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Clínica e In es igación en Ginecología y Obs e icia xxx (xxxx) 101018
www.else ie .es/gine
clínica e in es igación en
ginecología y obs e icia
REVIEW ARTICLE
Sys ema ic e iew and me a-analysis o he ul asound
diagnosis o pel ic o gan p olapse (MUDPOP)
J.A. Ga cía-Mejidoa,b,∗,F. Fe nández-Palacínc,J.A. Sainz-Buenoa,b
Q1
aDepa men o Obs e ics and Gynaecology, Valme Uni e si y Hospi al, Se ille, Spain
bDepa men o Su ge y, Facul y o Medicine, Uni e si y o Se ille, Spain
cDepa men o S a is ics and Ope a ional Resea ch, Uni e si y o Cadiz, Cadiz, Spain
Recei ed 2 Oc obe 2024; accep ed 11 Decembe 2024
KEYWORDS
Sys ema ic e iew;
Me a-analysis;
Pel ic floo ;
Ul asonog aphy;
Pel ic o gan p olapse
Abs ac We wan o de e mine wha he diagnos ic c i e ia o pel ic o gan p olapse (POP)
should be o each pel ic compa men , es ablishing hei diagnos ic capabili y based on he
cu en li e a u e.
This is a sys ema ic e iew and me a-analysis o s udies published un il Ma ch 2024 ha com-
pa ed he diagnosis o POP be ween anspe ineal ul asound and clinical POP-Q examina ion.
The au ho s sea ched a ious da abases including PubMed/MEDLINE, Scopus, Web o Science,
CINAHL, The Coch ane Lib a y and ClinicalT ials.go .
The Quali y Assessmen o Diagnos ic Accu acy S udies-2 (QUADAS-2) ool was used o assess
s udy quali y. Es ima es o odds a ios, 95% confidence in e als and significance o sensi i i y
and specifici y we e ob ained by agg ega ing all selec ed s udies. All analyses we e pe o med
wi h R so wa e.
The sea ch iden ified 2359 ci a ions and a e applying he inclusion and exclusion c i e ia,
a o al o 8 s udies we e finally included. All s udies we e conside ed o ha e low applicabili y
conce ns in e ms o pa ien selec ion, index es , e e ence s anda d, flow and iming. The
pooled sensi i i y o ul asound diagnosis o POP was 72.3% wi h a s anda d e o o 3.1%
(p< 0.001), au o 0.11, I2o 97.1% (p< 0.001). The pooled specifici y o ul asound diagnosis
o POP was 78.0% wi h a s anda d e o o 4.4% (p< 0.001), au o 0.16, I2o 98.6% (p< 0.001).
The alue o 10 mm is he cu -o poin o he diagnosis o symp oma ic cys ocele (s a ic
measu emen ). A alue o 15 mm is used o he diagnosis o symp oma ic ec ocele (s a ic mea-
su emen ) and o u e ine p olapse (dynamic measu emen ). The cu en e idence is limi ed,
so u u e esea ch is needed o p o ide u he confi ma ion.
© 2024 Else ie Espa˜
na, S.L.U. All igh s a e ese ed, including hose o ex and da a mining,
AI aining, and simila echnologies.
∗Co esponding au ho .
E-mail add ess: [email p o ec ed] (J.A. Ga cía-Mejido).
h ps://doi.o g/10.1016/j.gine.2024.101018
0210-573X/© 2024 Else ie Espa˜
na, S.L.U. All igh s a e ese ed, including hose o ex and da a mining, AI aining, and simila
echnologies.
