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García-Mejido JA, Galán-Paez J, Solis-Martín D, Martín-Morán M, Borrero-Gonzalez C, Fernández-Gomez A, Fernández-Palacín F, Sainz-Bueno JA. Artificial Intelligence to Determine Correct Midsagittal Plane in Dynamic Transperineal Ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025. [PMID: 40276937 DOI: 10.1002/jcu.24050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 12/26/2024] [Accepted: 03/31/2025] [Indexed: 04/26/2025]
Abstract
PURPOSE To create and validate a machine learning(ML) model that allows for identifying the correct capture of the midsagittal plane in a dynamic ultrasound study, as well as establishing its concordance with a senior explorer and a junior explorer. METHODS Observational and prospective study with 90 patients without pelvic floor pathology. Each patient was given an ultrasound video where the midsagittal plane of the pelvic floor was recorded at rest and during the Valsalva maneuver. A segmentation model was used that was trained on a previously published article, generating the segmentations of the 90 new videos to create the model. The algorithm selected to build the model in this project was XGBoost(Gradient Boosting). To obtain a tabular dataset on which to train the model, feature engineering was carried out on the raw segmentation data. The concordance of the model, of a junior examiner and a senior examiner, with the expert examiner was studied using the kappa index. RESULTS The first 60 videos were used to train the model and the last 30 videos were reserved for the test set. The model presented a kappa index 0.930(p < 0.001) with very good agreement for detection of the correct midsagittal plane. The junior explorer presented a very good agreement (kappa index = 0.930(p < 0.001)). The senior explorer presented a kappa index 0.789(p < 0.001) (good agreement) for detection of the correct midsagittal plane. CONCLUSION We have developed a model that allows determining the correct midsagittal plane captured through dynamic transperineal ultrasound with a level of agreement comparable to or greater than that of a junior or senior examiner, using expert examiner assessment as the gold standard.
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Affiliation(s)
| | - Juan Galán-Paez
- Department of Computer Science and Artificial Intelligence, Faculty of Mathematics, University of Seville, Seville, Spain
| | - David Solis-Martín
- Department of Computer Science and Artificial Intelligence, Faculty of Mathematics, University of Seville, Seville, Spain
| | - Marina Martín-Morán
- Department of Surgery, Faculty of Medicine, University of Seville, Seville, Spain
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Gao Q, Wang M, Zhang J, Qing Y, Yang Z, Wang X, Xu X, Ye Q, Zhang F. Pelvic floor dysfunction in postpartum women: A cross-sectional study. PLoS One 2024; 19:e0308563. [PMID: 39361594 PMCID: PMC11449369 DOI: 10.1371/journal.pone.0308563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/26/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is a disease of weakened pelvic floor support tissues, leading to changes in the pelvic organ position and function of pelvic organs, with long-term effects on women. This study aimed to assess pelvic floor function using electrophysiology and clinical symptoms, exploring the risk factors for PFD one month postpartum. METHODS This cross-sectional study included 845 women from postpartum outpatient clinic of Nantong Affiliated Hospital from August 2019 to October 2021. Pelvic floor muscle strength was evaluated via pelvic floor surface electromyography. Clinical symptoms (urinary incontinence (UI) and pelvic organ prolapse) were diagnosed by gynecologists. Sociodemographic, pregnancy, and obstetrical data were obtained from self-reported questionnaires and electronic records. RESULTS The study identified maternal age, parity, immigrant status, and economic income as factors were related to PFD. Gestational constipation increased the risk of abnormal resting muscle strength (OR:1.553, 95%CI: 1.022-2.359). Cesarean delivery was associated with higher rates of abnormal resting muscle strength than vaginal delivery (post-resting stage: OR, 2.712; 95% CI, 1.189-6.185), but a decreased incidence of UI (OR: 0.302; 95% CI, 0.117-0.782). Increased gestational weight gain was correlated with a greater risk of developing UI (OR:1.030, 95%CI: 1.002-1.058). Women with vaginal inflammation faced a higher risk of abnormal fast-twitch muscle (OR: 2.311, 95%CI: 1.125-4.748). CONCLUSIONS In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and constipation during pregnancy and vaginal flora could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with vaginal inflammation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles.
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Affiliation(s)
- Qian Gao
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Mingbo Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Jie Zhang
- Medical school of Nantong University, Nantong, Jiangsu Province, China
| | - Yangzhe Qing
- Medical school of Nantong University, Nantong, Jiangsu Province, China
| | - Ziyi Yang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Xin Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Xujuan Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Qing Ye
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Feng Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
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Xuan Y, Wang Y, Yue S, Zhang J, Yanfei Q, Xie J, Zhang G. Use of transrectal high-frequency ultrasound in assessment of middle compartment prolapse. Arch Gynecol Obstet 2024; 310:609-614. [PMID: 38836926 DOI: 10.1007/s00404-024-07515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/07/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To investigate the superiority of transrectal high-frequency ultrasound (TRUS) in precise assessment of middle compartment prolapse in comparison with routine transperineal ultrasound (TPUS). METHODS Prospectively analyzed and compared detection rates of entire cervical length and uterine descent on TPUS and TRUS in 101 patients with pelvic organ prolapse (POP). RESULTS Detection rates of entire cervix on TRUS were significantly higher than those on TPUS both at rest and during Valsalva maneuver (90.10% VS 49.50%, 92.08% VS 9.90% respectively, both p < 0.05). Uterine descent was able to be evaluated in 92.08% of patients by TRUS and in 5.94% of patients by TPUS, which was statistically significant (p < 0.05). The interobserver repeatability for the measurements of anterior lip, cervical canal and posterior lip on TRUS was excellent. The mean lengths of anterior lip, cervical canal and posterior lip were significantly increased during Valsalva maneuver than those measured at rest (p < 0.05). And mean length of anterior lip was longer than posterior lip both at rest and during Valsalva (p < 0.05). CONCLUSION TRUS can significantly raise detection rates of entire cervix, and make the direct evaluation of uterine descent feasible. TRUS can be used as a complementary method to TPUS to attain more comprehensive and accurate presurgical imaging information in middle compartment prolapse patients.
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Affiliation(s)
- Yinghua Xuan
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Beijing, 100026, Chaoyang, China
| | - Yidan Wang
- Department of Ultrasonography, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Song Yue
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Beijing, 100026, Chaoyang, China
| | - Juan Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Beijing, 100026, Chaoyang, China
| | - Qu Yanfei
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, 518000, China
| | - Jingyan Xie
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Qinhuai, China.
| | - Guohui Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Beijing, 100026, Chaoyang, China.
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García-Mejido JA, Martín-Martinez A, García-Jimenez R, González-Diaz E, Núñez-Matas MJ, Fernández-Palacín F, Carballo-Rastrilla S, Fernández-Fernández C, Sainz-Bueno JA. Is the Presence of Levator Ani Muscle Avulsion Relevant for the Diagnosis of Uterine Prolapse? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:265-272. [PMID: 37853913 DOI: 10.1002/jum.16356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). METHODS This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. RESULTS A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. CONCLUSION The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Alicia Martín-Martinez
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | - Rocío García-Jimenez
- Obstetrics and Gynecology Department, Juan Ramon Jiménez Hospital, Huelva, Spain
| | - Enrique González-Diaz
- Department of Obstetrics and Gynecology, University Healthcare Complex of Leon (CAULE), Leon, Spain
| | - María José Núñez-Matas
- Department of Obstetrics and Gynecology, Virgen de la Victoria University Hospital of Malaga, Malaga, Spain
| | | | - Sonia Carballo-Rastrilla
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | | | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
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Fang J, Zhang R, Lin S, Lai B, Chen Y, Lu Y, Wang M, Lin Y, Weng Y, Lin J, Shen J. Impact of parity on pelvic floor morphology and function: A retrospective study. Medicine (Baltimore) 2023; 102:e35738. [PMID: 37960825 PMCID: PMC10637539 DOI: 10.1097/md.0000000000035738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
To analyze the effect of parity on pelvic floor morphology and function during the postpartum period. A total of 971 participants, who attended the Fujian Maternity and Child Health Hospital (Fuzhou, China) between December 2019 and August 2021, were included. All participants were assessed using the modified Oxford scale (MOS), pelvic floor surface electromyography, and 3-dimensional pelvic floor ultrasound to assess pelvic floor morphology and function. Multivariate analysis revealed no differences among primipara, deuteripara, and tertipara in pre-baseline rest, phasic contraction, endurance contraction, post-baseline rest, and MOS, except for tonic contraction (P = .020), the amplitude of which was lower in primipara than in deuteripara in post hoc comparison (P = .008). Differences in bladder neck presentation and bladder neck descent were statistically significant in multivariate analysis (P = .002, P = .001, respectively), with the value of bladder neck presentation in primiparas being greater than that of deuteriparas and tertipara (P = .002, P = .008, respectively), and the value of bladder neck descent was lower than that of deuteripara and tertipara in further post hoc comparisons (P = .002, P = .003, respectively). Functional impairment was not statistically associated with parity according to the MOS score or surface electromyography. However, parity was significantly correlated with descent of the bladder neck, and most of the effects appeared to occur during the first delivery.
