OC18.02: Ultrasound‐based triage in the management of pelvic organ prolapse: long‐term surgical outcome

To assess the impact of a strict 3D- and 4D-transperineal (TPS) ultrasound-based triage in the surgical management of pelvic organ prolapse (POP). Since January 2016, consecutive patients complaining POP (uterine prolapse with or without cystocele) were prospectively recruited. Patient's assessment included a standardised interview, clinical examination and 3D- and 4D-TPS. Levator ani muscle (LAM) avulsion were assessed by TPS according to a strict sonographic protocol performed with the women supine after voiding, during maximal Valsalva manoeuvre and pelvic floor muscle contraction. LAM avulsion was assessed using volume contrast imaging (VCI) analysis and tomographic ultrasound imaging (TUI) on volumes obtained on pelvic floor muscle contraction. Depending of sonographic findings, vaginal pelvic floor fascial surgery (VS) or laparoscopic subtotal hysterectomy with mesh (lateral suspension or colposacropexy - LS) were proposed in absence (group A) or presence (group B) of LAM avulsion, respectively. A clinical or telephone follow-up was performed at least 6 months after surgery. At ad interim analysis, 130 patients were considered: 99 (76%) without and 31 (24%) with LAM avulsion. Median age was 68 (IR 58-74) and 55 (IR 51-62) in group A and B, respectively (p 0.00002). 91/99 (92%) and 24/31 (77%) patients in group A and B were postmenopausal, respectively. Median parity and BMI were 2 (IR 2-3) and 26 (IR 23-28) for both the groups, respectively (p n.s.). A complete follow-up (median 49 months, IR 15-79) was available for 110 patients. 8 POP clinical recurrences (6%) were observed, 6 and 2 after VS and LS, respectively. A strict transperineal ultrasound-based triage revealed to be an effective triage in identifying patients at higher risk of recurrence, thus determining an overall low prevalence of unsuccessful surgery. Longer and larger studies are necessary to properly confirm the effectiveness of this ultrasound-based tailored treatment.