Please ci e his a icle as: J.A. Ga cía-Mejido, F. Fe nández-Palacín and J.A. Sainz-Bueno, Sys ema ic e iew and
me a-analysis o he ul asound diagnosis o pel ic o gan p olapse (MUDPOP), Clínica e In es igación en Ginecología
y Obs e icia, h ps://doi.o g/10.1016/j.gine.2024.101018
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J.A. Ga cía-Mejido, F. Fe nández-Palacín and J.A. Sainz-Bueno
Q1
PALABRAS CLAVE
Re isión sis emá ica;
Me aanálisis;
Suelo pél ico;
Ecog a ía;
P olapso de ó ganos
pél icos
Re isión sis emá ica y me aanálisis del diagnós ico ecog áfico del p olapso de
ó ganos pél icos (MUDPOP)
Resumen Que emos de e mina cuáles deben se los c i e ios diagnós icos de p olapso de
ó ganos pél icos (POP) pa a cada compa imen o pél ico, es ableciendo su capacidad diagnós-
ica en unción de la li e a u a ac ual.
Se a a de una e isión sis emá ica y un me aanálisis de los es udios publicados has a ma zo
de 2024, que compa a on el diagnós ico de POP en e la ecog a ía anspe ineal y el exa-
men clínico POP-Q. Los au o es busca on en a ias bases de da os, incluidas PubMed/MEDLINE,
Scopus, Web o Science, CINAHL, The Coch ane Lib a y y ClinicalT ials.go .
Se u ilizó la he amien a Quali y Assessmen o Diagnos ic Accu acy S udies-2 (QUADAS-2)
pa a e alua la calidad de los es udios. Se ob u ie on es imaciones de odds a io, in e alos de
confianza del 95% y significancia de la sensibilidad y especificidad ag egando odos los es udios
seleccionados. Todos los análisis se ealiza on con el so wa e R.
La búsqueda iden ificó 2.359 ci as y, as aplica los c i e ios de inclusión y exclusión, se
incluye on finalmen e un o al de 8 es udios. Se conside ó que odos los es udios enían p ob-
lemas de aplicabilidad bajos en é minos de selección de pacien es, p ueba índice, es ánda
de e e encia, flujo y iempo. La sensibilidad combinada pa a el diagnós ico ecog áfico de POP
ue del 72,3% con un e o es ánda del 3,1% (p < 0,001), au de 0,11, I2del 97,1% (p < 0,001).
La especificidad combinada pa a el diagnós ico ecog áfico de POP ue del 78,0% con un e o
es ánda del 4,4% (p < 0,001), au de 0,16, I2del 98,6% (p < 0,001).
El alo de 10 mm es el pun o de co e pa a el diagnós ico de cis ocele sin omá ico (medición
es á ica). Se u iliza un alo de 15 mm pa a el diagnós ico de ec ocele sin omá ico (medición
es á ica) y pa a p olapso u e ino (medición dinámica). La e idencia ac ual es limi ada, po lo
que se necesi a in es igación u u a pa a p opo ciona una mayo confi mación.
© 2024 Else ie Espa˜
na, S.L.U. Se ese an odos los de echos, incluidos los de mine ´
ıa de ex o
y da os, en enamien o de IA y ecnolog´
ıas simila es.
In oduc ion
Pel ic o gan p olapse (POP) is defined as he descen o
one o mo e pel ic o gans om hei usual ana omical posi-
ion due o ailu e o he suppo ing s uc u es, which can
p og ess o di e en s ages. Su gical ea men o POP is
indica ed when i is symp oma ic and in e e es wi h he
pa ien ’s quali y o li e, usually a s age II o abo e. I is
es ima ed ha a woman’s li e ime isk o unde going su ge y
o POP o incon inence anges be ween 11% and 19%.1,2
The Pel ic O gan P olapse Quan ifica ion Sys em (POP-
Q) has become he s anda d s aging sys em o POP,3
selec ed by a ious scien ific socie ies.3,4 The POP-Q sys-
em in ol es quan i a i e measu emen s o di e en aginal
si es desc ibing he p olapse o each compa men , being an
objec i e and specific me hod o desc ibing and ca ego iz-
ing POP.5I has also demons a ed in e - and in a-obse e
eliabili y,6and has been es ablished as he mos widely used