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Affiliation(s)
- Jianqi Fang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
- Fujian Key Laboratory of Women and Children Critical Diseases Research [Fujian Maternity and Child Health Hospital (Fujian Women and Children Hospital)], Fujian, People’s Republic of China
| | - Ronghua Zhang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Shuqin Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Binglan Lai
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yi Chen
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yao Lu
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Miao Wang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yang Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yilin Weng
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Juan Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Jinming Shen
- Master of Medicine, Department of Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China
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Maheut C, Vernet T, Le Boité H, Fernandez H, Capmas P. Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse. J Gynecol Obstet Hum Reprod 2023; 52:102650. [PMID: 37619710 DOI: 10.1016/j.jogoh.2023.102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Lifetime risk of surgery for female pelvic organ prolapse (FPOP) is estimated at 10 to 20%. Prolapse assessment is mostly done by clinical examination. Perineal ultrasound is easily available and performed to evaluate and stage FPOP. This study's aim is to evaluate the agreement between clinical examination by POP-Q and perineal sonography in women presenting pelvic organ prolapse. MATERIALS AND METHODS We carried out a prospective study from December 2015 to March 2018 in the gynecologic department of a teaching hospital. Consecutive woman requiring a surgery for pelvic organ prolapse were included. All women underwent clinical examination by POP-Q, perineal ultrasound with measurements of each compartment descent, levator hiatus area and posterior perineal angle. They also answered several functional questionnaires (PFDI 20, PFIQ7, EQ-5D and PISQ12) before and after surgery. Data for clinical and sonographic assessments were compared with Spearman's test and correlation with functional questionnaires was tested. RESULTS 82 women were included. We found no significant agreement between POP-Q and sonographic measures of bladder prolapse, surface of the perineal hiatus or perineal posterior angle. There was a significant improvement of most of the functional scores after surgery. DISCUSSION Our study does not suggest correlation between clinical POP-Q and sonographic assessment of bladder prolapse, hiatus surface or perineal posterior angle. Ultrasound datasets were limited by an important number of missing data resulting in a lack of power.
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Affiliation(s)
- Célia Maheut
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
| | - Thibaud Vernet
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
| | - Hugo Le Boité
- University Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France; Faculty of medicine, University Paris-Saclay, 63 rue Gabriel Péri, Le Kremlin Bicêtre 94270, France; INSERM - UMR1018 - CESP - Hôpital Paul Brousse, 12 avenue Paul Vaillant Couturier, Villejuif 94800, France
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France; Faculty of medicine, University Paris-Saclay, 63 rue Gabriel Péri, Le Kremlin Bicêtre 94270, France; INSERM - UMR1018 - CESP - Hôpital Paul Brousse, 12 avenue Paul Vaillant Couturier, Villejuif 94800, France.
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García-Mejido JA, Martín-Martinez A, González-Diaz E, Núñez-Matas MJ, Fernández-Palacín A, Carballo-Rastrilla S, Fernández-Fernández C, García-Jimenez R, Sainz-Bueno JA. Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2673-2681. [PMID: 37421644 DOI: 10.1002/jum.16303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/24/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). METHODS Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II-IV UP. Transperineal ultrasound was used to assess the difference in the pubis-uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. RESULTS A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84-0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). CONCLUSIONS We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Alicia Martín-Martinez
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | - Enrique González-Diaz
- Department of Obstetrics and Gynecology, University Healthcare Complex of Leon (CAULE), Leon, Spain
| | - María José Núñez-Matas
- Department of Obstetrics and Gynecology, Virgen de la Victoria University Hospital of Malaga, Malaga, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Sonia Carballo-Rastrilla
- Department of Obstetrics and Gynecology, University Healthcare Complex of Gran Canaria, Gran Canaria, Spain
| | | | - Rocío García-Jimenez
- Department of Obstetrics and Gynecology, Juan Ramón Jimenez Hospital, Seville, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
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Cao X, Qiu Y, Peng Z, Chen L, Zhou L, Lu A, Chen C, Liu P. Clinical application of a fixed reference line in the ultrasound quantitative diagnosis of female pelvic organ prolapse. BMC Med Imaging 2023; 23:170. [PMID: 37904129 PMCID: PMC10617056 DOI: 10.1186/s12880-023-01013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/06/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP). DESIGN A transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle. METHOD Points Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS). RESULTS One hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed. CONCLUSIONS Introital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.
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Affiliation(s)
- Xiaojuan Cao
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Yuwen Qiu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhiyong Peng
- Department of Anesthesiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Lan Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Li Zhou
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Anwei Lu
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
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García-Mejido JA, Martín-Martinez A, González-Diaz E, Núñez-Matas MJ, Fernández-Palacín A, Carballo-Rastrilla S, Fernández-Fernández C, Sainz-Bueno JA. Identification of Surgical Uterine Prolapse in Premenopausal Patients With Clinical or Ultrasound Criteria? A Multicenter Comparative Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2269-2275. [PMID: 37163226 DOI: 10.1002/jum.16248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES It is unknown whether diagnosing uterine prolapse (UP) via ultrasound or surgical criteria is superior. Our objective is to determine whether the diagnostic capacity of ultrasound with surgical criteria differs from that of surgical criteria only. METHODS This was a multicenter prospective observational study with 54 premenopausal patients with surgical criteria for a dysfunctional pelvic floor pathology who were consecutively recruited for 1 year. Clinical UP with surgical criteria was defined when UP stage II-IV was identified (during pelvic floor consultation), and UP diagnosed by ultrasound with surgical criteria was established when a difference ≥15 mm was found between rest and Valsalva applied to the pubis-uterine fundus. The sensitivity, specificity and positive and negative predictive values were determined to evaluate clinical and ultrasound methodologies as diagnostic tests. RESULTS UP diagnosed by ultrasound with surgical criteria presented better sensitivity (78.57 vs 35.71%), specificity (92.11 vs 81.58%), positive predictive value (61.83 vs 23.99%), and negative predictive value (96.35 vs 11.37%) than UP diagnosed by surgical criteria only. CONCLUSION Ultrasound with surgical criteria is superior to surgical criteria alone when diagnosing UP.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Alicia Martín-Martinez
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - Enrique González-Diaz
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), León, Spain
| | - María José Núñez-Matas
- Department of Obstetrics and Gynecology, University Hospital Virgen de la Victoria of Malaga, Malaga, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Sonia Carballo-Rastrilla
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - Camino Fernández-Fernández
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), León, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, Seville, Spain
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10
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Subramaniam N, Altamirano FAS, Barhum TF, Brown B, Dietz HP. Does parity impact obstructed defecation in women with normal anorectal anatomy? Int Urogynecol J 2022; 33:3423-3428. [PMID: 35604419 DOI: 10.1007/s00192-022-05226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/25/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstructed defecation (OD) is often associated with trauma to pelvic connective tissue and nerves sustained during pregnancy and childbirth. Although there are multiple potential etiologies of defecatory dysfunction, the pathophysiology of this symptom complex is not well understood. The purpose of this study is to determine the role of parity in the development of obstructed defecatory symptoms in women with normal anorectal anatomy in a search for evidence of a presumptive neuropathic effect of pregnancy and childbirth. METHODS This study retrospectively evaluated the records of 754 women presenting at a tertiary urogynecology unit for pelvic floor dysfunction with no anatomical abnormalities of the anorectum on imaging. They were stratified according to parity. The authors determined the prevalence of obstructed defecation symptoms in these groups. Chi-squared test was performed for statistical analysis. RESULTS Median age was 51 (range 16-88) years, and median vaginal parity was 2 (0-8); 399 (53%) women reported symptoms of OD. When anatomical abnormalities of the anorectum were excluded, parity did not seem to have a major effect on the prevalence of symptoms of OD. CONCLUSIONS In this cohort, parity is unlikely to be a cause of OD in women with normal anorectal anatomy.
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Affiliation(s)
- Nishamini Subramaniam
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
- Northern Beaches Hospital, Frenchs Forest, Sydney, Australia.
| | - Francisca Andrea Solar Altamirano
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- Hospital Clínico San Borja Arriaran, Universidad de Chile, Santiago, Chile
| | - Talia Friedman Barhum
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Bernadette Brown
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- Pindara Private Hospital, Gold Coast, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
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11
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Fang J, Ye J, Huang Q, Lin Y, Weng Y, Wang M, Chen Y, Lu Y, Zhang R. Risk factors of pelvic floor muscle strength in south Chinese women: a retrospective study. BMC Pregnancy Childbirth 2022; 22:624. [PMID: 35933360 PMCID: PMC9356495 DOI: 10.1186/s12884-022-04952-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives To evaluate pelvic floor muscle strength using surface electromyography and risk factors for pelvic floor muscle strength in the early postpartum period. Methods This retrospective study included 21,302 participants who visited Fujian
Maternity and Child Health Hospital from September 2019 to February 2022. All participants
were assessed by
medical professionals for general information and surface electromyography. Results Univariate analysis indicated that age was inversely related to tonic and endurance contractions. In contrast, all the other variables, including education level, body mass index, neonatal weight, and number of fetuses, had a positive impact on rapid, tonic, and endurance contractions. Likewise, parity was also positively associated with rapid contractions. In addition, compared with vaginal delivery, cesarean section delivery had a protective effect on the amplitude of the three types of contractions. Stepwise regression analysis showed that both age and neonatal weight had a negative linear relationship with the amplitude of rapid, tonic and endurance contractions. In contrast, the amplitude of rapid, tonic and endurance contractions significantly increased as body mass index, parity (≤ 3), education level and gestational weight gain (endurance contractions only) increased. Participants with cesarean section delivery showed positive effects on rapid, tonic, and endurance contractions compared to participants with vaginal delivery. Conclusions We found that age, neonatal weight, vaginal delivery, episiotomy, and forceps delivery were risk factors for pelvic floor muscle strength; in contrast, body mass index, parity (≤ 3) and gestational weight gain had a positive relationship with pelvic floor muscle strength.
