CLINICAL EVALUATION OF ANTERIOR VAGINAL WALL SUPPORT DEFECTS: INTEREXAMINER VARIABILITY

J. Whiteside, MD, M. Barber, MD, M. Paraiso, MD, C. Hugney, RN, M. Walters, MD


   Objective: To determine the interobserver variability of the clinical examination for support defect of the anterior vaginal wall.

   Materials and Methods: Thirty-six patients with at least stage II anterior vaginal wall prolapse as defined by the International Continence Society’s pelvic organ prolapse quantification (POPQ) system were prospectively evaluated utilizing a standardized examination. All examiners before the onset of the study reviewed a standardized examination technique. Interobserver variation was assessed with a duplicate examination performed by a blinded second examiner. Additional vaginal defects (e.g. posterior vaginal wall defect) did not exclude patient participation.

Examination variability for the four types of defects (central, right lateral, left lateral and superior) was evaluated with the kappa statistic. Kappa values between 0.81 and 1.00 are considered near perfect agreement between two examinations. Kappa values between 0.61 and 0.80 are considered satisfactory agreement and values between 0.41 and 0.60 are regarded as poor agreement.

   Results: The average age and parity of enrolled patients was 58 and 3, respectively. Fifty-six percent of patients had stage II prolapse and 46% had stage III or IV prolapse. Half of the enrolled patients were estrogen deficient. Forty-two percent of patients had had previous gynecological surgery. The percent agreement between examiners for central defects was 75% with a kappa and standard error of 0.41 ± 0.16. Right and left lateral (paravaginal) defects demonstrated 83% and 89% agreement between examiners, respectively, with a kappa of 0.16 ± 0.21 and 0.54 ± 0.20 respectively. The concordance between examiners for superior defects was 86% with a kappa of 0.47 ± 0.19. Overall agreement was 47% with a kappa of 0.15 ± 0.11. Kappa was noted to improve with increasing stage of prolapse.

   Conclusions: The clinical examination of anterior vaginal wall defects displays poor interobserver agreement. Surgical planning based on clinically detected anterior vaginal wall defects may be problematic.

   Key Words: Paravaginal defect, Clinical examination, Variability