Simulation of apical support when assessing anterior and posterior compartment prolapse

Objective: To evaluate whether simulated correction of apical prolapse determines the reduction or disappearance of anterior and posterior vaginal prolapse, using the Pelvic Organ Prolapse Quantification (POPQ) system. Methods: Cross-sectional study. The population consisted of patients who attended to the Hospital Universitario de Caracas with pelvic organ prolapse stage II or greater and who had involvement of the apical compartment between 2021 and 2022. The selection of the sample was made in a non-probabilistic, sequential way. Each patient underwent POPQ before and after simulation of apical support with the posterior blade of a standard Graves speculum. The Aa Ba Ap and Bp points were evaluated before and after simulation and the proportion of patients in whom the stage of anterior or posterior prolapse changed when simulating apical support was also determined. Results: We included 100 patients, most of them with prolapse stage III and IV. After apical support, the anterior compartment points were corrected to a value between 0 to -2 or -3 in most cases (p< 0.05). The points corresponding to the posterior vaginal wall changed to -3 in most patients (p< 0.05). The prolapse stage of the anterior compartment, changed to stage ≤ II in 99 % of cases (p< 0.05), and in 100% in the posterior compartment (p<0.05). Conclusion: Simulation of apical support during POPQ demonstrated correction of anterior and posterior compartment prolapse in a high percentage of patients.