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Affiliation(s)
- Jianqi Fang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Jiajia Ye
- Department of Rehabilitation Assessment, Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fujian, 350000, Fuzhou, People's Republic of China
| | - Qing Huang
- College of Environment and Public Health, Xiamen Huaxia University, Xiamen Fujian, People's Republic of China
| | - Yang Lin
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yilin Weng
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Miao Wang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yi Chen
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yao Lu
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Ronghua Zhang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China. .,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China.
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12
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García-Mejido JA, Ramos-Vega Z, Fernández-Palacín A, Borrero C, Valdivia M, Pelayo-Delgado I, Sainz-Bueno JA. Predictive Model for the Diagnosis of Uterine Prolapse Based on Transperineal Ultrasound. Tomography 2022; 8:1716-1725. [PMID: 35894009 PMCID: PMC9326672 DOI: 10.3390/tomography8040144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022] Open
Abstract
We want to describe a model that allows the use of transperineal ultrasound to define the probability of experiencing uterine prolapse (UP). This was a prospective observational study involving 107 patients with UP or cervical elongation (CE) without UP. The ultrasound study was performed using transperineal ultrasound and evaluated the differences in the pubis−uterine fundus distance at rest and with the Valsalva maneuver. We generated different multivariate binary logistic regression models using nonautomated methods to predict UP, including the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver. The parameters were added progressively according to their simplicity of use and their predictive capacity for identifying UP. We used two binary logistic regression models to predict UP. Model 1 was based on the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient [AUC: 0.967 (95% CI, 0.939−0.995; p < 0.0005)]. Model 2 used the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver, age, avulsion and ballooning (AUC: 0.971 (95% CI, 0.945−0.997; p < 0.0005)). In conclusion, the model based on the difference in the pubis−uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient could predict 96.7% of patients with UP.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
- Correspondence: (J.A.G.-M.); (A.F.-P.)
| | - Zenaida Ramos-Vega
- Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, 41640 Seville, Spain;
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, 41009 Seville, Spain
- Correspondence: (J.A.G.-M.); (A.F.-P.)
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
| | - Maribel Valdivia
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
| | - Irene Pelayo-Delgado
- Department of Obstetrics and Gynecology, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alcalá de Henares, 28871 Madrid, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain; (C.B.); (M.V.); (J.A.S.-B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, 41009 Seville, Spain
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13
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García Mejido JA, Ortega I, García-Jiménez R, Sainz-Bueno JA. Differential diagnosis of posterior compartment prolapse using transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:142-144. [PMID: 34779077 DOI: 10.1002/uog.24814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Affiliation(s)
- J A García Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - I Ortega
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - R García-Jiménez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - J A Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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14
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Khatri G, Bhosale PR, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Glanc P, Henrichsen TL, Learman LA, Sadowski EA, Saphier CJ, Wasnik AP, Maturen KE. ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females. J Am Coll Radiol 2022; 19:S137-S155. [PMID: 35550798 DOI: 10.1016/j.jacr.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Pelvic floor disorders including pelvic organ prolapse (POP), urinary dysfunction, defecatory dysfunction, and complications after pelvic floor surgery are relatively common in the female population. Imaging tests are obtained when the initial clinical evaluation is thought to be incomplete or inconclusive or demonstrates findings that are discordant with patients' symptoms. An integrated imaging approach is optimal to evaluate the complex anatomy and dynamic functionality of the pelvic floor. Fluoroscopic cystocolpoproctography (CCP) and MR defecography are considered the initial imaging tests of choice for evaluation of POP. Fluoroscopic voiding cystourethrography is considered the initial imaging test for patients with urinary dysfunction. Fluoroscopic CCP and MR defecography are considered the initial imaging test for patients with defecatory dysfunction, whereas ultrasound pelvis transrectal is a complementary test in patients requiring evaluation for anal sphincter defects. MRI pelvis without and with intravenous contrast, MRI pelvis with dynamic maneuvers, and MR defecography are considered the initial imaging tests in patients with suspected complications of prior pelvic floor surgical repair. Transperineal ultrasound is emerging as an important imaging tool, in particular for screening of pelvic floor dysfunction and for evaluation of midurethral slings, vaginal mesh, and complications related to prior pelvic floor surgical repair. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gaurav Khatri
- Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging, UT Southwestern Medical Center, Dallas, Texas; Program Director, Body MRI Fellowship.
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Section Chief of Abdominal Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Director Endometriosis and Chronic Pelvic Pain, Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Lee A Learman
- Dean, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | - Elizabeth A Sadowski
- University of Wisconsin, Madison, Wisconsin; and ACR O-RADS MRI Education Subcommittee Chair
| | - Carl J Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | - Ashish P Wasnik
- Division Chief, Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
| | - Katherine E Maturen
- Associate Chair for Ambulatory Care and Specialty Chair, University of Michigan, Ann Arbor, Michigan
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15
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García-Mejido JA, González-Diaz E, Ortega I, Borrero C, Fernández-Palacín A, Sainz-Bueno JA. 2D ultrasound diagnosis of middle compartment prolapse: a multicenter study. Quant Imaging Med Surg 2022; 12:959-966. [PMID: 35111597 DOI: 10.21037/qims-21-707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recently, a specific methodology has been defined, using transperineal ultrasound, for the differential diagnosis of middle compartment prolapse [uterine prolapse (UP) or cervical elongation (CE) without UP] based on the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver, with a cutoff point of 15 mm. The objective of this study was to validate the diagnostic utility of a ≥15 mm difference between the pubis-uterine fundus distance at rest and during the Valsalva maneuver to define UP in a multicenter study. METHODS This prospective multicenter observational study included 94 patients (UP =51; CE without UP =43). The clinical examination was based on the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system for assessing pelvic organ prolapse (POP) and patients were candidates for corrective surgery of the middle compartment of the pelvic floor (correction of UP or CE without UP). The ultrasound study was performed by transperineal ultrasound (B-mode) with the patient undergoing dorsal lithotomy. The distance evaluation was performed in relation to the posteroinferior pubic margin in the midsagittal plane, with reference to the uterine fundus (established as the most distal hyperechogenic) line from the pubis to the uterine fundus at rest and with the Valsalva maneuver. We defined UP detected using UP as a difference of ≥15 mm between the pubis-uterine fundus distance at rest and with the Valsalva maneuver. Agreement between the clinical and ultrasound diagnosis of UP was assessed using the Cohen kappa coefficient of agreement and its 95% CIs. RESULTS The ultrasound diagnosis of global UP at the three centers showed very good agreement, with a kappa index of 0.826 (0.71, 0.94). The agreement of ultrasound with the clinical diagnosis of UP using the ICS POP-Q system was very good for each of the hospitals [Hospital 1: 0.814 (0.64, 0.98), Hospital 2: 0.847 (0.64, 1) and Hospital 3: 0.824 (0.59, 1)]. CONCLUSIONS A difference of ≥15 mm between the pubis-uterine fundus distance at rest and during the Valsalva maneuver for the diagnosis of UP presents very good agreement with the results of clinical evaluation with the ICS POP-Q system.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.,Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - Enrique González-Diaz
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), León, Spain
| | - Ismael Ortega
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.,Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.,Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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16
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Nam G, Song JY, Lee SR. A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse. Diagnostics (Basel) 2022; 12:diagnostics12010098. [PMID: 35054265 PMCID: PMC8775178 DOI: 10.3390/diagnostics12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.
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Affiliation(s)
- Gina Nam
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea;
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (J.-Y.S.); (S.-R.L.); Tel.: +82-2-2258-6166 (J.-Y.S.); +82-2-3010-3648 (S.-R.L.); Fax: +82-2-595-1549 (J.-Y.S.); +82-2-3010-3630 (S.-R.L.)
| | - Sa-Ra Lee
- Seoul Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
- Correspondence: (J.-Y.S.); (S.-R.L.); Tel.: +82-2-2258-6166 (J.-Y.S.); +82-2-3010-3648 (S.-R.L.); Fax: +82-2-595-1549 (J.-Y.S.); +82-2-3010-3630 (S.-R.L.)
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17
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Yao YB, Yin HQ, Wang HJ, Liang HT, Wang B, Wang C. Is the transperineal ultrasonography approach effective for the diagnosis of rectocele? Gastroenterol Rep (Oxf) 2021; 9:461-469. [PMID: 34733532 PMCID: PMC8560031 DOI: 10.1093/gastro/goab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory. This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele. Methods In this pilot study, participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019. All participants separately underwent defecation proctography at sitting and squatting positions, and undertook transperineal ultrasonography at left lateral, sitting, and squatting positions. The consistency of ultrasonography and defecography was evaluated. Results Thirty female volunteers with rectocele were included in this study. The degree of anorectal angle was significantly larger at rest and during contraction, maximal Valsalva, and evacuation; the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation; and the length of the perineum descending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography. The degree of anorectal angle, the depth of rectocele, the area of levator hiatus, and the volume of the rectocele were significantly different in using squatting, sitting, and left lateral positions when performing the transperineal ultrasonography. Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions. Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.
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Affiliation(s)
- Yi-Bo Yao
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Hao-Qiang Yin
- Department of Ultrasonic, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Hai-Jun Wang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Hong-Tao Liang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Bo Wang
- Shanghai Hao Zhuo Data Service Co. Ltd, Shanghai, P. R. China
| | - Chen Wang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
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18
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Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse. Int Urogynecol J 2021; 33:2825-2831. [PMID: 34618192 PMCID: PMC9477898 DOI: 10.1007/s00192-021-04980-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/13/2021] [Indexed: 10/30/2022]
Abstract
OBJECTIVES Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. MATERIALS AND METHODS We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. RESULTS For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). CONCLUSIONS There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.
