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Guo Z, Lu X, Yao J, Zhou Y, Chen C, Chen J, Yang D, Cao Y, Zheng W, Yang X, Ni D. Fully Automated Localization and Measurement of Levator Hiatus Dimensions Using 3-D Pelvic Floor Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1329-1338. [PMID: 38845332 DOI: 10.1016/j.ultrasmedbio.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/26/2024] [Accepted: 05/05/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE To develop an algorithm for the automated localization and measurement of levator hiatus (LH) dimensions (AI-LH) using 3-D pelvic floor ultrasound. METHODS The AI-LH included a 3-D plane regression model and a 2-D segmentation model, which first achieved automated localization of the minimal LH dimension plane (C-plane) and measurement of the hiatal area (HA) on maximum Valsalva on the rendered LH images, but not on the C-plane. The dataset included 600 volumetric data. We compared AI-LH with sonographer difference (ASD) as well as the inter-sonographer differences (IESD) in the testing dataset (n = 240). The assessment encompassed the mean absolute error (MAE) for the angle and center point distance of the C-plane, along with the Dice coefficient, MAE, and intra-class correlation coefficient (ICC) for HA, and included the time consumption. RESULTS The MAE of the C-plane of ASD was 4.81 ± 2.47° with 1.92 ± 1.54 mm. AI-LH achieved a mean Dice coefficient of 0.93 for LH segmentation. The MAE on HA of ASD (1.44 ± 1.12 mm²) was lower than that of IESD (1.63 ± 1.58 mm²). The ICC on HA of ASD (0.964) was higher than that of IESD (0.949). The average time costs of AI-LH and manual measurement were 2.00 ± 0.22 s and 59.60 ± 2.63 s (t = 18.87, p < 0.01), respectively. CONCLUSION AI-LH is accurate, reliable, and robust in the localization and measurement of LH dimensions, which can shorten the time cost, simplify the operation process, and have good value in clinical applications.
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Affiliation(s)
- Zhijie Guo
- Department of Ultrasound, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiduo Lu
- Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, China
| | - Jiezhi Yao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China
| | - Yongsong Zhou
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China
| | - Chaoyu Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China
| | - Jiongquan Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China
| | - Danling Yang
- Department of Ultrasound, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yan Cao
- Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, China
| | - Wei Zheng
- Department of Ultrasound, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen, China.
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Hesham H, Orejuela F, Rood KM, Turrentine M, Casey B, Khandelwal M, Dajao R, Azad S, Rosen T, Hoffman MK, Wang EY, Hart L, Sheen JJ, Grisales T, Gibson KS, Torbenson V, Williams SF, Evantash E, Dietz HP, Wapner RJ. Effect of an Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial. Int Urogynecol J 2024:10.1007/s00192-024-05881-6. [PMID: 39096389 DOI: 10.1007/s00192-024-05881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/30/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery. METHODS A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months. RESULTS A total of 214 women were randomized to Device (n = 113) or Control (n = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (p = 0.040; two-tailed Fisher's test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related. CONCLUSIONS The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse.
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Affiliation(s)
- Helai Hesham
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Francisco Orejuela
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Kara M Rood
- Department of Obstetrics & Gynecology, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Mark Turrentine
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Brian Casey
- Department of Obstetrics & Gynecology, University Medical Center, University of Alabama, Tuscaloosa, AL, USA
| | - Meena Khandelwal
- Department of Obstetrics & Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Rori Dajao
- Department of Obstetrics & Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Sarah Azad
- El Camino Women's Medical Group, El Camino Health, Mountain View, CA, USA
| | - Todd Rosen
- Department of Obstetrics, Gynecology and Reproductive Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Matthew K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Eileen Y Wang
- Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Hart
- Department of Obstetrics, Gynecology and Reproductive Medicine, Temple University, Philadelphia, PA, USA
| | - Jean-Ju Sheen
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tamara Grisales
- Department of Obstetrics & Gynecology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Kelly S Gibson
- Division of Fetal Maternal Medicine, The Metro-Health System, Cleveland, OH, USA
| | - Vanessa Torbenson
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Shauna F Williams
- Department of Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Hans P Dietz
- Sydney Urodynamic Centres, Sydney, NSW, Australia
| | - Ronald J Wapner
