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

OBJECTIVE. 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. MATERIALS AND METHODS. The presence or absence of rectocele, enterocele, si gmoidocele, 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. RESULTS. A rectocele was detected by proctography in 155 patients (91%); 11 9 (77%) of these rectoceles were also found on physical examination. Barium trapping at proctography was related to rectocele size. Proctography showe d an enterocele in 47 patients (28%); 24 (51%) of these enteroceles were al so found on physical examination. Physical examination also found 44 entero celes that could not be corroborated radiologically. At proctography, the e nteroceles 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 pa tients (94%); 132 (83%) of these cystoceles were also found on physical exa mination. CONCLUSION. The correlation between finding prolapsed pelvic organs on dyna mic 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 p oor. Dynamic cystoproctography provides direct visualization and quantifica tion of female pelvic organ prolapse, information that usually can only be inferred by physical examination.