Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination.

Abstract

The aim of this study was to assess the contribution of dynamic cystoproctography to the evaluation of female pelvic organ prolapse and to compare this contribution with that of physical examination. The presence or absence of rectocele, enterocele, sigmoidocele, and cystocele on physical examination and on cystoproctography was retrospectively analyzed in 170 consecutive patients. For each of these diagnostic methods, organ prolapse was graded as small, moderate, or large on the basis of specific, defined measurements. A rectocele was detected by proctography in 155 patients (91%); 119 (77%) of these rectoceles were also found on physical examination. Barium trapping at proctography was related to rectocele size. Proctography showed an enterocele in 47 patients (28%); 24 (51%) of these enteroceles were also found on physical examination. Physical examination also found 44 enteroceles that could not be corroborated radiologically. At proctography, the enteroceles were relatively large, extending an average of 7.3 cm below the vaginal apex. Eight patients had sigmoidoceles, none of which were found on physical examination. A cystocele was shown by cystoproctography in 159 patients (94%); 132 (83%) of these cystoceles were also found on physical examination. The correlation between finding prolapsed pelvic organs on dynamic cystoproctography and finding them on physical examination varies. Most radiographically detected rectoceles and cystoceles are found on physical examination, whereas the correlation for enteroceles and sigmoidoceles is poor. Dynamic cystoproctography provides direct visualization and quantification of female pelvic organ prolapse, information that usually can only be inferred by physical examination.