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Maluenda A, Santis-Moya F, Arévalo D, Pohlhammer D, Blumel B, Guzmán-Rojas R, Pizarro-Berdichevsky J. Levator Ani Avulsion in Ultrasound Increases Recurrence in Sacrospinous Fixation. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:505-510. [PMID: 38019478 DOI: 10.1097/spv.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
IMPORTANCE Pelvic floor translabial ultrasound (TLUS) can identify levator ani muscle (LAM) avulsion and ballooning, which some studies have shown to be possible risk factors for prolapse recurrence. Our group uses TLUS to counsel patients preoperatively. If any of these risk factors exist, we offer sacrocolpopexy over vaginal repair. However, some patients, even though they have these possible risk factors, prefer to undergo vaginal surgery. OBJECTIVE The objective of this study was to determine if TLUS LAM avulsion and/or ballooning are risk factors for composite outcome recurrence in patients undergoing sacrospinous ligament fixation for pelvic organ prolapse. STUDY DESIGN This was a retrospective observational study. All patients with vaginal apical repair with sacrospinous ligament fixation with preoperative TLUS were included. Demographics, clinical characteristics, and follow-up were analyzed. Multivariable logistic regression analysis was performed for composite outcome that included TLUS risk factors, age, Pelvic Organ Prolapse Quantification System measurements and stage, and variables with P < 0.1 in the univariate analysis. RESULTS Eighty-two patients were included. All patients had symptomatic vaginal bulge; 65.4% had stage III prolapse. Concomitant hysterectomy was performed in 54.3%. Median follow-up was 20 months (interquartile range, 8-35 months); 19.8% had LAM avulsion, and 43.2% had ballooning. Anatomic recurrence rate was 23.5%, symptomatic was 22.2%, and reoperation was 1.2%. The composite recurrence rate was 29.6%. In the multivariable logistic regression analysis, unilateral/bilateral avulsion in TLUS was found to be a significant risk factor for composite outcome with an odds ratio of 4.33 (confidence interval, 1.219-15.398; P = 0.023). CONCLUSIONS Composite outcome of recurrence in our study was 29.6%. Avulsion on TLUS increased the risk of recurrence of pelvic organ prolapse by fourfold.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Guzmán-Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo
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Zhao H, Liu XN, Liu LN. Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations. Arch Gynecol Obstet 2024; 309:2177-2182. [PMID: 37755534 DOI: 10.1007/s00404-023-07226-y] [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: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. METHODS Sixty patients who volunteered for a PFMT assessment at 6-8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). RESULTS Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. CONCLUSIONS Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.
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Affiliation(s)
- Hui Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China
| | - Xiu-Ni Liu
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China.
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Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med 2024; 13:2336. [PMID: 38673609 PMCID: PMC11051119 DOI: 10.3390/jcm13082336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
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Affiliation(s)
| | | | | | - Ewa Barcz
- Department of Gynaecology and Obstetrics, Medical Faculty Collegium Medicum, University of Cardinal Stefan Wyszynski, 01-938 Warsaw, Poland; (A.Z.); (P.T.); (E.H.)
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Resta S, De Vito M, Patelli C, Lu JLA, Gabrielli G, Chiodo E, Mappa I, Rizzo G. Validation of an automated software (Smartpelvic™) in assessing hiatal area from three dimensional transperineal pelvic volumes of pregnant women: comparison with manual analysis. J Perinat Med 2024; 52:165-170. [PMID: 37938105 DOI: 10.1515/jpm-2023-0323] [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: 08/07/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES The aim of this investigation was to evaluate the agreement between a manual and an automatic technique in assessing levator hiatus area (LHA) during pregnancy from three-dimensional (3D) pelvic floor volumes obtained by trans-perineal ultrasound (TPUS). METHODS 3D volumes were acquired during rest, maximum pelvic floor contraction and Valsalva maneuver from 66 pregnant women. Manual selection of LHA and automatic software (Smart Pelvic™) were applied on TPUS volume starting from a C-plane view. To evaluate intra- and inter-observer variability measurements of LHA were performed twice by the same operator and once by a second sonographer. Reference hiatal contours obtained manually by the first operator were compared with the automated ones. Reproducibility was evaluated by intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS LHA measurement, using automatic software, achieved excellent intra-observer and inter-observer reproducibility in pregnant women both at rest and after dynamic analysis (ICC>0.9). Further, an excellent agreement resulted between manual selection of the LHA and automatic imaging (ICC>0.9). The average time taken to obtain LHA manually was significantly longer when compared to the automatic analysis (p≤0.0001). CONCLUSIONS Smart pelvic software resulted from a reliable method for automatically measuring the LHA, showing high reproducibility and accuracy.
