A New POP (Pelvic Organ Prolapse) Scoring System: Validity and Reliability

All patients presented with organ prolapse in the outpatient clinic will be reviewed. Patients are eligible for enrollment in the study when they are complied with all general inclusion criteria, and when none of the exclusion criteria are met after getting written consent from the patients. Study location: (Please provide where the study will be conducted and from where study participants will be recruited) Obstetrics and Gynecology Department, Cairo University Hospital ( Kasr Al Aini), Faculty of Medicine, Cairo University.

All eligible patients will undergo a baseline clinical examination to collect clinical data. This consisted of detailed medical history (including age, parity, detailed obstetric history in the mode of delivery and circumstances associated with each delivery), symptoms, exacerbating and relieving factors, associated symptoms, medication record, history of any previous treatment as pelvic floor muscle training or surgeries, physical examination including weight & height, abdominal and pelvic examination , and clinical category of prolapse according to the POP Q classification system.

Interventions details:

A FIXED APCD classification system will be used to grade the patient symptoms as follows:

A: Associated symptoms:

Incontinence Urgency Constipation Vaginal keratosis/ ulceration

FIXED: the following symptoms will be noted down and graded from 0-10 according to severity:

F: frequency I: infection X: sex problems E: everted mass(external protrusion of mass from the valva as PV lump sensation ,heaviness,itching and ulceration) D: digitation(patient need to digitate to complete the act of micturation or defecation)

APCD: The recruited subject will be examined in lithotomy position. Inspection of the perineum and introitus to look for any vaginal keratosis and measure the introitus length. Examination will be done using sims speculum while the patient is in sims position. The following points will be assessed and noted down as follows:

A: Dependent point on anterior wall. P: Dependent point on posterior wall. C: Cuff point either cervix or vault. Distance to hymen in centimeters (minus above or plus below) after pushing the opposite wall during maximal straining D: Dimensions; base diameter of vestibule/ perineal length.

The staging system will be interpreted as follows:

Normal:

A-3 P-3 C-8 D 2/2

Stages:

0: No prolapse.

• A/P-2 OR C-7 to C-2
• A,P or C-1 to +1
• A,P or C ˃ +1

X component: (alone or with any stage):

Dimension disruption: ˃2 or <2

In order to test the interobserver reliability of the classification system, both history taking and examination will be done by trainee and specialist. The intraobserver reliability will be assessed by repeating the examination by the same examiner two weeks later.

The reliability of the scoring system will be assessed by comparing it to the POP Q classification system, results obtained for each patient at recruitment regarding accuracy and time consumed in the assessed scoring system (using a stopwatch to calculate the time needed for each system applied).

Inclusion criteria

Age : 18 years and more Symptoms : Pelvic heaviness, urinary symptoms as: stress urinary incontinence, voiding difficulties, dysuria frequency, bowel symptoms as difficulty in defecation sexual symptoms Informed consent

Exclusion criteria

Refusal intolerance to the physical examination

• presence of pelvic floor disorders secondary to neurological disease malignancy.