The role of vaginal apical support in the genesis of anterior rectal wall prolapse

A. Gunnemann, P. E. Petros

Research output: Chapter in Book/Conference paperChapterpeer-review


OBJECTIVE: To describe how simulated apical support
affects the appearance of prolapse in the anterior and
posterior vagina using a modification of the Pelvic Organ
Prolapse Quantification (POP-Q) examination.
METHODS: Women with prolapse stage II or greater
were examined using the POP-Q. To simulate apical
support, the posterior blade of a standard Graves speculum was positioned over the posterior vagina to support
the vaginal apex while remeasuring points Aa and Ba and
over the anterior vagina to support the apex while
remeasuring points Ap and Bp. Change in anterior and
posterior POP-Q points and prolapse stage with apical
support were calculated.
RESULTS: One hundred ninety-seven women were enrolled with mean age of 6214 years, median parity of 2
(range 0 – 8), and mean body mass index of 285 kg/m2
By standard POP-Q, 36% had stage II prolapse, 54% had
stage III, and 10% had stage IV prolapse. With simulated
apical support, point Ba changed to stage 0 or I in 55% of
cases and point Bp changed to stage 0 or I in 30% (P<.001
for each point). Mean change for point Ba with apical
support was 3.52.6 cm and point Bp was 1.92.9 cm
Original languageEnglish
Title of host publicationThe American College of Obstetricians and Gynecologist
PublisherLippincott Williams & Wilkins
Number of pages6
ISBN (Print)0029-7844/07
Publication statusPublished - 1 Jan 2008

Publication series

NameTech Coloproctol


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