sys em in he medical li e a u e.7,8
Howe e , clinical assessmen based on he POP-Q is an
inaccu a e ool o e alua ing pel ic floo unc ion and
ana omy, since i ocuses on he ana omy o he aginal su -
ace a he han on ac ual s uc u al abno mali ies9and uses
a a iable e e ence poin ; he hymen.5In addi ion, POP-Q
does no allow o he ecogni ion o ce ain aspec s ha
may influence he diagnosis o POP, such as he de e mina-
ion o bladde olume,10 he coac i a ion o he le a o ani
muscle du ing Valsal a,11 o he Valsal a ime equi ed o
comple e descen o he POP.12 In ac , i has been shown
ha in aope a i e assessmen o POP may exhibi signifi-
can di e ences compa ed o p eope a i e assessmen .13
Ne e heless, he use o ul asound in he diagnosis o
POP has become pa o ou ou ine managemen in ecen
yea s. The in oduc ion o anspe ineal ul asound in POP
has allowed us o e alua e and con ol he a ious con-
ounding ac o s p esen in he clinical assessmen o POP.14
Ac ually, i has allowed us o ob ain be e diagnos ic a es
o su gical p olapse compa ed o POP-Q.15
The cu en li e a u e on he ul asound diagnosis o POP
is becoming inc easingly ex ensi e, making i necessa y o
es ablish defini i e diagnos ic c i e ia. The e o e, we p o-
posed his sys ema ic e iew and me a-analysis wi h he
aim o de e mining wha he diagnos ic c i e ia o POP o
each compa men should be, es ablishing hei diagnos ic
capaci y based on he cu en li e a u e.
Ma e ials and me hods
P o ocol and egis y
These sys ema ic e iew and me a-analysis we e conduc ed
acco ding o he PRISMA 2020 guidelines. The me hodol-
ogy was egis e ed wi h PROSPERO ( egis a ion numbe :
CRD42024535429) be o e he s a o he s udy (unchanged
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a e egis a ion). Due o he me hodology used, his wo k
did no equi e he app o al o a esea ch e hics commi ee.
The di e en au ho s o his pape sea ched se e al
da abases: PubMed/MEDLINE, Scopus, Web o Science,
CINAHL, The Coch ane Lib a y and ClinicalT ials.go . The
sea ch was pe o med using he ollowing e ms and
Boolean ope a o s (‘pel ic o gan p olapse’ OR ‘pel ic
o gan p olapse/diagnos ic imaging’ OR ‘pel ic floo diso -
de s/diagnos ic imaging’ OR ‘u e ine p olapse’ OR ‘cys-
ocele/diagnos ic imaging’ OR ‘ ec al p olapse/diagnos ic
imaging’) AND (ul asound OR ‘ul asound/me hods’), o
pape s published un il Ma ch 2024.
Inclusion and exclusion c i e ia
S udies ha me he ollowing c i e ia we e conside ed o
inclusion:
•S udies in women.
•C oss-sec ional, p ospec i e o e ospec i e design.
•S udies e e ing o he use o anspe ineal ul asound as
a diagnos ic me hod o POP.
•S udies compa ing he diagnosis o POP be ween anspe -
ineal ul asound and clinical examina ion wi h POP-Q.
•S udies ha used a fixed poin (e.g. he pubis) as a e e-
ence o he ul asound diagnosis o POP.
S udies we e excluded when:
•They coun ed wi h less han 30 women (sample size se
a bi a ily).
•They did no p o ide da a on sensi i i y o specifici y o
anspe ineal ul asound diagnosis compa ed o POP-Q.
•The aim o he s udy was no o de e mine an ul asound
measu emen o diagnose POP as defined by POP-Q.
S udy selec ion p ocedu e
Ini ially, he au ho s examined he i les o he a icles
iden ified in he esea ch, finally excluding hose o no ele-
ance, clinical cases, e iews, me a-analyses, commen s o
le e s o he edi o . Subsequen ly, a e ha ing ead he
abs ac s, some addi ional a icles we e excluded using he
same sys ema ic app oach as desc ibed abo e. The emain-
ing s udies we e examined in ull ex and a e wa ds he
inclusion and exclusion c i e ia we e applied.