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19
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van Gruting IM, Stankiewicz A, Thakar R, Santoro GA, IntHout J, Sultan AH. Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome. Cochrane Database Syst Rev 2021; 9:CD011482. [PMID: 34553773 PMCID: PMC8459393 DOI: 10.1002/14651858.cd011482.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obstructed defaecation syndrome (ODS) is difficulty in evacuating stools, requiring straining efforts at defaecation, having the sensation of incomplete evacuation, or the need to manually assist defaecation. This is due to a physical blockage of the faecal stream during defaecation attempts, caused by rectocele, enterocele, intussusception, anismus or pelvic floor descent. Evacuation proctography (EP) is the most common imaging technique for diagnosis of posterior pelvic floor disorders. It has been regarded as the reference standard because of extensive experience, although it has been proven not to have perfect accuracy. Moreover, EP is invasive, embarrassing and uses ionising radiation. Alternative imaging techniques addressing these issues have been developed and assessed for their accuracy. Because of varying results, leading to a lack of consensus, a systematic review and meta-analysis of the literature are required. OBJECTIVES To determine the diagnostic test accuracy of EP, dynamic magnetic resonance imaging (MRI) and pelvic floor ultrasound for the detection of posterior pelvic floor disorders in women with ODS, using latent class analysis in the absence of a reference standard, and to assess whether MRI or ultrasound could replace EP. The secondary objective was to investigate differences in diagnostic test accuracy in relation to the use of rectal contrast, evacuation phase, patient position and cut-off values, which could influence test outcome. SEARCH METHODS We ran an electronic search on 18 December 2019 in the Cochrane Library, MEDLINE, Embase, SCI, CINAHL and CPCI. Reference list, Google scholar. We also searched WHO ICTRP and clinicaltrials.gov for eligible articles. Two review authors conducted title and abstract screening and full-text assessment, resolving disagreements with a third review author. SELECTION CRITERIA Diagnostic test accuracy and cohort studies were eligible for inclusion if they evaluated the test accuracy of EP, and MRI or pelvic floor ultrasound, or both, for the detection of posterior pelvic floor disorders in women with ODS. We excluded case-control studies. If studies partially met the inclusion criteria, we contacted the authors for additional information. DATA COLLECTION AND ANALYSIS Two review authors performed data extraction, including study characteristics, 'Risk-of-bias' assessment, sources of heterogeneity and test accuracy results. We excluded studies if test accuracy data could not be retrieved despite all efforts. We performed meta-analysis using Bayesian hierarchical latent class analysis. For the index test to qualify as a replacement test for EP, both sensitivity and specificity should be similar or higher than the historic reference standard (EP), and for a triage test either specificity or sensitivity should be similar or higher. We conducted heterogeneity analysis assessing the effect of different test conditions on test accuracy. We ran sensitivity analyses by excluding studies with high risk of bias, with concerns about applicability, or those published before 2010. We assessed the overall quality of evidence (QoE) according to GRADE. MAIN RESULTS Thirty-nine studies covering 2483 participants were included into the meta-analyses. We produced pooled estimates of sensitivity and specificity for all index tests for each target condition. Findings of the sensitivity analyses were consistent with the main analysis. Sensitivity of EP for diagnosis of rectocele was 98% (credible interval (CrI)94%-99%), enterocele 91%(CrI 83%-97%), intussusception 89%(CrI 79%-96%) and pelvic floor descent 98%(CrI 93%-100%); specificity for enterocele was 96%(CrI 93%-99%), intussusception 92%(CrI 86%-97%) and anismus 97%(CrI 94%-99%), all with high QoE. Moderate to low QoE showed a sensitivity for anismus of 80%(CrI 63%-94%), and specificity for rectocele of 78%(CrI 63%-90%) and pelvic floor descent 83%(CrI 59%-96%). Specificity of MRI for diagnosis of rectocele was 90% (CrI 79%-97%), enterocele 99% (CrI 96%-100%) and intussusception 97% (CrI 88%-100%), meeting the criteria for a triage test with high QoE. MRI did not meet the criteria to replace EP. Heterogeneity analysis showed that sensitivity of MRI performed with evacuation phase was higher than without for rectocele (94%, CrI 87%-98%) versus 65%, CrI 52% to 89%, and enterocele (87%, CrI 74%-95% versus 62%, CrI 51%-88%), and sensitivity of MRI without evacuation phase was significantly lower than EP. Specificity of transperineal ultrasound (TPUS) for diagnosis of rectocele was 89% (CrI 81%-96%), enterocele 98% (CrI 95%-100%) and intussusception 96% (CrI 91%-99%); sensitivity for anismus was 92% (CrI 72%-98%), meeting the criteria for a triage test with high QoE. TPUS did not meet the criteria to replace EP. Heterogeneity analysis showed that sensitivity of TPUS performed with rectal contrast was not significantly higher than without for rectocele(92%, CrI 69%-99% versus 81%, CrI 58%-95%), enterocele (90%, CrI 71%-99% versus 67%, CrI 51%-90%) and intussusception (90%, CrI 69%-98% versus 61%, CrI 51%-86%), and was lower than EP. Specificity of endovaginal ultrasound (EVUS) for diagnosis of rectocele was 76% (CrI 54%-93%), enterocele 97% (CrI 80%-99%) and intussusception 93% (CrI 72%-99%); sensitivity for anismus was 84% (CrI 59%-96%), meeting the criteria for a triage test with very low to moderate QoE. EVUS did not meet the criteria to replace EP. Specificity of dynamic anal endosonography (DAE) for diagnosis of rectocele was 88% (CrI 62%-99%), enterocele 97% (CrI 75%-100%) and intussusception 93% (CrI 65%-99%), meeting the criteria for a triage test with very low to moderate QoE. DAE did not meet the criteria to replace EP. Echodefaecography (EDF) had a sensitivity of 89% (CrI 65%-98%) and specificity of 92% (CrI 72%-99%) for intussusception, meeting the criteria to replace EP but with very low QoE. Specificity of EDF for diagnosis of rectocele was 89% (CrI 60%-99%) and for enterocele 97% (CrI 87%-100%); sensitivity for anismus was 87% (CrI 72%-96%), meeting the criteria for a triage test with low to very low QoE. AUTHORS' CONCLUSIONS In a population of women with symptoms of ODS, none of the imaging techniques met the criteria to replace EP. MRI and TPUS met the criteria of a triage test, as a positive test confirms diagnosis of rectocele, enterocele and intussusception, and a negative test rules out diagnosis of anismus. An evacuation phase increased sensitivity of MRI. Rectal contrast did not increase sensitivity of TPUS. QoE of EVUS, DAE and EDF was too low to draw conclusions. More well-designed studies are required to define their role in the diagnostic pathway of ODS.
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Affiliation(s)
- Isabelle Ma van Gruting
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, Netherlands
| | | | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, UK
| | - Giulio A Santoro
- Section of Anal Physiology and Ultrasound, Department of Surgery, Regional Hospital, Treviso, Italy
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, Croydon, UK
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Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases. J Clin Med 2021; 10:jcm10184267. [PMID: 34575378 PMCID: PMC8466392 DOI: 10.3390/jcm10184267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.
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21
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Routzong MR, Abramowitch SD, Chang C, Goldberg RP, Rostaminia G. Obstructed Defecation Symptom Severity and Degree of Rectal Hypermobility and Folding Detected by Dynamic Ultrasound. Ultrasound Q 2021; 37:229-236. [PMID: 34478420 DOI: 10.1097/ruq.0000000000000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We used dynamic pelvic floor ultrasound to investigate the relationship between obstructed defecation symptom (ODS) severity and the degree of rectal hypermobility/folding. In this retrospective study, women who presented with ODS from October 2017 to January 2019 and underwent an interview, pelvic examination, and pelvic floor ultrasound were recruited. Patients were diagnosed with abdominal constipation, dyssynergia, or pelvic constipation. Pelvic constipation patients were categorized based on their reported frequency of incomplete emptying of stool (<50% or ≥50% of bowel movements) representing mild and severe ODS, respectively. Using dynamic ultrasound, rectal hypermobility was quantified via rectovaginal septum length at rest and Valsalva and its compression ratio, where shorter lengths and larger compression ratios are indicative of increased rectal hypermobility. One hundred twenty-one patients (41 with abdominal constipation, 7 with dyssynergia, and 73 with pelvic constipation) were included. Compression ratios were higher in women with severe versus mild ODS (17.36 ± 16.89 vs 36.38 ± 25.82, P = 0.0039). The risk of having severe symptoms was 4 times greater (odds ratio = 4.2, 95% confidence interval = 1.4 to 12.6, P = 0.01) among those with a high compression ratio (≥20%) after controlling for age, body mass index, and levator plate descent angle. Incomplete emptying was weakly, positively, linearly correlated with rectal hypermobility/folding (r = -0.2724, -0.3767 to 0.3922, and P = 0.0197, 0.0010, 0.0006, respectively). Women with more severe ODS experienced more rectal hypermobility/folding as measured via dynamic ultrasound-a cheaper, effective alternative to magnetic resonance defecography for evaluation of obstructed defecation.
