Physiologic outcome measures for urinary incontinence Ingrid Nygaard  Gastroenterology  Volume 126, Pages S99-S105 (January 2004) DOI: 10.1053/j.gastro.2003.10.009

Figure 1 POP-Q. Pelvic organ support is assessed during Valsalva efforts. Measurements are described relative to the hymeneal ring; points above the hymen, except total vaginal length (TVL), are recorded as negative values, and those beyond the hymen are recorded as positive values. The points include the following: 2 anterior points (Aa, that point 3 cm above the urethral meatus on the anterior vaginal wall in the midline [corresponding to the approximate location of the “urethrovesical crease”]; Ba, the most dependent portion of the anterior vaginal wall above Aa), 3 apical points (C, the leading edge of the cervix or vaginal cuff [or hysterectomy scar]; D, the posterior fornix in women with intact uteri [this point is not recorded in women without a cervix]; TVL, total vaginal length [distance from cervix or vaginal cuff, measured without Valsalva]), 2 posterior points (Ap, that point 3 cm above the hymen in the midline on the posterior vaginal wall; Bp, the most dependent portion of the posterior vaginal wall above Ap), and 2 points outside the vagina (gh, the distance from the middle of the urethral meatus to the posterior hymen in the midline; pb, the distance from the superior aspect of the perineal body to the midanal opening). Adapted with permission from Bump et al.44 Gastroenterology 2004 126, S99-S105DOI: (10.1053/j.gastro.2003.10.009)

Figure 2 The current staging system, used to describe the severity of prolapse, is based on the POP-Q measurement system and includes 5 stages as follows: stage 0, no prolapse; stage I, the most distal prolapse does not descend past 2 cm above the hymeneal ring; stage II, the most distal prolapse is between 1 cm above and 1 cm below the hymeneal ring; stage III, the most distal prolapse is at least 2 cm below the hymeneal ring but not as far out as stage IV; stage IV, complete vault eversion and the most distal prolapse protrudes at least as far out as TVL −2 cm.44 This figure shows examples of stages III and IV. Gastroenterology 2004 126, S99-S105DOI: (10.1053/j.gastro.2003.10.009)