As men ioned in he sec ion abo e, we excluded case
epo s and s udies wi h a sample size < 30, s udies ha did
no use POP-Q as he gold s anda d, and hose ha did
no use anspe ineal ul asound o diagnose POP. We also
excluded s udies ha did no conside he pubic bone as
he e e ence poin o he ul asound diagnosis o POP, and
hose in espec o which he pape did no p o ide sensi i -
i y and specifici y alues.
Da a collec ed om he s udies
The ollowing da a we e ex ac ed om each included
s udy: name o fi s au ho , yea o publica ion, s udy design
(p ospec i e o e ospec i e coho ), ype o compa men
s udied (an e io , middle, pos e io ), ype o POP ana-
lyzed (cys ocele, u e ine p olapse, ec ocele), popula ion
included in he s udy and popula ion a ec ed by he POP
s udied.
We also sc eened o in o ma ion on he ul asound
me hodology, such as he fixed e e ence poin used in he
ul asound assessmen , he o gan and he e e ence poin
o he o gan o which he measu emen is applied, he ype
o measu emen (isola ed o dynamic; whe e es ing and
Valsal a measu emen s a e compa ed), he es used as a
gold s anda d, he cu -o poin o he measu emen o he
ul asound diagnosis o POP, and he sensi i i y and speci-
fici y o his cu -o poin .
Risk o bias assessmen
The QUADAS-2 ool was used in his me a-analysis o assess
he isk o bias o he di e en s udies. This ool consis s o
ou key domains: pa ien selec ion, index es , e e ence
s anda d, and flow and iming. Fo each domain, he isk o
bias and conce ns ega ding applicabili y we e classified as
high, low o unclea .16 Disag eemen s be ween au ho s we e
esol ed by discussion o each consensus. The assessmen o
he ‘‘pa ien selec ion’’ domain was based on he inclusion
and exclusion c i e ia o he s udies. In he ‘‘index es ’’
domain, i was de e mined ha he measu emen c i e ia
o he diagnosis o POP had o be clea , so hey could be
ep oduced in di e en s udies. The ‘‘ e e ence s anda d’’
domain was he clinical examina ion wi h he POP-Q sco e
(gold s anda d o POP diagnosis3). Fo he ‘‘flow and ime’’
domain, he s udies had o epo ha he clinical examina-
ion and he ul asound examina ion we e pe o med in he
same ac . The anspe ineal ul asound diagnos ic pe o -
mance da a e alua ed in his me a-analysis we e ex ac ed
om he included s udies, compa ing clinical examina ion
by POP-Q and ul asound measu emen s om a fixed e e-
ence poin , he pubis.
S a is ical analysis
S a is ical analyses we e pe o med using R so wa e. The
me a-analysis consis ed o wo s ages: a fi s s age in which
he esul s o each s udy we e es ima ed using an odds a io
es ima e and 95% confidence in e als o sensi i i y and
specifici y, and a second s age including Chi-squa ed es s
o compa e sensi i i y and specifici y be ween he p ima y
s udies.
The diagnos ic odds a io (OR) and confidence in e als
(95%), as well as posi i e and nega i e likelihood a ios,
we e calcula ed o each selec ed s udy. The ollowing
uni a ia e measu es o o e all diagnos ic accu acy we e cal-
cula ed: (1) he DSL es ima o o weigh ed es ima es o he
likelihood a ios obse ed in he p ima y s udies, (2) he
s a is ics au (), 2(2), and (3) he I2s a is ic ( o exam-
ine he me hodological he e ogenei y o he s udies in he
e iew).
The h eshold e ec was assessed nume ically using
Spea man’s ho s a is ic and g aphically using ROC cu e
plo s.
Publica ion bias was assessed using he Fail-Sa e N analy-
sis calcula ed om Rosen hal’s app oxima ion. Fo es plo s
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J.A. Ga cía-Mejido, F. Fe nández-Palacín and J.A. Sainz-Bueno
Q1
we e included o supplemen s udy he e ogenei y and un-
nel plo s we e d awn o conduc bias s udies.