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Affiliation(s)
- Megan R Routzong
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Steven D Abramowitch
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Cecilia Chang
- NorthShore University HealthSystem Research Institute, Evanston
| | | | - Ghazaleh Rostaminia
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL
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22
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Collins SA, O'Shea M, Dykes N, Ramm O, Edenfield A, Shek KL, van Delft K, Beestrum M, Kenton K. International Urogynecological Consultation: clinical definition of pelvic organ prolapse. Int Urogynecol J 2021; 32:2011-2019. [PMID: 34191102 DOI: 10.1007/s00192-021-04875-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This segment of Chapter 1 of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) reviews the literature on the clinical definition of POP with the intent of creating standard terminology. METHODS An international group containing nine urogynecologists and one university-based medical librarian performed a search of the literature using pre-specified search terms in PubMed, Embase, and Scopus. Publications were eliminated if not relevant to the clinical definition of POP, and those articles remaining were evaluated for quality using the Specialist Unit for Review Evidence (SURE). The resulting list of articles was used to inform a comprehensive review and creation of the clinical definition of POP. RESULTS The original search yielded 31,931 references, of which 167 were used by the writing group. Ultimately, 78 are referenced in the manuscript. CONCLUSIONS The clinical definition of POP for this review of the literature is: "anatomical prolapse with descent of at least one of the vaginal walls to or beyond the vaginal hymen with maximal Valsalva effort WITH the presence either of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due to prolapse without symptom bother."
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Affiliation(s)
- Sarah A Collins
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA.
| | - Michele O'Shea
- Department of Obstetrics and Gynecology, Duke University Health System, Raleigh, NC, USA
| | | | - Olga Ramm
- Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente East Bay, Alameda, CA, USA
| | - Autumn Edenfield
- Division of Urogynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Mt Pleasant, SC, 29464, USA
| | - Ka Lai Shek
- Department of Obstetrics and Gynecology, Liverpool Hospital, University of Western Sydney, Liverpool, NSW, 2170, Australia
| | - Kim van Delft
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Molly Beestrum
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
| | - Kimberly Kenton
- Northwestern Feinberg School of Medicine, 250 E. Superior St. Suite 05-2113, Chicago, IL, 60611, USA
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23
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Tan YH, Gillor M, Dietz HP. Abdominal pressure and pelvic organ prolapse: is there an association? Int Urogynecol J 2021; 33:337-342. [PMID: 33944978 DOI: 10.1007/s00192-021-04811-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/17/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The primary aim of this study was to assess for an association between maximal intra-abdominal pressure reached on Valsalva (MAP) and pelvic organ prolapse (POP) on subjective, clinical and sonographic evaluation. Another objective was to test for association between MAP and body mass index (BMI). METHODS A retrospective cross-sectional study was carried out on 504 archived datasets of women seen for pelvic floor dysfunction symptoms between January 2017 to September 2019 at a tertiary urogynaecology clinic. Patients underwent a standardized interview including use of visual analogue scores (VAS) to evaluate bother of pelvic floor symptoms, examination using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q), dual-channel filling and voiding cystometry, test for MAP as well as four-dimensional (4D) transperineal ultrasound. Analysis of ultrasound volumes for pelvic organ descent was performed blinded against all other data. RESULTS There was a weak but significant association between MAP and sonographic rectal ampulla descent (p = 0.0275). There was also a significant association between MAP and bother of obstructed defecation symptoms (p = 0.0065). Symptomatic, clinical and sonographic POP in the anterior or the apical compartments was not significantly associated with MAP. On multivariate analysis, the association between MAP and rectal descent remained significant (p = 0.01). There was no significant association between BMI and MAP. CONCLUSIONS This cross-sectional study showed an association between MAP and posterior compartment prolapse on imaging as well as between MAP and the bother score of obstructed defecation symptoms. There was no association between BMI and MAP.
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Affiliation(s)
- Yu Hwee Tan
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, Australia.
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia.
| | - Moshe Gillor
- Kaplan Medical Center, Rehovot, Israel
- University of Sydney, Penrith, NSW, Australia
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24
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Tan C, Tan M, Geng J, Tang J, Yang X. Rectal-vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele. BMC WOMENS HEALTH 2021; 21:165. [PMID: 33879140 PMCID: PMC8056717 DOI: 10.1186/s12905-021-01304-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O, p < 0.001). Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.
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Affiliation(s)
- Cheng Tan
- Department of Obstetrics and Gyencology, Peking University People's Hospital, No. 11 of Xizhimen south Street, Xicheng District, Beijing, 100048, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Man Tan
- Department of Obstetrics and Gyencology, Peking University People's Hospital, No. 11 of Xizhimen south Street, Xicheng District, Beijing, 100048, China
| | - Jing Geng
- Department of Obstetrics and Gyencology, Peking University People's Hospital, No. 11 of Xizhimen south Street, Xicheng District, Beijing, 100048, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Jun Tang
- Department of Obstetrics and Gyencology, Peking University People's Hospital, No. 11 of Xizhimen south Street, Xicheng District, Beijing, 100048, China
| | - Xin Yang
- Department of Obstetrics and Gyencology, Peking University People's Hospital, No. 11 of Xizhimen south Street, Xicheng District, Beijing, 100048, China. .,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China.
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Dietz HP, Alcoba ME, Friedman T, Subramaniam N. Is perineal hypermobility an independent predictor of obstructive defecation? Int Urogynecol J 2021; 32:2377-2381. [PMID: 33635352 DOI: 10.1007/s00192-021-04734-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Symptoms of obstructed defecation (OD) and anatomical abnormalities of the posterior compartment are prevalent in urogynecological patients. The aim of this study was to determine whether perineal hypermobility is an independent predictor of OD, as is the case for rectocele, enterocele and rectal intussusception. METHODS This is a retrospective study of 2447 women attending a tertiary urodynamic center between September 2011 and December 2016. The assessment included a structured interview, urodynamic testing, a clinical examination and 4D transperineal ultrasound. After exclusion of previous pelvic floor surgery and defined anatomical abnormalities of the anorectum, 796 patients were left for analysis. Perineal hypermobility was defined as rectal descent ≥ 15 mm below the symphysis pubis, determined in stored ultrasound volume datasets offline, using proprietary software, blinded to all other data. Any association between perineal hypermobility and symptoms of obstructed defecation was tested for by chi-square (X2) test. RESULTS For the 796 patients analyzed, median age was 52 (range, 16-88) years with a mean BMI of 27 (range, 15-64) kg/m2. Average vaginal parity was two (range, 0-8). Reported OD symptoms in this group included sensation of incomplete emptying in 335 (42%), straining at stool in 300 (37%) and digitation in 83 (10%). At least one of those symptoms was reported by 424 (53%) women; 153 showed perineal hypermobility. There was no significant association between perineal hypermobility and OD symptoms on univariate testing. CONCLUSIONS We found no evidence of an independent association between perineal hypermobility and obstructed defecation.
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Affiliation(s)
- Hans Peter Dietz
- University of Sydney, 62 Derby St., Penrith, 2751, NSW, Australia.
| | - Maria Emilia Alcoba
- University of Sydney, 62 Derby St., Penrith, 2751, NSW, Australia.,Hospital Universitario Austral, Buenos Aires, Argentina
| | - Talia Friedman
- University of Sydney, 62 Derby St., Penrith, 2751, NSW, Australia.,Sheba Medical Center, Tel Aviv University, Tel Aviv-Yafo, Israel
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Leombroni M, Buca D, Liberati M, Falò E, Rizzo G, Khalil A, Manzoli L, Flacco ME, Santarelli A, Makatsariya A, Frondaroli F, D'Antonio F. Post-partum pelvic floor dysfunction assessed on 3D rotational ultrasound: a prospective study on women with first- and second-degree perineal tears and episiotomy. J Matern Fetal Neonatal Med 2021; 34:445-455. [PMID: 31291792 DOI: 10.1080/14767058.2019.1609932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
Abstract
Purpose: To evaluate the morphology and biometry of pelvic floor structures 3 months after birth in women experiencing first- or second-degree perineal tears or undergoing episiotomy during labor.Material and methods: Prospective observational study including nulliparous women delivering at term with a clinical diagnosis of first- or second-degree perineal tears after birth or undergoing episiotomy. The role of Kristeller maneuver during labor in affecting pelvic structure and function is also explored. All women underwent 2D trans-perineal and 3D endovaginal or endoanal ultrasound 3 months after birth.Results: 115 women assessed 3 months after delivery were enrolled in the study. Compared with controls, women who experienced first-degree perineal tears had higher bladder neck-symphysis (versus 20.9 ± 4.9 versus 16.1 ± 4.9 mm, p = .017), bladder wall-pubic symphysis (22.4 ± 7.4 versus 14.2 ± 9.5 mm, p = .02) and anorectal angle-symphysis distance (12.5 ± 4.7 versus 9.3 ± 4.3 mm, p = .018). Furthermore, they have thicker internal and external anal sphincter. The incidence of partial right and left pubo-rectalis muscle avulsion was higher in women experiencing first-degree vaginal tear during labor (16.2 versus 0%, p = .004 for both). In women affected by second-degree tears, the occurrence of partial avulsion of the right and left pubo-rectalis muscle was 16.2%, while Oasis was detected in 10.8% of the cases. Women receiving Kristeller maneuver during labor had a higher incidence of either right or left puborectalis muscle avulsion.Conclusion: Women who had either first- and second-degree perineal tears or episiotomy show signs of abnormal pelvic morphometry on 3D rotational ultrasound 3 months after birth.
