WORKSHOP ON POP-Q BENGALORE

1. WORKSHOP ON POP-Q BENGALORE Dr Nilgar B. R. Professor (obgyn) J. N. Medical college Belgaum

2. P O P-Q(Pelvic organ prolapse-Quantification) The existing system: -Terminology ill-defined - None of the grading systems are adequately validated - Not reproducible - Clinical significance of different grades not clear - Comparison not possible

3. P O P-Q(Pelvic organ prolapse-Quantification) Universally accepted system for describing the anatomic position of pelvic organs

4. P O P-Q(Pelvic organ prolapse-Quantification) Site specific system Quantitating Staging pelvic supports Describing Enhances clinical and academic communication

5. P O P-Q(Pelvic organ prolapse-Quantification) 1993 Rome: (1995-6) International multidisciplinary committee -ICS Members -The American urogynecologic society -Society of Gynecologic surgeons ( one year trial and review)

6. P O P-Q(Pelvic organ prolapse-Quantification) Publications and presentations : Methods section- �Methods, definitions, and descriptions conform to the standards recommended by the ICS except where specifically noted

7. P O P-Q(Pelvic organ prolapse-Quantification) Segments of lower reproductive tract; Replace terminology such as- �cystocele, rectocele, enterocele, or urethrovesical junction� (unrealistic terms)

8. POP- criteria for demonstration Any protrusion has become tight during straining by pt. Traction causes no further descent The pt confirms the size and extent of prolapse seen by examiner (pt�s perception) A Standing and straining examination confirms the full extent of prolapse observed in other position

9. POP-demo other variables Position of subject Type of table or examination chair Type of vaginal specula retractors or tractors used The type of assistance (valsalva,cough etc) Type of customized devices used Fullness of bladder Content of rectum

10. Functional symtoms Lower urinary tract Bowel Sexual Other local symtoms

11. Urinary symptoms(no ICS guidelines) Stress urinary incont Frequency (diurnal / nocturnal) Urgency Urge incont Hesitancy Weak or prolonged urinary stream Feeling of incomplete voiding Manual reduction of prolapse Position changes to start or complete emtying

12. Bowel symptoms Difficulty in defecation Incontinence for flatus, liquid or solid stools. Urgency of defecation or discomfort Digital manipulation of vagina or perineum Incomplete evacuation Rectal protrusion

13. Sexual symptoms Sexually active? If not why ? Coitus vaginal ? Frequency , pain ? Satisfactory orgasmic response? Any incontinence experienced during sexual activity?

14. Other local symptoms Vaginal pressure , heaviness or pain Low back pain Observation or palpation of vaginal mass

15. POP-Q Develop condition specific quality of life questionnaire

16. Pelvic floor muscle testing Voluntarily controlled Valsalva maneuver, coughing, holding breath, forced inspiration Pt position, (legs) Instructions given to the pt Status of bowel and bladder Technique of quantification

17. Palpation -Digital examination of pelvic floor muscles through vagina and rectum -Assessment of perineum and abdominal wall (Develop standardized palpation methods for semi quantification estimation of bulk and thickness of pelvic floor around circumference of genital hiatus)

18. POP-Q Points of references Fixed ref points (introitus imprecise) -Hymen, Ext urinary meatus Defined ref points (located in ref to these points) six points two on anterior vaginal wall two on in superior vagina two on posterior vaginal wall Three measurements

19. Surgical assessment (under anesthesia) Unproved value -Effects of anesthesia -Diminished muscle tone -Loss of conciousness -Position of patient

20. Imaging in POP-Q Define land marks to allow comparison Lower edge of pubic symphysis high priority Include scale

23. POP-Q Point Aa Located in midline of anterior vaginal wall 3cm proximal to ext urinary meatus (corresponding to urethro -vaginal crease)