The esul s o he s udies we e agg ega ed using a an-
dom e ec s model (a e compa ing hei adequacy). In his
s ep, we ob ained he OR alue, 95% confidence in e als
and significance o sensi i i y and specifici y by in eg a -
ing all selec ed s udies. All analyses we e pe o med wi h R
so wa e.17
Resul s
Sea ch esul s
A flow cha summa izing he li e a u e iden ifica ion and
s udy selec ion is shown in Fig. 1. The elec onic sea ch
iden ified 2359 ci a ions (1481 in PubMed/MEDLINE, 38 in
Scopus, 817 in Web o Science, 19 in CINAHL, 1 in The
Coch ane Lib a y, 3 in ClinicalT ials.go ). We excluded 293
ials ha we e duplica ed o ha had no been conduc ed in
women. O he emaining 2066 s udies, 1256 we e excluded
a e i le sc eening (992 no ele an , 130 case epo s, 120
e iews, 2 sys ema ic e iews, 7 me a-analyses, 5 commen s
o le e s o he edi o ). O he emaining 810 s udies, we
pe o med a second sc eening by e iewing he abs ac s,
and 743 pape s we e excluded (700 no ele an , 26 case
epo s, 12 e iews, 5 commen s o le e s o he edi-
o ).
We e iewed he ull ex o he emaining 67 pape s,
excluding 59 o he ollowing easons: case epo s (n= 2),
sample size < 30 (n= 1), POP-Q no used as gold s anda d
(n= 40), anspe ineal ul asound no used as diagnos ic
me hod o POP (n= 3), pubis no used as e e ence poin o
ul asound diagnosis o POP (n= 6) and o he s no p o iding
sensi i i y o specifici y (n= 7).
Finally, we included a o al o 8 s udies in he
e iew,15,18---24 o which 3 examined he an e io
compa men ,18---20 6 he middle compa men 15,19,21---24
and 2 he pos e io compa men .18,19
Cha ac e is ics o included s udies
The cha ac e is ics o he included s udies a e lis ed in
Table 1. The selec ed s udies we e published be ween 2007
and 2024 and included a o al o 4481 pa ien s, 1454 o
whom we e diagnosed wi h POP using he POP-Q clinical
sco e. The 2 s udies based on he an e io and pos e io
compa men s18,19 we e e ospec i e and 1 p ospec i e20
ocused on cys ocele and ec ocele, espec i ely. O
he pape s examining he middle compa men ,15,19,21---24
2 we e e ospec i e19,21 and 4 p ospec i e.15,22---24 The
fixed e e ence poin o ul asound examina ion o POP
was he pubic bone in all s udies,15,18---24 mo e speci -
ically he pos e io ---in e io bo de o he symphysis
pubis.
In ela ion o he an e io compa men , he ul asound
diagnosis o cys ocele was based on a s a ic Valsal a mea-
su emen om he pos e io ---in e io bo de o he pubic
symphysis o he mos descended pa o he bladde , wi h
a cu -o poin o a leas 10 mm.18---20
Rega ding he middle compa men , 3 a icles19,21,23
based he ul asound diagnosis o u e ine p olapse on a s a ic
Valsal a measu emen om he pos e io ---in e io bo de
o he pubic symphysis o he mos descended pa o he
u e ine ce ix, wi h a cu -o poin o 15 mm. In 3 o he
ele an a icles15,22,24 his ul asound diagnosis was defined
as a dynamic measu emen (di e ence be ween es and
Valsal a) om he pos e io ---in e io bo de o he pubic
symphysis o he u e ine undus, wi h a cu -o poin o
15 mm.
In espec o he pos e io compa men , 2 a icles18,19
defined he ul asound diagnosis o ec ocele as a s a ic Val-
sal a measu emen om he pos e io ---in e io bo de o he
pubic symphysis o he mos descending pa o he ec um,
wi h a cu -o poin o 15 mm. All s udies used he POP-Q
clinical assessmen as he gold s anda d o he diagnosis o
POP.