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Affiliation(s)
- Martina Leombroni
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Eleonora Falò
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Maternal Fetal Medicine, Ospedale Cristo Re Roma, University of Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Asma Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St. George's University of London, London, UK
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Alexander Makatsariya
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Franco Frondaroli
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Women´s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Sciences, Women'S Health and Perinatology Research Group, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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García-Mejido JA, Ramos-Vega Z, Armijo-Sánchez A, Fernández-Palacín A, García-Jimenez R, Sainz JA. Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound. Int Urogynecol J 2021; 32:2219-2225. [PMID: 33484288 DOI: 10.1007/s00192-020-04646-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to identify the best parameter (pubis-cervix measurement, pubis-uterine fundus measurement or pubis-pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP. METHODS A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test. RESULTS Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis-cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis-uterine fundus distance, the AUC was 0.81; and for the pubis-pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%). CONCLUSION A difference of ≥15 mm in the pubis-uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
| | - Zenaida Ramos-Vega
- Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, Seville, Spain
| | | | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Rocío García-Jimenez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - José Antonio Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Does the presence of a true radiological rectocele increase the likelihood of symptoms of prolapse? Int Urogynecol J 2020; 32:2233-2237. [PMID: 33196881 DOI: 10.1007/s00192-020-04476-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Posterior compartment prolapse is commonly due to a 'true' rectocele, i.e., a diverticulum of the rectal ampulla. This condition is associated with symptoms of obstructed defecation and may contribute to prolapse symptoms. We tested the hypothesis: 'A true rectocele is an independent predictor of symptoms of prolapse.' METHODS This was a retrospective cohort study of patients presenting to a urogynecology unit for symptoms of pelvic floor dysfunction between September 2011 and June 2016. Assessment included a structured interview, POP-Q examination and 4D TLUS. Ultrasound volume data were acquired on Valsalva. Offline measurements were performed by analysis of stored volume data sets at a later date, blinded to all clinical data. RESULTS One hundred six patients were excluded because of incomplete data. Of the remainder, Bp was the most distal point on POP-Q in 348. Statistical analysis was performed on this cohort. Mean age was 60 (33-86) years and mean BMI 31 (18-55) kg/m². One hundred fifty-three patients (44%) presented with symptoms of prolapse; 272 were diagnosed with a true rectocele on TLUS. Bp on POP-Q and true rectocele on TLUS were both significantly associated with prolapse symptoms; however, on multivariate analysis the latter became nonsignificant (p = 0.059). Receiver-operating characteristic (ROC) analysis confirmed that the presence of a true rectocele on TLUS did not contribute significantly to symptoms of prolapse (AUC 0.66 for model with rectocele, AUC 0.65 without). CONCLUSIONS The presence of a true rectocele on TLUS does not seem to contribute substantially to the manifestation of clinical symptoms of prolapse.
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Orazov MR, Toktar L, Rybina A, Gevorgian D, Dostieva S, Lologaeva M, Karimova G. MAGNETIC RESONANCE IMAGING OF PELVIC FLOOR DYSFUNCTION, REVIEW. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pelvic floor dysfunction is an important medical and social problem in the female population. The impact of pelvic floor disorders (PFD) is likely to grow as the prevalence of these disorders increases with an aging population. Pregnancy and delivery are considered major risk factors in the development of POP and stress urinary incontinence. Pelvic floor dysfunction may involve pelvic organ prolapse and/or pelvic floor relaxation. Organ prolapse can include any combination of the following: urethra (urethrocele), bladder (cystocele), or both (cystourethrocele), vaginal vault and cervix (vaginal vault prolapse), uterus (uterineprolapse), rectum (rectocele), sigmoid colon (sigmoidocele),and small bowel (enterocele).Given the paucity of understanding of PFD pathophysiology ,multicompartmental pathology, the high rate of recurrence and repeat surgery imaging plays a major role in its clinical management.The magnetic resonance imaging (MRI) allows noninvasive, radiation-free, rapid, high-resolution evaluation the multicompartment defects in one examination.Findings reported at MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach.
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The relationship between obstructed defecation and true rectocele in patients with pelvic organ prolapse. Sci Rep 2020; 10:5599. [PMID: 32221359 PMCID: PMC7101397 DOI: 10.1038/s41598-020-62376-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed to investigate the prevalence of true rectocele and obstructed defecation (OD) in patients with pelvic organ prolapse (POP), to investigate the correlation between true rectocele and OD, and to understand the diagnostic value of translabial ultrasound (TLUS) in the diagnosis of true rectocele. The patients who scheduled for POP surgery were enrolled in this study. Patients who had previous reconstructive pelvic surgery or repair of rectocele were excluded. Birmingham Bowel and Urinary symptoms questionnaires and Longo's obstructed defecation syndrome scoring system were used to assess the bowel symptoms of patients. TLUS was used to evaluate anatomical defects. P value <0.05 was considered statistically significant, and confidence intervals were set at 95%. 279 patients were included into this study. The prevalence rate of OD was 43%, and the average value of ODS score was 6.67. 17% patients presented straining at stool, 33% presented incomplete emptying, 13% presented digitations, and 12% required laxatives or enema. The prevalence rate of true rectocele was 23%. Defecation symptoms were significantly correlated with age, levator-ani hiatus, levator-ani muscle injury and true rectocele. Logistic regression showed that true rectocele and increased levator-ani hiatus were independent risk factors of OD. True rectocele was significantly correlated with straining at stool, digitation, incomplete emptying and requirement of laxatives or enema.In POP patients, the prevalence rate of true rectocele and OD was 23% and 43%, respectively. True rectocele was related to OD. TLUS was a valuable approach in anatomical evaluation of POP.
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Tan YH, Frazer MI, Hughes I, Wong V. Correlation between translabial ultrasound parameters and outcomes in retropubic mid-urethral slings: can we predict success? World J Urol 2020; 39:163-168. [PMID: 32193651 DOI: 10.1007/s00345-020-03153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/29/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to assess the association between four-dimensional translabial ultrasound (4D-TLUS) features of the retropubic mid-urethral sling (MUS) and post-operative pelvic floor symptoms. METHODS A prospective cohort study was performed involving 100 women who had a solitary retropubic MUS (TVT Exact™) between Jan 2013 and Dec 2017 for urodynamic stress incontinence (SI) at a tertiary urogynaecological centre. All patients completed a standardised interview and had free flowmetry, prolapse evaluation and assessment for mesh exposure and tenderness. 4D-TLUS parameters measured included pelvic organ descent, levator ani status, sling-symphysis pubis (SP) gap at rest and Valsalva, angle formed by cranial and caudal ends of the sling, cranio-caudal and dorso-ventral sling-symphysis pubis distance at Valsalva. The primary outcome was treatment success as defined by patient report of cure or improvement and no objective demonstrable SI. RESULTS Eighty-nine (89%) patients reported treatment success. Two patients (2%) had mesh exposure; one was symptomatic with pain, requiring complete sling removal. There was a significant association between treatment success and a SP gap at Valsalva of 10-12 mm (p = 0.001); and independently with a SP angle at Valsalva of 45°-80° (p = 0.007). A narrower SP gap at Valsalva closer to 10 mm was associated with voiding symptoms (p = 0.036). CONCLUSION Sling-pubis gap and sling-pubis angle at Valsalva appear to be significantly associated with treatment success in retropubic MUS. There is a significant association between a narrower sling-pubis gap at Valsalva and voiding symptoms.
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Affiliation(s)
- Yu Hwee Tan
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia.
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia.
| | - Malcolm I Frazer
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia
| | - Ian Hughes
- Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Vivien Wong
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia
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Jeong HY, Yang SJ, Cho DH, Park DH, Lee JK. Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders. Ann Coloproctol 2020; 36:256-263. [PMID: 32178497 PMCID: PMC7508475 DOI: 10.3393/ac.2020.02.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/09/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders. METHODS Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms. RESULTS There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen's kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement. CONCLUSION This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.
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Affiliation(s)
| | - Shi-Jun Yang
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Dong Ho Cho
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Duk Hoon Park
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Jong Kyun Lee
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
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Latif MA, Shady M, Elawadly NM, Thabet WM. Role of three-dimensional ultrasound in females with obstructed defecation (in comparison with defecography). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0116-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Growing attention of pelvic floor disorders has led to development of new imaging techniques, with increasing importance of ultrasonography. The 3DUS technique is considered an accessible tool for imaging of the posterior pelvic compartment. The purpose of this study is to highlight the role of 3D ultrasound in evaluation of obstructed defecation in females and comparing the findings with defecography.
Results
Study included 30 females classified into two groups: (1) 20 patients (case group complaining of obstructed defecation); (2) ten females (control group-normal nulliparous females). All of them were subjected to defecography and 3D ultrasound during resting, squeezing, and straining. Detection rate of rectocele and intussusception with 3D ultrasound was lower than defecography. By US, significant statistical difference between patients and controls in all measurements of levator hiatus, IS, ES, and PRS thickness during straining (P value < 0.001). During straining, cut-off value of 20.75 cm2 for hiatal area gives sensitivity of 100% and specificity of 95% and using ARA, cut-off value of 105° gives sensitivity of 98% and specificity of 90% for differentiation between patients and controls.
Conclusion
Ultrasound can be considered a complementary test to defecography in investigation of patients with obstructed defecation. Ultrasound can diagnose levator muscle attenuation and avulsion, thickness of IS, ES, PRS, and distensibility of hiatal area.
