Symptoms of female pelvic organ prolapse: Correlation with organ descent in women with single compartment prolapse

Background: Female pelvic organ prolapse is a common condition that often leads to surgical intervention to alleviate symptoms. The relationship between symptoms of prolapse and pelvic organ descent however, remains unclear. Aim: To determine the correlation between the symptom of a vaginal lump and objective measures of female pelvic organ descent. Methods: Women seen at a tertiary urogynaecological unit were assessed using an interview, clinical examination, multichannel urodynamics and ultrasound imaging for symptoms of urinary dysfunction and pelvic organ prolapse. Receiver-operating characteristic curves were developed to determine the correlation between a vaginal lump and pelvic organ prolapse on ultrasound and clinical assessment. In order to reduce the confounding effect of prolapse in other than the reference compartment, we included only patients with a prolapse that showed one compartment clearly dominant. Results: A total of 1022 women were evaluated, of which 299 (29%) reported the symptom of a vaginal lump. The area under the curve for cystocele on ultrasound and clinical examination was 0.86 and 0.89, respectively. For rectocele, the areas were 0.81 for ultrasound and 0.89 for examination. The low number of women with an isolated uterine prolapse or enterocele limits the significance of the results for those two groups. Conclusion: The symptom of a vaginal lump correlates strongly with the degree of female pelvic organ prolapse as ascertained on clinical examination and ultrasound imaging. Ultrasound and clinical examination perform very well as tests for predicting symptomatic prolapse, provided that the confounding effect of other compartments is accounted for.