ADOPTION OF THE PELVIC ORGAN PROLAPSE QUANTIFICATION SYSTEM (POPQ) IN PEER REVIEW LITERATURE

T.W. Muir, MD and M.D. Barber, MD, MHS
Cleveland Clinic Foundation, Cleveland, Ohio

   Objective: To examine the staging/grading systems used to describe pelvic organ prolapse in the peer reviewed literature since the introduction of the POPQ system in 1996.

   Materials and Methods: The following representative United States and international gynecology and urology journals were selected for review: American Journal of Obstetrics and Gynecology, Obstetrics and Gynecology, International Urogynecology Journal, British Journal of Obstetrics and Gynaecology, and Journal of Urology. All articles published in January to December of 1999 (Period 1) and July, 2001 to June, 2002 (Period 2) for each journal were hand searched by two independent reviewers. Articles were included in this study if an anatomic description of pelvic organ support was provided. Systems for grading the severity of pelvic organ prolapse were separated into the following categories: POPQ, Baden-Walker system, Beecham system, no standardized system described, or other. Statistical comparisons were made with the Chi-square test or Fisher’s Exact Test where appropriate.

   Results: During periods 1 and 2, 85 articles were published in the reviewed journals that provided an anatomical description of pelvic organ prolapse. Overall, the POPQ system was the most common standardized prolapse grading system used (25 articles, 28%) followed by the Baden –Walker system (21 articles, 24%). Forty-seven percent (42 articles) either did not use a standardized prolapse grading system or did not provide a citation or reference for the system used. There was no significant change in the proportion of articles that used the POPQ system from Period 1 to Period 2 (22% vs 30%, p=.20). Articles from U.S. journals were significantly more likely to use the POPQ system than articles from non-U.S. journals (38% vs. 15%, p = 0.02) and articles published in Ob/Gyn journals were significantly more likely to use the POPQ system than articles published in Urology journals (32% vs 8%, p = 0.03). There was no significant association between the study design and the use ! of POPQ. Preoperative exam position was reported in 37% (n=31) of articles and postoperative exam position reported in 55% (n=47) articles. Articles in which the POPQ was used were significantly more likely to report examination position than those that did not (79% vs 46%; p=.007).

   Conclusion: Since its introduction in 1996 and adoption by the Society of Gynecologic Surgeons, American Urogynecologic Society and International Continence Society, the POPQ system has become the most common standardized prolapse grading system used in the medical literature. In spite of this, it is still used only in a minority of studies. Almost half of articles published during the periods studied used a non-standardized, non-validated prolapse grading method or did not report what grading method was used.

   Key Words: POPQ, pelvic organ prolapse, staging system