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Comparison of measurement systems for posterior vaginal wall prolapse on magnetic resonance imaging. Int Urogynecol J 2019; 30:1269-1277. [PMID: 30972442 DOI: 10.1007/s00192-019-03939-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A wide variety of reference lines and landmarks have been used in imaging studies to diagnose and quantify posterior vaginal wall prolapse without consensus. We sought to determine which is the best system to (1) identify posterior vaginal wall prolapse and its appropriate cutoff values and (2) assess the prolapse size. METHODS This was a secondary analysis of sagittal maximal Valsalva dynamic MRI scans from 52 posterior-predominant prolapse cases and 60 comparable controls from ongoing research. All eight existing measurement lines and a new parameter, the exposed vaginal length, were measured. Expert opinions were used to score the prolapse sizes. Simple linear regressions, effect sizes, area under the curve, and classification and regression tree analyses were used to compare these reference systems and determine cutoff values. Linear and ordinal logistic regressions were used to assess the effectiveness of the prolapse size. RESULTS Among existing parameters, "the perineal line-internal pubis," a reference line from the inside of the pubic symphysis to the front tip of the perineal body (cutoff value 0.9 cm), had the largest effect size (1.61), showed the highest sensitivity and specificity to discriminate prolapse with area under the curve (0.91), and explained the most variation (68%) in prolapse size scores. The exposed vaginal length (cutoff value 2.9) outperformed all the existing lines, with the largest effect size (2.09), area under the curve (0.95), and R-squared value (0.77). CONCLUSIONS The exposed vaginal length performs slightly better than the best of the existing systems, for both diagnosing and quantifying posterior prolapse size. Performance characteristics and evidence-based cutoffs might be useful in clinical practice.
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Cheung RYK, Chan SSC, Shek KL, Chung TKH, Dietz HP. Pelvic organ prolapse in Caucasian and East Asian women: a comparative study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:541-545. [PMID: 30246270 DOI: 10.1002/uog.20124] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/19/2018] [Accepted: 09/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Ethnicity has been suggested to be a significant risk factor for pelvic organ prolapse (POP); yet, pelvic organ descent in different ethnic groups, especially in Asian populations, is not well studied. The aim of this study was to compare prolapse stages, pelvic organ descent and hiatal dimensions between East Asian and Caucasian women presenting with symptoms of POP. METHODS This was a prospective observational study of East Asian and Caucasian women presenting with symptoms of POP to a tertiary urogynecology clinic in, respectively, Hong Kong and Sydney. Demographic data, prolapse symptoms and prolapse stage were assessed. Physical examination was performed using the pelvic organ prolapse quantification (POP-Q) system. All women underwent transperineal ultrasound using Voluson systems. Offline analysis of four-dimensional ultrasound volume data was performed at a later date, by one operator blinded to all clinical data, to ascertain pelvic organ descent and hiatal dimensions on Valsalva maneuver. Levator muscle avulsion was assessed in volumes obtained on pelvic floor muscle contraction. Multiple logistic regression analysis was performed to assess factors associated with prolapse on clinical and ultrasound examinations. RESULTS A total of 225 East Asian women were included between July 2012 and February 2014 from the Hong Kong clinic and 206 Caucasian women between January 2015 and July 2016 from the Sydney clinic. There was no significant difference in the overall staging of prolapse. However, in East Asian women, compared with Caucasians, apical compartment prolapse was more common (99.6% vs 71.8%, P < 0.001) and posterior compartment prolapse less common (16.9% vs 48.5%, P < 0.001) on POP-Q examination. On Valsalva maneuver, the position of the uterus was lower in East Asian than in Caucasian women (-11.3 vs 1.35 mm, P < 0.001), while the rectal ampulla position was lower in Caucasians than in East Asians (-10.6 vs - 4.1 mm, P < 0.001). On multiple regression analysis, Caucasian ethnicity was a significant factor for lower risk of apical compartment prolapse on clinical assessment (odds ratio (OR), 0.01; P < 0.001) and on ultrasound (OR, 0.13; P < 0.001), and for a higher risk of posterior compartment prolapse on clinical assessment (OR, 4.36; P < 0.001) and of true rectocele on ultrasound (OR, 8.14; P < 0.001). CONCLUSIONS East Asian women present more commonly with uterine prolapse while Caucasians show more often posterior compartment prolapse. Ethnicity was a significant predictor of type of prolapse on multivariate analysis. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Y K Cheung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - S S C Chan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - K L Shek
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
- Liverpool Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - T K H Chung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - H P Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
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Gillor M, Langer S, Dietz HP. Long-term subjective, clinical and sonographic outcomes after native-tissue and mesh-augmented posterior colporrhaphy. Int Urogynecol J 2019; 30:1581-1585. [DOI: 10.1007/s00192-019-03921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/05/2019] [Indexed: 12/26/2022]
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García-Mejido JA, Fernández-Palacín A, Bonomi-Barby MJ, De la Fuente Vaquero P, Iglesias E, Sainz JA. Online learning for 3D/4D transperineal ultrasound of the pelvic floor. J Matern Fetal Neonatal Med 2019; 33:2805-2811. [PMID: 30563391 DOI: 10.1080/14767058.2018.1560416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction. To evaluate the feasibility of an online learning process for performing and analyzing 3D/4D transperineal ultrasound imaging of the pelvic floor.Materials and methods: A prospective study was conducted with 20 patients. The learning process of three inexperienced examiners (IEs) performing and analyzing 3D/4D transperineal ultrasound volumes was evaluated. The learning process for the IEs was conducted online by an expert examiner (EE); no face-to-face tutoring was provided. The IEs' competency and analysis of the volumes were estimated using the intraclass correlation coefficient (ICC).Results: The interobserver analysis of the levator hiatus dimensions provided by the EE and those from each IE (for the 20 studied cases) had ICCs ranging from 0.81 to 0.96. The dimensions of the levator hiatus performed by the IEs for the first 10 patients showed ICCs ranging from 0.55 to 0.9. However, when the IEs proceeded with the next 10 patients, they obtained ICCs ranging from 0.81 to 0.96.Conclusions: Conducting 3D/4D transperineal ultrasound of the pelvic floor is a technique that can be learned online in a short period of time. A learning programme designed specifically for this purpose provides excellent reliability.Key Message: Conducting 3D/4D transperineal ultrasound of the pelvic floor is a technique that can be learned online in a short period of time.
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Affiliation(s)
- J A García-Mejido
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - A Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - M J Bonomi-Barby
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | | | - E Iglesias
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - J A Sainz
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.,Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
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Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, Dietrich CF, Gilja OH, Lorentzen T, Maconi G, Mihmanli I, Nolsoe CP, Pfeffer F, Rafaelsen SR, Sparchez Z, Vilmann P, Waage JER. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open 2019; 5:E34-E51. [PMID: 30729231 PMCID: PMC6363590 DOI: 10.1055/a-0825-6708] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023] Open
Abstract
This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.
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Affiliation(s)
- Dieter Nuernberg
- Medical School Brandenburg Theodor Fontane, Gastroenterology, Neuruppin, Germany
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ana Paula Barreiros
- Deutsche Stiftung Organtransplantation, Head of Organisation Center Middle, Frankfurt, Germany
| | - Eike Burmester
- Department of Internal Medicine/Gastroenterology, Sana-Kliniken Lübeck, Lübeck, Germany
| | - Elena Tatiana Ivan
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dirk-André Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University of Munich-Grosshadern Campus, Munich, Germany
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, Milan, Italy
| | - Ismail Mihmanli
- Istanbul University – Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology and ALKA Radyoloji Tani Merkezi, Istanbul, Turkey
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Søren Rafael Rafaelsen
- Colorectal Centre of Excellence, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
| | - Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jo Erling Riise Waage
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Volløyhaug I, Rojas RG, Mørkved S, Salvesen KÅ. Comparison of transperineal ultrasound with POP-Q for assessing symptoms of prolapse. Int Urogynecol J 2018; 30:595-602. [PMID: 30069728 DOI: 10.1007/s00192-018-3722-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Our aim was to study any correlation between pelvic organ prolapse quantification (POP-Q) and ultrasound measurement of prolapse in women from a normal population and to identify the method with a stronger association with prolapse symptoms. METHODS A cross-sectional study of 590 parous women responding to the Pelvic Floor Distress Inventory was carried out. They were examined using POP-Q and transperineal ultrasound, and correlation was tested using Spearman's rank test. Numerical measurements and significant prolapse (POP-Q ≥ 2 in any compartment or bladder ≥10 mm, cervix ≥0 mm or rectal ampulla ≥15 mm below the symphysis on ultrasound) were compared in symptomatic and asymptomatic women (Mann-Whitney U and Chi-squared tests). RESULTS A total of 256 women had POP-Q ≥ 2 and 209 had significant prolapse on ultrasound. The correlation (rs) between POP-Q and ultrasound was 0.69 (anterior compartment), 0.53 (middle), and 0.39 (posterior), p < 0.01. Women with a "vaginal bulge" (n = 68) had greater descent on POP-Q and ultrasound in the anterior and middle compartments than asymptomatic women, p < 0.01. For women with a symptomatic bulge, the odds ratio was 3.8 (95% CI 2.2-6.7) for POP-Q ≥ grade 2 and 2.4 (95% CI 1.4-3.9) for prolapse on ultrasound. A sensation of heaviness (n = 90) and incomplete bladder emptying (n = 4) were more weakly associated with ultrasound (p = 0.03 and 0.04), and splinting (n = 137) was associated with POP-Q Bp, p = 0.02. CONCLUSION POP-Q and ultrasound measurement of prolapse had moderate to strong correlation in the anterior and middle compartments and weak correlation in the posterior compartment. Both methods were strongly associated with the symptom "vaginal bulge," but POP-Q had a stronger association than ultrasound.