The sensi i i y and specifici y o anspe ineal ul asound
o diagnosing POP in he an e io compa men ange om
55.9% o 89.9% and om 56.0% o 82%, espec i ely.18---20 Fo
he middle compa men , he sensi i i y and specifici y o
anspe ineal ul asound o diagnosing POP a y om 60.2%
o 81.2% and om 64% o 95%, espec i ely.15,19,21---24 Fo
he pos e io compa men , he sensi i i y and specifici y o
anspe ineal ul asound o diagnosing POP fluc ua e om
70.8% o 93.1% and om 47.1% o 78%, espec i ely.18,19
Quali a i e syn hesis
Table 2 shows he assessmen o isk o bias and conce ns
abou applicabili y o he included s udies acco ding o he
QUADAS-2 ool. All s udies had a low isk o pa ien selec-
ion bias, as hey we e e ospec i e o p ospec i e s udies
ha included pa ien s wi h pel ic o gan p olapse diag-
nosed a clinical examina ion. Fo he index es domain,
he included s udies we e conside ed o ha e a low isk
o bias as hey used a fixed ul asound e e ence poin
(pos e io ---in e io bo de o he pubic symphysis) and clea
measu emen s applied o he compa men s. In he e e-
ence s anda d a ea, he e a e wo pape s whe e he isk
o bias is unclea due o he lack o defini ion o he p o-
lapse s ages included, based on he POP-Q. The isk o bias
o flow and iming is low in all included a icles, gi en ha
he ul asound assessmen was pe o med a e he clinical
examina ion.
All s udies we e conside ed o ha e low applicabili y con-
ce ns in e ms o pa ien selec ion, index es , e e ence
s anda d, flow and iming.
Quan i a i e syn hesis
The diagnos ic OR es ima es, confidence in e als (95%), and
posi i e and nega i e likelihood a ios o each selec ed
s udy a e shown in Table 3. Fo es plo s a e p esen ed in
Figs. 2 and 3.
The pooled sensi i i y o he ul asound diagnosis o POP
was 72.3% wi h a s anda d e o o 3.1% (p< 0.001), au o
0.11, I2o 97.1% (p< 0.001) (Table 4). A unnel plo o sensi-
i i y o he diagnosis o POP using anspe ineal ul asound
is shown in Fig. 4. The pooled specifici y o ul asound
diagnosis o POP was 78.0% wi h a s anda d e o o 4.4%
(p< 0.001), au o 0.16, I2o 98.6% (p< 0.001) (Table 4). A
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GINE 101018 1---12
Clínica e In es igación en Ginecología y Obs e icia xxx (xxxx) 101018
Table 1 Cha ac e is ics o he included s udies.
S udy Compa -
men
O gan
p olapse
S udy
design
Pa ien s
(n)
Pa ien
wi h
p olapse
(n)
Re e ence
poin
O gan o
e e ence
Type o
measu e
Cu poin Gold
s anda d
Sensi i i y Sensi i i y
(95% CI)
Specifici y Specifici y
(95% CI)
Die z
200718
An e io Cys ocele Re o 735 56 Pubic
symphysis
U ina y
bladde
S a ic 10 mm POP-Q 71.4% 58.5%;
81.6%
82.0% 79.0%;
84.7%
Die z
201619
An e io Cys ocele Re o 825 477 Pubic
symphysis
U ina y
bladde
S a ic 10 mm POP-Q 89.9% 86.9%;
92.3%
64.1% 58.9%;
68.9%
Wu 202220 An e io Cys ocele P osp 674 440 Pubic
symphysis
U ina y
bladde
S a ic 10 mm POP-Q
(s age II)
55.9% 51.2%;
60.5%
56.0% 49.6%;
62.2%
Shek
201521
Medium U e ine
p olapse
Re o 538 63 Pubic
symphysis
U e ine
ce ix
