Ultrasound of prolapse

The pathology of female genital prolapse has a very high prevalence in the population. Despite the disparity of published data, most studies report a 3-6% prevalence of symptomatic prolapse.

A high percentage of symptomatic patients will require some type of treatment, whether it be conservative or surgical; in fact, 15% of patients with prolapse will require surgical repair. Although it is a benign pathology, it can significantly affect patients' quality of life.

The physical examination is crucial for assessing pelvic organ prolapse.

Pelvic floor ultrasound has proven useful, in a plethora of ways, for pelvic floor dysfunction (for the monitoring of mesh implants, complementary study of the incontinent patient, assessment of pelvic muscles, assessment of associated pathology, etc.).

Ultrasound's contribution to the study of genital prolapse lies in the fact that it offers professionals the opportunity to identify aspects which are otherwise difficult to assess by physical examination alone and which can predetermine the therapeutic approach.

Female genital prolapse is the descent through the vagina of one or more anatomical elements: the anterior vaginal compartment, posterior vaginal compartment, uterus or vaginal vault in women with previous hysterectomy.

Different classifications are used in the study of genital prolapse. In the past, the Baden-Walker system was traditionally used; it consists of a simple and practical classification that establishes four degrees of prolapse, but it also has the disadvantage of being poorly reproducible. In 1996, the ICS-IUGA devised a new system in order to increase the accuracy and reproducibility of graduation: the POP-Q classification. The POP-Q is more complex in its assessment, but it allows professionals to standardise, with great precision, both the degree and type of prolapse; it has therefore, at present, become the most standardised type of classification in the literature (1).

There is no need for ultrasound to provide us with a better classification system for the assessment of prolapse, since we already have an excellent one at hand; ultrasound does, however, allow us to see beyond the physical examination – it highlights hidden defects and allow us to understand the shortcomings of surgery. In turn, it also allows us to delve deeper into the identifying levator ani injuries and fascia defects, as well as the process of figuring these into the final decision of what type of prolapse surgery technique is to be used. This last aspect is still being researched.

More information

  • Residual urine test

    About 20% of patients with pelvic floor symptoms have a voiding dysfunction. In addition, it has been demonstrated that these dysfunctions are associated with increased age and pelvic organ prolapse, which can be …Read more

  • Pelvic organ prolapse

    In addition to providing information about the physiopathology of prolapse – as we will see in the next section – ultrasound imaging also allows us to quantify prolapse it in a very simple way. Starting from the …Read more

  • Anterior compartment

    Ultrasound allows us to easily differentiate between two types of cystocele, depending on whether the retrovesical angle is modified (3). Cystourethrocele, which occurs with an open retrovesical angle, is usually …Read more

  • Middle compartment

    When the uterus is prolapsed, ultrasound can be used to assess if it is a case of isolated uterine prolapse (Clip 1) or if there are other types of associated prolapse present. It can also differentiate whether the …Read more

  • Posterior compartment

    Ultrasound can help us the most in cases of prolapse of the posterior compartment because it identifies the prolapsed organ – whether a rectocele (Clip 2), an enterocele or a combination of both (Figure 3 and Clip 3). …Read more

  • Rehabilitation

    Ultrasound has also been used in pelvic floor rehabilitation so that patients can learn, using biofeedback, to exercise their pelvic musculature more consciously, thus increasing the effectiveness ofRead more