Systematic review and meta-analysis of the ultrasound diagnosis of pelvic organ prolapse (MUDPOP)

Abstract

We want to determine what the diagnostic criteria for pelvic organ prolapse (POP) should be for each pelvic compartment, establishing their diagnostic capability based on the current literature.

This is a systematic review and meta-analysis of studies published until March 2024 that compared the diagnosis of POP between transperineal ultrasound and clinical POP-Q examination. The authors searched various databases including PubMed/MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library and ClinicalTrials.gov.

The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess study quality. Estimates of odds ratios, 95% confidence intervals and significance of sensitivity and specificity were obtained by aggregating all selected studies. All analyses were performed with R software.

The search identified 2359 citations and after applying the inclusion and exclusion criteria, a total of 8 studies were finally included. All studies were considered to have low applicability concerns in terms of patient selection, index test, reference standard, flow and timing. The pooled sensitivity for ultrasound diagnosis of POP was 72.3% with a standard error of 3.1% (p < 0.001), tau of 0.11, I² of 97.1% (p < 0.001). The pooled specificity for ultrasound diagnosis of POP was 78.0% with a standard error of 4.4% (p < 0.001), tau of 0.16, I² of 98.6% (p < 0.001).

The value of 10 mm is the cut-off point for the diagnosis of symptomatic cystocele (static measurement). A value of 15 mm is used for the diagnosis of symptomatic rectocele (static measurement) and for uterine prolapse (dynamic measurement). The current evidence is limited, so future research is needed to provide further confirmation.