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Affiliation(s)
- Serena Resta
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Marika De Vito
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Chiara Patelli
- Department of Obstetrics and Gynecology, Università di Verona, Verona Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Gianluca Gabrielli
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Erika Chiodo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
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Yang Z, Zhou L, Yang L, He H. Restoration of bladder neck activity and levator hiatus dimensions in Asian primipara: a prospective study. J OBSTET GYNAECOL 2023; 43:2173564. [PMID: 36752287 DOI: 10.1080/01443615.2023.2173564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pelvic floor muscle training (PFMT) reduces the symptoms in women with pelvic floor dysfunction (PFD); however, the optimal initial timing for secondary prevention of PFD by PFMT is not clear. To identify the optimal timing in Asian primiparas with vaginal delivery, bladder neck descent (BND), levator hiatus areas, and levator hiatus distensibility and contractility were assessed in 26 nulliparous women at 36 weeks of gestation and at 2, 4, 6, and 12 weeks postpartum. We found that BND increased significantly from 2 weeks onwards until 6 weeks postpartum (p = 0.004); the levator hiatus area at rest and contraction both showed the largest value at 2 weeks postpartum (p = 0.005 and p < 0.005 respectively), followed by a continuous decrease; the hiatus area during Valsalva manoeuvre, and the levator hiatus distensibility and contractility showed the lowest value at 2 weeks postpartum, followed by a continuous increase; the changes in BND showed no correlation with the changes in distensibility or hiatus area during Valsalva manoeuvre (p = 0.073 and 0.590 respectively). In Asian primiparas with vaginal delivery, the recovery of levator hiatus and bladder neck mobility begins at 2 and 6 weeks, respectively. This information could be useful in defining the best time to begin PFMT for secondary prevention of postpartum PFD in Asian primiparous women.IMPACT STATEMENTWhat is already known on this subject? Pelvic floor muscle training (PFMT) helps to reduce symptoms of pelvic floor dysfunction (PFD), however, there are no clear time strategies for the secondary prevention of PFD by PFMT in Asian primiparas with vaginal delivery.What do the results of this study add? This study was the first longitudinal study in Asian primipara to investigate the natural regeneration of pelvic floor functions in the early postpartum period by intensively monitoring the bladder neck mobility and levator hiatus dimensions at multiple time points. We found that bladder neck descent (BND) increased significantly from 2 weeks onwards until 6 weeks postpartum; the levator hiatus area at rest and contraction both showed the largest value at 2 weeks postpartum, followed by a continuous decrease; the hiatus area during Valsalva manoeuvre, and the levator hiatus distensibility and contractility showed the lowest value at 2 weeks postpartum, followed by a continuous increase; the changes in BND showed no correlation with the changes in distensibility or hiatus area during Valsalva manoeuvre.What are the implications of these findings for clinical practice and/or further research? Our study suggested that in Asian primipara, the recovery of bladder neck mobility after vaginal delivery begins at 6 weeks postpartum, while the levator hiatus muscle begins to recover within the first 2 weeks postpartum. Therefore, it could be useful in deciding the best time to start PFMT for secondary prevention of postpartum PFD in Asian primiparous women.
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Affiliation(s)
- Zexuan Yang
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, The People's Republic of China (PRC)
| | - Liuying Zhou
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, The People's Republic of China (PRC)
| | - Liwen Yang
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, The People's Republic of China (PRC)
| | - Hui He
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, The People's Republic of China (PRC)
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Xiao T, Cao Y, Zhen C, Chen Z, Huang W, Su Z. Nomogram Analysis Based on Clinical and Sonographic Characteristics for the Assessment of Postpartum Stress Urinary Incontinence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2591-2601. [PMID: 37341131 DOI: 10.1002/jum.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES We aimed to develop and validate a nomogram integrating clinical and sonographic characteristics for the individualized SUI risk evaluation in the early postpartum stage. METHODS This was a prospective cross-sectional study. From June 2020 to September 2022, singleton primiparas who underwent TPUS examination at 6-8 weeks postpartum were recruited. They were divided into the training and validation cohorts at a ratio of 8:2 according to the temporal split. All subjects were interviewed before TPUS examination. Univariate and multivariate logistic analyses were performed to develop three models: the clinical, sonographic, and combined models. The ROC curve was plotted to evaluate model discrimination ability. Finally, the combined model was selected to establish the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were evaluated in the training and validation cohorts. RESULTS The performance of the combined model was better than that of the clinical and sonographic models. Six predictors (BMI, delivery mode, lateral episiotomy, SUI during pregnancy, cystocele, and bladder neck funneling) remained in the combined model. The nomogram based on the combined model had good discrimination with AUCs of 0.848 (95% CI: 0.796-0.900) and 0.872 (95% CI: 0.789-0.955) in the training and validation cohorts, respectively, and the calibration curve showed good efficiency in assessing postpartum SUI. Decision curve analysis showed that the nomogram was clinically useful. CONCLUSIONS The nomogram based on clinical and sonographic characteristics showed good efficiency in assessing postpartum SUI risk and can be a convenient and reliable tool for individual SUI risk assessment.
