A study on relationship between pelvic organ prolapse and sacral slope
IUGA Academy. Matsushita C. Jun 30, 2018; 212963; 514 Topic: Pelvic Organ Prolapse
Chie Matsushita
Chie Matsushita

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A study on relationship between pelvic organ prolapse and sacral slope

Matsushita, C1; Shinohara, M1; Saka, T1; Hirao, Y1; Torimoto, K2; Fujimoto, K2

1: Osaka Gyomeikan Hospital; 2: Nara Medical University

Introduction: Although obesity is considered to be one of the risk factors for pelvic organ prolapse (POP), relationship between BMI and the condition has not yet been established. Cases of POP in underweight women are also not clinically uncommon.

Objective: Association between pelvic inclination and pelvic organ prolapse was retrospectively examined with consideration of a possibility that the spine becomes out of alignment and the vector of abdominal pressure changes, increasing chances of POP to occur.

Methods: Subjects of the study were eleven patients who had preoperative chain urethrocystography and underwent transvaginal mesh surgery for treatment of stage2 POP or above in our hospital between May 2016 and February 2018. Sacral slope (SS) defined as the angle between the sacral plate and the horizontal plane was measured using standing lateral images taken in chain urethrocystography, and the correlation with age, the number of vaginal delivery, BMI, presence or absence of spinal disease, POP-Q scores was examined. Statistical analysis was conducted using Pearson's correlation coefficient.

Results: The average age of eleven patients was 69.0±5.95 years, mean BMI was 27.8±8.34, and mean POP-Q scores were Aa1.39±0.99, Ba1.57±1.34, C-2.87±3.47, gh4.17±0.78, pb2.04 ±0.56, tvl7.26±1.39, Ap-2.48±1.73, Bp-2.09±2.47, D-5.20±3.62, respectively. With regards to physiological curvature, a normal value of SS is considered to be between 25° and 45°. In this study, the average of measured SS was 27.8±8.34°. Correlation between SS and each parameter was not found. Also, when considering cases presented SS between 25° to 45° to be normal, less than 25° to be posterior pelvic tilt, and over 45° to be anterior pelvic tilt, there were 18 cases in the normal group, 7 in the posterior pelvic tilt group, and 1 in the anterior pelvic tilt group. No difference was found among three groups in terms of BMI and POP-Q scores.

Conclusion: Although obesity is one of the risk factors of POP, there are clinical cases of severe POP in underweight women, and thus, it was considered that posterior pelvic tilt could be a risk factor of POP. Cine MRI and transperineal ultrasound are used in image diagnosis of POP, although all examinations are carried out in the recumbent position and not in the standing position. Therefore, the study attempted to evaluate pelvic inclination in the standing position with sacral slope measured using standing lateral images taken in chain urethrocystography. Since the sample size is small, it would be necessary to examine a larger number of cases as well as carry out comparison with non-POP cases in the future. The study investigated pelvic inclination of patients with POP.


Work supported by industry: no.

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