Clinical relevance of routine transvaginal ultrasound in women referred with pelvic organ prolapse

“A meticulous anamnesis and a good clinical examination, including a digital vaginal examination, are crucial before deciding if TVS can be omitted.”

Background: The aim of this study was to investigate the prevalence of incidental findings on transvaginal ultrasound scans in women referred with pelvic organ prolapse by a general practitioner and to investigate which further examinations and treatments were performed because of these findings.

Methods: This was a retrospective cohort study that investigated women with pelvic organ prolapse referred to the outpatient urogynaecological clinics at Randers Regional Hospital and Aarhus University Hospital, Denmark.

Results: A total of 521 women were included, and all of them were examined with a routine transvaginal ultrasound scan and a gynecological examination. Prolapse symptoms only and no specific indication for transvaginal ultrasound scans were seen in 507 women (97.3%), while 14 women (2.7%) received scans on the indication.

Among the latter women, five (35.7%) had cancer. In the women with solely prolapse symptoms, 59 (11.6%) had incidental findings on transvaginal ultrasound scans, but all were benign. However, two patients were later diagnosed with cancer unrelated to the initial ultrasound findings. The treatment was extended with further examinations not related to POP in 19 of the women (32.2%) with incidental ultrasound findings.

Conclusion: The prevalence of incidental ultrasound findings was not high in the women referred with pelvic organ prolapse and no additional symptoms, and all these findings were benign. However, it should be considered that these findings resulted in further investigations and changes to the patient’s initial treatment plans. A meticulous anamnesis and digital vaginal examination are crucial to rule out the need for a vaginal ultrasound.