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Affiliation(s)
- Ting Xiao
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Yunqing Cao
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Chaojiong Zhen
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Ziman Chen
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Weijun Huang
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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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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Packet B, Page AS, Cattani L, Bosteels J, Deprest J, Richter J. Predictive factors for obstetric anal sphincter injury in primiparous women: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:486-496. [PMID: 37329513 DOI: 10.1002/uog.26292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the diagnosis made by ultrasound (US-OASI). The secondary objective was to report on incidence rates of sonographic anal sphincter (AS) trauma, including trauma that was not clinically reported at childbirth, among the studies providing data for our primary objective. METHODS We conducted a systematic search of MEDLINE, EMBASE, Web of Science, CINAHL, The Cochrane Library and ClinicalTrials.gov databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random-effects meta-analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary odds ratio (OR) or mean difference (MD) is reported with 95% CI. Heterogeneity was assessed using the I2 statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool. RESULTS A total of 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort studies, three retrospective cohort studies and two interventional non-randomized trials). Increasing gestational age at delivery (MD, 0.34 (95% CI, 0.04-0.64) weeks), shorter antepartum perineal body length (MD, -0.60 (95% CI, -1.09 to -0.11) cm), labor augmentation (OR, 1.81 (95% CI, 1.21-2.71)), instrumental delivery (OR, 2.13 (95% CI, 1.13-4.01)), in particular forceps extraction (OR, 3.56 (95% CI, 1.31-9.67)), shoulder dystocia (OR, 12.07 (95% CI, 1.06-137.60)), episiotomy use (OR, 1.85 (95% CI, 1.11-3.06)) and shorter episiotomy length (MD, -0.40 (95% CI, -0.75 to -0.05) cm) were associated with US-OASI. When pooling incidence rates, 26% (95% CI, 20-32%) of women who had a first vaginal delivery had US-OASI (20 studies; I2 = 88%). In studies reporting on both clinical and US-OASI rates, 20% (95% CI, 14-28%) of women had AS trauma on ultrasound that was not reported clinically at childbirth (16 studies; I2 = 90%). No differences were found in maternal age, body mass index, weight, subpubic arch angle, induction of labor, epidural analgesia, episiotomy angle, duration of first/second/active-second stages of labor, vacuum extraction, neonatal birth weight or head circumference between cases with and those without US-OASI. Antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US-OASI. Most (81%) studies were judged to be at high risk of bias in at least one domain and only four (19%) studies had an overall low risk of bias. CONCLUSION Given the ultrasound evidence of structural damage to the AS in 26% of women following a first vaginal delivery, clinicians should have a low threshold of suspicion for the condition. This systematic review identified several predictive factors for this. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Packet
- Department of Development and Regeneration, Unit of Woman and Child, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - A-S Page
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - L Cattani
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - J Bosteels
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
| | - J Deprest
- Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery, Catholic University of Leuven (KU Leuven), Leuven, Belgium
- Research Department of Maternal-Fetal Medicine, Institute for Women's Health, University College London, London, UK
| | - J Richter
- Department of Development and Regeneration, Unit of Woman and Child, Catholic University of Leuven (KU Leuven), Leuven, Belgium
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Ahuja M, Sarkar A, Sharma V. Integrating Technologies: An Affordable Health Care System in Digital India. J Midlife Health 2023; 14:66-68. [PMID: 38029028 PMCID: PMC10664050 DOI: 10.4103/jmh.jmh_138_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Maninder Ahuja
- Director, Ahuja Health Care Services, Faridabad, Haryana, New Delhi, India
- Founder President SMLM (Society of Meaningful Life Management), Faridabad, Haryana, New Delhi, India
| | - Avir Sarkar
- Department of Obstetrics and Gynecology, ESIC Medical College and Hospital, Faridabad, Haryana, New Delhi, India
| | - Vartika Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India E-mail:
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Okeahialam NA, Thakar R, Sultan AH. Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study. Acta Obstet Gynecol Scand 2023; 102:473-479. [PMID: 36707852 PMCID: PMC10008287 DOI: 10.1111/aogs.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). MATERIAL AND METHODS Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. RESULTS Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. CONCLUSIONS We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.
