterior wall repair be predicted? Acta Obstet Gynecol Scand. 2011;90(5):488–93.CrossRefGoogle Scholar
  27. 27.
    Bergman A, Koonings PP, Ballard CA. Negative Q-tip test as a risk factor for failed incontinence surgery in women. J Reprod Med. 1989;34(3):193–7.PubMedGoogle Scholar
  28. 28.
    Santoro GA, Wieczorek CI. Pelvic floor disorders. Berlin: Springer; 2010.Google Scholar
  29. 29.
    Santoro GA, Wieczorek CI. Endovaginal ultrasonography: methodology and normal pelvic floor anatomy. Berlin: Springer; 2010.CrossRefGoogle Scholar
  30. 30.
    Dietz HP. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol. 2004;23(1):80–92.CrossRefGoogle Scholar
  31. 31.
    Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18(5):511–4.CrossRefGoogle Scholar
  32. 32.
    Dietz HP. Why pelvic floor surgeons should utilize ultrasound imaging. Ultrasound Obstet Gynecol. 2006;28(5):629–34.CrossRefGoogle Scholar
  33. 33.
    Santoro GA, Wieczorek AP, Dietz HP, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011;37(4):381–96.CrossRefGoogle Scholar
  34. 34.
    Tunn R, Petri E. Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol. 2003;22(2):205–13.CrossRefGoogle Scholar
  35. 35.
    Haylen BT. Verification of the accuracy and range of transvaginal ultrasound in measuring bladder volumes in women. Br J Urol. 1989;64(4):350–2.CrossRefGoogle Scholar
  36. 36.
    Dietz HP, Velez D, Shek KL, et al. Determination of postvoid residual by translabial ultrasound. Int Urogynecol J. 2012;23(12):1749–52.CrossRefGoogle Scholar
  37. 37.
    Dicuio M, Pomara G, Menchini Fabris F, et al. Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers. Arch Ital Urol Androl. 2005;77(1):60–2.PubMedGoogle Scholar
  38. 38.
    Lekskulchai O, Dietz HP. Detrusor wall thickness as a test for detrusor overactivity in women. Ultrasound Obstet Gynecol. 2008;32(4):535–9.CrossRefGoogle Scholar
  39. 39.
    Pannu HK, Kaufman HS, Cundiff GW, et al. Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics. 2000;20(6):1567–82.CrossRefGoogle Scholar
  40. 40.
    Kaufman HS, Buller JL, Thompson JR, et al. Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum. 2001;44:1575–83. discussion 1583-1584.CrossRefGoogle Scholar
  41. 41.
    Yang A, Mostwin JL, Rosenshein NB, et al. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology. 1991;179:25–33.CrossRefGoogle Scholar
  42. 42.
    Lienemann A, Anthuber C, Baron A, et al. Dynamic MR colpocystorectography assessing pelvic floor descent. Eur Radiol. 1997;7:1309–17.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Fabio Del Deo
    • 1
  • Antonio Grimaldi
    • 1
  • Marco Torella
    • 1
  1. 1.Department of Woman, Child and General and Specialistic SurgeryUniversity of Campania Luigi VanvitelliCasertaItaly

Personalised recommendations