S a ic 15 mm POP-Q
(s age II)
69.8% 57.6%;
79.8%
64.0% 59.6%;
68.2%
Die z
201619
Medium U e ine
p olapse
Re o 568 221 Pubic
symphysis
U e ine
ce ix
S a ic 15 mm POP-Q 60.2% 53.6%;
66.4%
76.9% 72.2%;
81.1%
Ga cía-
Mejido
202122
Medium U e ine
p olapse
P osp 60 40 Pubic
symphysis
U e ine
undus
Dynamic 15 mm POP-Q
(s age II)
75.0% 59.8%;
85.8%
95.0% 76.4%;
99.1%
Wu 202123 Medium U e ine
p olapse
P osp 534 274 Pubic
symphysis
U e ine
ce ix
S a ic 15 mm POP-Q
(s age II)
63.9% 58.0%;
69.3%
93.1% 89.3%;
95.6%
Ga cía-
Mejido
202315
Medium U e ine
p olapse
P osp 52 16 Pubic
symphysis
U e ine
undus
Dynamic 15 mm POP-Q
(s age II)
and
su gical
c i e ia
81.2% 57.0%;
93.4%
91.7% 78.2%;
97.1%
Ga cía-
Mejido
202424
Medium U e ine
p olapse
P osp 143 69 Pubic
symphysis
U e ine
undus
Dynamic 15 mm POP-Q
(es adio II)
Gene al
68.1% 56.4%;
77.9%
89.2% 80.1%;
94.4%
POP-Q
(es adio II)
P emeno-
pausal
76.8% 65.6%;
85.2%
91.9% 83.4%;
96.2%
POP-Q
(es adio II)
Pos meno-
pausal
66.7% 54.9%;
76.6%
86.5% 76.9%;
92.5%
Die z
200718
Pos e io Rec ocele Re o 735 48 Pubic
symphysis
Rec um S a ic 15 mm POP-Q 70.8% 56.8%;
81.8%
78.0% 74.8%;
81.0%
Die z
201619
Pos e io Rec ocele Re o 825 464 Pubic
symphysis
Rec um S a ic 15 mm POP-Q 93.1% 90.4%;
95.1%
47.1% 42.0%;
52.2%
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ARTICLE IN PRESS
+Model
GINE 101018 1---12
J.A. Ga cía-Mejido, F. Fe nández-Palacín and J.A. Sainz-Bueno
Q1
Table 2 E alua ion o bias isk and conce ns ega ding he applicabili y o s udies included acco ding o he QUADAS-2 ool.
Risk o bias Applicabili y conce ns
Index es Index es
S udy Pa ien
selec ion
Cys ocele U e ine
p olapse
Rec ocele Re e ence
s anda d
Flow and
iming
Pa ien
selec ion
Cys ocele U e ine
p olapse
Rec ocele Re e ence
s anda d
Flow and
iming
Die z 200718 Low Low --- Low Unclea Low Low Low --- Low Low Low
Die z 201619 Low Low Low Low Unclea Low Low Low Low Low Low Low
Wu 202220 Low Low --- --- Low Low Low Low --- --- Low Low
Shek 201521 Low --- Low --- Unclea Low Low --- Low --- Low Low
Ga cía-
Mejido
202122
Low --- Low --- Low Low Low --- Low --- Low Low
Wu 202123 Low --- Low --- Low Low Low --- Low --- Low Low
Ga cía-
Mejido
202315
Low --- Low --- Low Low Low --- Low --- Low Low
Ga cía-
Mejido
202424
Low --- Low --- Low Low Low --- Low --- Low Low
6
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GINE 101018 1---12
Clínica e In es igación en Ginecología y Obs e icia xxx (xxxx) 101018
Figu e 1 A flowcha summa izing li e a u e iden ifica ion and selec ion o s udies.
unnel plo o he specifici y o he diagnosis o POP by
anspe ineal ul asound is ep esen ed in Fig. 5.
The ROC cu e esul ing om he se e al included s udies
is shown in Fig. 6.
An a emp was made o pe o m a subg oup analysis
acco ding o he compa men a ec ed by POP. Howe e ,
his was no possible due o he small numbe o s udies e al-
ua ing he an e io and pos e io compa men s. The e o e,
he analysis was finally based on he s udy ha included all
h ee compa men s.