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Affiliation(s)
| | - Ranee Thakar
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
| | - Abdul H Sultan
- Croydon University Hospital, Croydon, UK.,St George's University of London, London, UK
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. Nurs Womens Health 2023; 27:e12-e25. [PMID: 36759284 DOI: 10.1016/j.nwh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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14
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Alshiek J, Murad-Regadas SM, Mellgren A, Glanc P, Khatri G, Quiroz LH, Weinstein MM, Rostaminia G, Oliveira L, Arif-Tiwari H, Ferrari L, Bordeianou L, Shobeiri SA. Consensus definitions and interpretation templates for dynamic ultrasound imaging of defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the american society of colon and rectal surgeons, the society of abdominal radiology, the international continence society, the American urogynecologic society, the international urogynecological association, and the society of gynecologic surgeons. Int Urogynecol J 2023; 34:603-619. [PMID: 36617601 DOI: 10.1007/s00192-022-05414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
- Urogynecology Unit, Technion Medical School, Hillel Yaffe Medical Center, Hadera, Israel
| | - Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Anders Mellgren
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Milena M Weinstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Northshore Hospital, Chicago, IL, USA
| | - Lucia Oliveira
- Department of Colorectal Surgery Hospital Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
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15
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Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:327-343. [PMID: 36652546 DOI: 10.1097/spv.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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16
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. J Obstet Gynecol Neonatal Nurs 2023; 52:e9-e22. [PMID: 36759268 DOI: 10.1016/j.jogn.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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17
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Alshiek J, Murad-Regadas SM, Mellgren A, Glanc P, Khatri G, Quiroz LH, Weinstein MM, Rostaminia G, Oliveira L, Arif-Tiwari H, Ferrari L, Bordeianou LG, Shobeiri SA. Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2023; 66:200-216. [PMID: 36627252 DOI: 10.1097/dcr.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, Virginia
- Urogynecology Unit, Hillel Yaffe Medical Center, Technion Medical School, Hadera, Israel
| | - Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Anders Mellgren
- Department of Surgery, University of Illinois, Chicago, Illinois
| | - Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Milena M Weinstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Northshore Hospital, Chicago, Illinois
| | - Lucia Oliveira
- Department of Colorectal Surgery' Hospital Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, Arizona
| | - Linda Ferrari
- Pelvic Floor Unit, St. Thomas' Hospital, London, United Kingdom
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, Virginia
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Doumouchtsis SK, de Tayrac R, Lee J, Daly O, Melendez-Munoz J, Lindo FM, Cross A, White A, Cichowski S, Falconi G, Haylen B. An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders. Int Urogynecol J 2023; 34:1-42. [PMID: 36443462 PMCID: PMC9834366 DOI: 10.1007/s00192-022-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AIMS The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
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Affiliation(s)
- Stergios K. Doumouchtsis
- grid.419496.7Department of Obstetrics and Gynaecology, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
- grid.264200.20000 0000 8546 682XSt. George’s University of London, London, UK
- grid.5216.00000 0001 2155 0800Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
- School of Medicine, Ross University, Miramar, FL USA
| | - Renaud de Tayrac
- grid.411165.60000 0004 0593 8241Nimes University Hospital, Nimes, France
| | - Joseph Lee
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
| | - Oliver Daly
- grid.417072.70000 0004 0645 2884Western Health, Melbourne, Australia
| | - Joan Melendez-Munoz
- grid.411295.a0000 0001 1837 4818Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Fiona M. Lindo
- grid.63368.380000 0004 0445 0041Houston Methodist Hospital, Texas A&M University College of Medicine, Houston Methodist Hospital, Houston, TX USA
| | - Angela Cross
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Amanda White
- grid.89336.370000 0004 1936 9924University of Texas at Austin, Austin, TX USA
| | - Sara Cichowski
- grid.5288.70000 0000 9758 5690Oregon Health & Sciences University, Portland, OR USA
| | - Gabriele Falconi
- grid.413009.fComplex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Bernard Haylen
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