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Affiliation(s)
- Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, PO Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.
| | - Rodrigo Guzmán Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Research Department, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, PO Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway
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Dietz HP, Gómez M, Atan IK, Ferreira CSW. Association between vaginal parity and rectocele. Int Urogynecol J 2018; 29:1479-1483. [PMID: 29464300 DOI: 10.1007/s00192-017-3552-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/20/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Rectocele is common in parous women but also seen in nulliparae. This study was designed to investigate the association between vaginal parity and descent of the rectal ampulla/rectocele depth as determined by translabial ultrasound (TLUS). METHODS This retrospective observational study involved 1296 women seen in a urogynaecological centre. All had undergone an interview, clinical examination and 4D ultrasound (US) imaging supine and after voiding. Offline analysis of volume data was undertaken blinded against other data. Rectal ampulla position and rectocele depth were measured on Valsalva. A pocket depth of 10 mm was used as a cutoff to define rectocele on imaging. RESULTS Most women presented with prolapse (53%, n = 686); 810 (63%) complained of obstructed defecation (OD). Clinically, 53% (n = 690) had posterior-compartment prolapse with a mean Bp of -1 [standard deviation (SD)1.5; -3 to 9 cm]. Mean descent of the rectal ampulla was 10 mm below the symphysis (SD 15.8; -50 to 41). A rectocele on imaging was found in 48% (n = 618). On univariate analysis, OD symptoms were strongly associated with rectal descent, rectocele depth and rectocele on imaging (all P < 0.001). The prevalence of a rectocele seen on imaging increased with vaginal parity (P < 0.001). One-way analysis of variance (ANOVA) of vaginal parity against rectal descent and rectocele depth showed a dose-response relationship (both P < 0.001). CONCLUSIONS Vaginal parity was strongly associated with descent of the rectal ampulla and rectocele depth. This relationship approximated dose-response characteristics, with the greatest effect due to the first vaginal delivery.
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Affiliation(s)
- Hans Peter Dietz
- Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
| | - Mariángeles Gómez
- Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia
- Tomografía Computada de Buenos Aires, entidad afiliada a la Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ixora Kamisan Atan
- Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia
- Department of Obstetrics & Gynecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Caroline S Wanderley Ferreira
- Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
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Albuquerque A, Macedo G. Anal Sphincters Evaluation by Endoanal Ultrasound in Obstructed Defecation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2519-2524. [PMID: 28649718 DOI: 10.1002/jum.14300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/06/2023]
Abstract
OBJECTIVES To evaluate anal sphincter abnormalities detected by endoanal ultrasound in obstructed defecation due to rectocele and rectal intussusception. METHODS The retrospective analysis includes 45 patients with obstructed defecation syndrome due to rectocele and/or rectal intussusception with or without fecal incontinence, and submitted to endoanal ultrasound. RESULTS Ninety-three percent (n = 42) were women (mean age of 63 ± 12 years), and 47% (n = 21) of the patients had fecal incontinence. In total, 29% (n = 13) had a previous anorectal surgery, and 93% (n = 39) of the women had a previous vaginal delivery. An isolated rectal intussusception was diagnosed in 20% (n = 9) of the patients, an isolated rectocele in 24% (n = 11), and rectal intussusception and rectocele in 56% (n = 25). Thirty-six percent of patients had anal sphincter lacerations (n = 16): 12% (n = 2) had only internal laceration, 69% (n = 11) had only external laceration, and 19% (n = 3) had both. Two patients had a thinner internal anal sphincter with 0.9 and 1.2 mm, respectively. In total, 25% of the patients without fecal incontinence had an occult anal sphincter laceration, and all were women with an external sphincter laceration in the anterior quadrant and a previous vaginal delivery. In patients with obstructed defecation and fecal incontinence, 48% had sphincter lacerations. Previous anorectal surgery was a predictor of anal sphincter laceration (odds ratio [OR] 4.8; 95% confidence interval [CI] = 1.214-18.971; P = .025), but fecal incontinence (OR 2.7; 95% CI = 0.774-9.613; P = .119) and previous vaginal delivery (OR 1.250; 95% CI = 0.104-15.011; P = .860) were not. CONCLUSIONS Endoanal ultrasound should be considered in obstructed defecation with or without fecal incontinence, especially if surgical correction is planned.
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Affiliation(s)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Obesity: how much does it matter for female pelvic organ prolapse? Int Urogynecol J 2017; 29:1129-1134. [DOI: 10.1007/s00192-017-3455-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
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Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques? Tech Coloproctol 2017; 21:555-565. [PMID: 28674949 DOI: 10.1007/s10151-017-1658-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the role of dynamic translabial ultrasound (TLUS) in the assessment of pelvic floor dysfunction and compare the results with echodefecography (EDF) combined with the endovaginal approach. METHODS Consecutive female patients with pelvic floor dysfunction were eligible. Each patient was assessed with EDF combined with the endovaginal approach and TLUS. The diagnostic accuracy of the TLUS was evaluated using the results of EDF as the standard for comparison. RESULTS A total of 42 women were included. Four sphincter defects were identified with both techniques, and EDF clearly showed if the defect was partial or total and additionally identified the pubovisceral muscle defect. There was substantial concordance regarding normal relaxation and anismus. Perfect concordance was found with rectocele and cystocele. The rectocele depth was measured with TLUS and quantified according to the EDF classification. Fair concordance was found for intussusception. There was no correlation between the displacement of the puborectal muscle at maximum straining on EDF with the displacement of the anorectal junction (ARJ), compared at rest with maximal straining on TLUS to determine perineal descent (PD). The mean ARJ displacement was similar in patients with normal and those with excessive PD on TLUS. CONCLUSIONS Both modalities can be used as a method to assess pelvic floor dysfunction. The EDF using 3D anorectal and endovaginal approaches showed advantages in identification of the anal sphincters and pubodefects (partial or total). There was good correlation between the two techniques, and a TLUS rectocele classification based on size that corresponds to the established classification using EDF was established.
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Affiliation(s)
- G A Santoro
- Pelvic Floor Unit, I°Department of Surgery, Regional Hospital, Treviso, Italy.
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Rachaneni S, Atan IK, Shek KL, Dietz HP. Digital rectal examination in the evaluation of rectovaginal septal defects. Int Urogynecol J 2017; 28:1401-1405. [PMID: 28213798 DOI: 10.1007/s00192-017-3285-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/25/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the diagnostic potential of digital rectal examination in the identification of a true rectocele. METHODS This is a retrospective observational study utilising 187 archived data sets of women presenting with lower urinary tract symptoms and/or pelvic organ prolapse between August 2012 and November 2013. Evaluation included a standardised interview, ICS-POPQ, rectal examination and 4D translabial ultrasound. The main outcome measure was the diagnosis of rectocele by digital rectal palpation on Valsalva manoeuvre. This diagnosis correlated with the sonographic diagnosis of rectocele to determine agreement between digital examination and ultrasound findings. RESULTS Complete data sets were available for 180 participants. On imaging, the mean position of the rectal ampulla was 11.07 (-36.3 to 44.3) mm below the symphysis pubis; 42.8% (77) had a rectocele of a depth of ≥10 mm. On palpation, a rectocele was detected in 60 women (33%). Agreement between palpation and imaging was observed in 77%; the kappa was 0.52 (CI 0.39-0.65). On receiver operator characteristic analysis, the area under the curve was 0.854 for the relationship between rectocele pocket depth and the detection of rectocele on palpation. CONCLUSION Moderate agreement was found between digital rectal examination for rectocele and translabial ultrasound findings of a "true rectocele". Digital rectal examination may be used to identify these defects in clinical practice. Extending the clinical examination of prolapse to include rectal examination to palpate defects in the rectovaginal septum may reduce the need for defecatory proctograms for the assessment of obstructive defecation and may help triage patients in the management of posterior compartment prolapse.
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Affiliation(s)
- Suneetha Rachaneni
- School of Clinical and Experimental Medicine , University of Birmingham, Birmingham, UK.
| | | | - Ka Lai Shek
- Department of Obstetrics and Gynecology, Liverpool Clinical School, University of Western Sydney, Parramatta, Australia
| | - Hans Peter Dietz
- Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia
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Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms. Dis Colon Rectum 2016; 59:1191-1199. [PMID: 27824705 DOI: 10.1097/dcr.0000000000000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures. OBJECTIVE The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor. DESIGN This was a prospective study. SETTING The study was conducted at a large university tertiary care hospital. PATIENTS Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale. INTERVENTIONS Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction. MAIN OUTCOME MEASURES Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm. RESULTS Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus). LIMITATIONS The study did not include a control group without symptoms. CONCLUSIONS Three-dimensional endovaginal ultrasonography is a reliable technique for assessment of perineal descent. Using this technique, excessive perineal descent can be defined as displacement of the anorectal junction >1 cm and/or its position below the symphysis pubis on Valsalva maneuver.
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Shek KL, Dietz HP. Assessment of pelvic organ prolapse: a review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:681-692. [PMID: 26865209 DOI: 10.1002/uog.15881] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Affiliation(s)
- K L Shek
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
- Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Sydney, Australia
| | - H P Dietz
- Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Sydney, Australia
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Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, Hull T, Berghmans B, Brody S, Haylen BT. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Int Urogynecol J 2016; 28:5-31. [DOI: 10.1007/s00192-016-3140-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
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