Discussion
Summa y o he e idence
Acco ding o ou esul s, he diagnosis o POP by anspe -
ineal ul asound has a mode a e sensi i i y (72.3%) and
specifici y (78.0%). Due o he limi ed numbe o publica-
ions e e ing o he an e io and pos e io compa men s,
we we e no able o de e mine he diagnos ic capaci y o
ul asound o POP acco ding o each compa men .
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GINE 101018 1---12
J.A. Ga cía-Mejido, F. Fe nández-Palacín and J.A. Sainz-Bueno
Q1
Table 3 The poin es ima es and confidence in e als (95%) o he diagnos ic ORs, and likelihood a ios o a posi i e esul and
a nega i e esul o each selec ed s udy.
S udy DOR DOR (95% CI) POSLR POSLR (95% CI) NEGLR NEGLR (95% CI)
Die z 200718 11.4 6.2; 21.0 3.9 3.2; 5.0 0.3 0.2; 0.5
Die z 201619 15.9 11.9; 23.1 2.5 2.2; 2.9 0.2 0.1; 0.2
Wu 202220 1.6 1.2; 2.2 1.3 1.1;1.5 0.8 0.7; 0.9
Shek 201521 4.1 2.3; 7.3 1.9 1.6; 2.4 0.5 0.3; 0.7
Die z 201619 5.0 3.5; 7.3 2.6 2.1; 23.2 0.5 0.4; 0.6
Ga cía-Mejido 202122 57.0 6.7; 481.8 15.0 2.2; 102.2 0.3 0.2; 0.5
Wu 202123 23.8 13.9; 40.7 9.2 5.9; 14.5 0.4 0.3; 0.5
Ga cía-Mejido 202315 47.7 8.5; 267.3 9.8 3.2; 29.5 0.2 0.1; 0.6
Ga cía-Mejido 202424 Gene al 17.6 7.2; 42.9 6.3 3.2; 12.4 0.4 0.3; 0.5
Ga cía-Mejido 202424 P emenopausal 37.5 13.7; 102.5 9.5 4.4; 20.6 0.3 0.2; 0.4
Ga cía-Mejido 202424Pos menopausal 12.8 5.6; 29.5 4.9 2.7; 8.9 0.4 0.3; 0.6
Die z 200718 8.6 4.5; 16.5 3.2 2.6; 4.1 0.4 0.2; 0.6
Die z 201619 12.0 7.9; 18.2 1.8 1.8; 1.6 0.1 0.1; 0.2
DOR: diagnos ic odds a io. POSLR: posi i e likelihood a io. NEGSLR: nega i e likelihood a io.
Table 4 Global p ecision diagnosis wi h he DSL es ima o o es ima e in a weigh ed way he likelihood a ios obse ed in he
p ima y s udies and he s a is ics au (), 2(2), as well as he I2s a is ic ( o he s udy o he he e ogenei y o he me hodology
o he s udies in he e iew).
Es ima e S anda d e o p(95% CI) Tau Tau2I2p
Sensi i i y 72.3% 3.1% <0.001 66.2%; 78.3% 0.11 0.01 (SE = 0.005) 97.1% <0.001
Specifici y 78.0% 4.4% <0.001 69.5%; 86.6% 0.16 0.024 (SE = 0.01) 98.6% <0.001
Figu e 2 Fo es plo s o sensi i i y in he diagnosis o POP
using anspe ineal ul asound. Only fi s au ho o each s udy
is gi en.
In e p e a ion o he esul s
Cu en ly, he diagnosis o POP is made clinically based on
he POP-Q sco e.5Ul asonog aphy has eme ged as a com-
plemen a y es ha can aid in he diagnosis o symp oma ic
Figu e 3 Fo es plo s o specifici y in he diagnosis o POP
by anspe ineal ul asound. Only fi s au ho o each s udy is
gi en.
POP. Howe e , he numbe o s udies compa ing ul asound
diagnosis wi h clinical POP-Q assessmen is limi ed.15,18---24
Ne e heless, all hese s udies show sensi i i ies be ween
55% and 93% o he diagnosis o he a ious POPs in di e -
en compa men s. Howe e , specifici ies ange om 56% o
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