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Wang L, Liu Y, Wang X, Shi G, Huang J, Xiao X, Xie Y. Association between urethral funneling in stress urinary incontinence and the biological properties of the urethral rhabdosphincter muscle based on shear wave elastography. Neurourol Urodyn 2023; 42:282-288. [PMID: 36335601 DOI: 10.1002/nau.25080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/12/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To apply shear wave elastography (SWE) combined with transperineal ultrasonography (TPUS) to study the association between urethral funneling in stress urinary incontinence (SUI) and the biological properties of the urethral rhabdosphincter muscle in women. METHODS This single-center retrospective study included 166 women with SUI (SUI group) and 185 women who underwent a routine physical examination (control group). The control group and SUI group were divided into nonfunneling and funneling groups according to the presence or absence of urethral funneling, respectively, and their ultrasound findings were compared to analyze the association between funneling and ultrasound measurements. RESULTS The SUI group had a lower mean E than the control group (15.54 vs. 20.82 kPa, p < 0.001). The SUI-funneling group had a lower mean E than the SUI-nonfunneling group (15.50 vs. 17.21 kPa, p < 0.001). The area under the (AUC) receiver operating characteristic (ROC) curve of the mean E for predicting SUI was 0.864, with a cutoff value of 19.19 kPa. The AUC of the mean E for predicting urethral funneling was 0.832, with a cutoff value of 17.15 kPa. The stiffness of the urethral rhabdosphincter was an independent factor related to SUI and urethral funneling in SUI. CONCLUSIONS SWE can be used to assess the biological properties of the urethral rhabdosphincter, and reduced stiffness of the rhabdosphincter was significantly correlated with SUI and funneling in SUI. Thus, women with urethral funneling in SUI may have a weak urethral rhabdosphincter.
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Affiliation(s)
- Liang Wang
- Department of Ultrasound Diagnosis, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Xiaona Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Guoqiang Shi
- Department of Urology Surgery, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Jun Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xue Xiao
- Department of Gynecology and Obstetrics, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Ying Xie
- Department of Gynecology and Obstetrics, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
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Okeahialam NA, Thakar R, Sultan AH. Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:793-799. [PMID: 35638253 PMCID: PMC10100122 DOI: 10.1002/uog.24957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the agreement between three-dimensional endoanal ultrasound (EAUS) and four-dimensional transperineal ultrasound (TPUS) in measuring anal sphincter defect angle. METHODS This was a secondary analysis of the PERINEAL study, which evaluated the effect of perineal wound infection on anal sphincter integrity. Women were reviewed once a week, until their perineal wound had healed or for up to a maximum of 16 weeks. At each visit, both EAUS and TPUS (the latter at rest and on maximum pelvic floor muscle contraction (PFMC)) were performed to evaluate the presence of external (EAS) and internal (IAS) anal sphincter defect and measure the defect size. The largest angle size of a defect at the same sphincter level was analyzed. A defect was deemed significant if it was > 30°. Kappa coefficient (κ), intraclass correlation coefficient and standard error of measurement (SEM) were calculated, using EAUS as the reference standard. RESULTS In 73 women scanned at weekly intervals, a total of 250 EAUS and 250 TPUS scans were performed. An EAS defect was found in 55 (22.0%) EAUS images and 47 (18.8%) TPUS images. An IAS defect was found in 26 (10.4%) images on both modalities. There was excellent agreement (κ = 0.87) between TPUS and EAUS in diagnosing the presence of an EAS defect and perfect agreement (κ = 1.00) in diagnosing the presence of an IAS defect. TPUS performed at rest had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.1° and ± 27.9°. TPUS performed during maximum PFMC had poor and moderate agreement with EAUS in measuring EAS and IAS defect size, respectively, with respective SEMs of ± 16.5° and ± 26.4°. Based on the SEMs, if the diagnostic cut-off of 30° for defect size on TPUS was used, an incorrect diagnosis of significant EAS defect could occur in approximately 9-36% of women and an incorrect diagnosis of a significant IAS defect could occur in approximately 4-15% of women, using EAUS as the reference. CONCLUSIONS This is the first study to compare directly anal sphincter defect angle measurements obtained on EAUS and TPUS. A cut-off angle of 30° should not be used for the diagnosis of a significant residual anal sphincter defect during TPUS examination. Further research is required to determine the optimal defect cut-off angle for TPUS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. A. Okeahialam
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
| | - R. Thakar
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
- St George's University of LondonLondonUK
| | - A. H. Sultan
- Urogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK
- St George's University of LondonLondonUK
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Okeahialam NA, Thakar R, Sultan AH. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:818-819. [PMID: 36454635 DOI: 10.1002/uog.26104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 05/27/2023]
Affiliation(s)
| | - R Thakar
- Croydon University Hospital, Croydon, UK
- St George's University of London, London, UK
| | - A H Sultan
- Croydon University Hospital, Croydon, UK
- St George's University of London, London, UK
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22
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Barnes HC, Akl A, Taege SK, Brincat C, Brubaker L, Mueller ER. Using clinical estimate or catheter measurement of urethral mid-point result in similar retropubic mid-urethral sling position: a randomized trial. Int Urogynecol J 2022; 33:3555-3561. [PMID: 35353246 DOI: 10.1007/s00192-022-05167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to determine whether standardized, intraoperative urethral measurement improves retropubic mid-urethral sling (RPMUS) positioning and if the intraoperative position remains stable at 2 weeks postoperatively. METHODS Participants undergoing a RPMUS were randomized to mid-urethral placement as per usual surgical care (no Foley catheter measurement, no-FCM) vs urethral mid-point Foley catheter measurement (FCM). The primary outcomes were RPMUS location as determined by 2D and 3D ultrasound 2 weeks postoperatively (as percentage from urethral meatus - relative to the urethral length) and intraoperatively following the RPMUS placement. RESULTS Forty-four women enrolled, underwent RPMUS, and provided baseline data and intraoperative ultrasound measurements; of these, 36 (82%) had interpretable intraoperative and postoperative ultrasound measurements. Demographic data were similar in the two groups. The mean RPMUS mid-point was 57 % and 55 % in measured and controls (p = 0.685); this same measurement was relatively unchanged at 2 weeks postoperatively at 57% and 54% respectively (p = 0.538). Very much and much improvement was reported on the PGI-I by 84% and 85% of participants in the FCM and no-FCM groups respectively. CONCLUSIONS Intraoperative RPMUS position at 2 weeks after surgery is similar to the intraoperative position. Compared with usual surgical care, intraoperative measurement of urethral mid-point with a Foley catheter did not affect RPMUS sling position.
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Affiliation(s)
- H C Barnes
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.,University of Cincinnati College of Medicine, 231 Albert Sabin Way, Medical Sciences Building Room 4505, Cincinnati, OH, 45267-0526, USA
| | - A Akl
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.,AZ Urogynecology & Pelvic Health Center, 9700 N. 91st Street, Suite A-103, Scottsdale, AZ, 85258, USA
| | - S K Taege
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.,Mount Carmel Urogynecology-Mount Carmel Medical Group, 495 Cooper Road Suite 320, Westerville, OH, 43081, USA
| | - C Brincat
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, USA
| | - L Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - E R Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.
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Shibata A. Point-of-care ultrasound for abdominal pain in obstetrics and gynecological diseases. J Med Ultrason (2001) 2022; 49:629-637. [PMID: 35689711 DOI: 10.1007/s10396-022-01218-2] [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: 08/15/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
Ultrasound is a minimally invasive technique recommended for the evaluation of abdominal pain in young, premenopausal women and pregnant women. Ectopic pregnancy, ovarian cyst torsion, ovarian hemorrhage, myoma degeneration, and pyometra can be detected with point-of-care ultrasound (POCUS) in the case of acute abdominal pain. This article describes the utility of POCUS in females with abdominal pain in obstetrics and gynecological diseases.
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Affiliation(s)
- Ayako Shibata
- Obstetrics and Gynecology, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan.
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Zhao B, Wen L, Liu D, Huang S. The Visualized Urethral Mobility Profile in Stress Urinary Incontinence Described by Four-Dimensional Transperineal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1439-1445. [PMID: 34515354 DOI: 10.1002/jum.15828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/25/2021] [Accepted: 08/29/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To describe the urethral mobility during urine leaking in stress urinary incontinence (SUI) by transperineal ultrasound (TPUS) with urethral mobility profile (UMP) analysis. METHODS This was a prospective study of 380 women who had a cough stress test (CST) with TPUS. UMP software automatically placed six equidistant points from the bladder neck (Point 1) to the external urethral meatus (Point 6) and determined their x and y coordinates relative to the symphysis pubis. Urethral mobility vector of Points 1-6 (Vectors 1-6) and the distance between the six points and the symphysis (Dist. 1-6) were calculated and compared between the two groups. The visualized UMP was created by reproducing the positions of the six points at rest and on Valsalva. RESULTS Valid data of 188 women with SUI and 174 continent women were analyzed. The mean age of all 362 women was 49.3 years. Mean body mass index in the SUI group was significantly increased (23.8 vs 22.2 kg/m2 , P < .001). During CST, Vectors 1-6 and Dist. 2-6 were significantly increased (all P < .005) in the SUI group. The UMP showed the mid-urethral rotated down around the symphysis pubis. The upper urethral profile in the two groups was similar. But the gap between the mid-urethra and the symphysis was wider in the SUI group. CONCLUSIONS The visualized UMP illustrated the mid-urethral hypermobility in SUI by showing a wider gap due to the unstable connection between the mid-urethra and the symphysis pubis.
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Affiliation(s)
- Baihua Zhao
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lieming Wen
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Shanya Huang
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Shi Q, Wen L, Zhao B, Huang S, Liu D. The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:671-677. [PMID: 33987879 DOI: 10.1002/jum.15748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the association of hiatal area (HA), bladder neck mobility, and urethral mobility during the cough stress test (CST) with stress urinary incontinence (SUI). METHODS This was a prospective study of 110 continent and 190 incontinent women using transperineal ultrasound. HA, bladder neck mobility, and the mobility of six points along the urethra (Vectors 1-6) were measured. The cohort was randomly divided at a ratio of 2:1 into a training cohort and a validation cohort. The correlations of HA with bladder neck mobility, urethral mobility, and SUI were tested. The predictive model was yielded by fisher linear discriminant analysis and receiver operating characteristics to assess the parameters' ability to predict SUI. RESULTS Valid data were collected from 177 incontinent women and 105 continent women. Significant differences were identified in HA, body mass index (BMI), funneling, bladder neck mobility, and Vectors 1-6 between them. HA was positively correlated to bladder neck mobility. In the training cohort, bladder neck position on Valsalva, Vectors 3, and BMI had the area under curves of 0.74, 0.69, and 0.66 (all P < 0.001); Funneling and Vector 3 had odds ratios of 18.96 and 3.65 (all P < 0.001), for predicting SUI. The predictive model incorporating funneling, Vectors 3, and BMI provided the best performance in predicting SUI in both cohorts. CONCLUSION The larger the HA was, the higher the bladder neck mobility. However, it was mid-urethral mobility rather than bladder neck mobility that performed best at predicting SUI.
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Affiliation(s)
- Qingling Shi
- Second Xiangya Hospital, Central South University, China
| | - Lieming Wen
- Second Xiangya Hospital, Central South University, China
| | - Baihua Zhao
- Second Xiangya Hospital, Central South University, China
| | - Shanya Huang
- Second Xiangya Hospital, Central South University, China
| | - Dan Liu
- Second Xiangya Hospital, Central South University, China
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Smith M, Donnelly GM, Berry L, Innes S, Dixon J. Point of care ultrasound in pelvic health: scope of practice, education and governance for physiotherapists. Int Urogynecol J 2022; 33:2669-2680. [PMID: 35552775 PMCID: PMC9477927 DOI: 10.1007/s00192-022-05200-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 02/05/2023]
Abstract
Pelvic health and pelvic floor dysfunction have wide-reaching implications across a range of patient groups. Placing ultrasound imaging into the hands of assessing and treating clinicians (i.e. point of care ultrasound, PoCUS) can provide a step change in clinical effectiveness and efficiency. Pelvic floor dysfunction is managed by one or more members of a multi-disciplinary team that includes physiotherapists. Physiotherapists' involvement includes diagnosis, patient education, identifying shared treatment goals, using rehabilitative strategies and empowering patients through self-management. Drawing upon existing publications in this area and applying framework principles, the authors propose a clinical and sonographic scope of practice for physiotherapists as part of supporting the consolidation and expansion of pelvic health PoCUS. Education and governance considerations are detailed to ensure the robust and safe use of this modality. Alongside empowering the use of ultrasound imaging by clinicians such as physiotherapists in the UK and internationally, we provide clarity to other members of the care pathway and ultrasound imaging professionals.
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Affiliation(s)
- Mike Smith
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | | | - Lucia Berry
- College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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Williams H, Cattani L, Van Schoubroeck D, Yaqub M, Sudre C, Vercauteren T, D'Hooge J, Deprest J. Automatic Extraction of Hiatal Dimensions in 3-D Transperineal Pelvic Ultrasound Recordings. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3470-3479. [PMID: 34538535 DOI: 10.1016/j.ultrasmedbio.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
The aims of this work were to create a robust automatic software tool for measurement of the levator hiatal area on transperineal ultrasound (TPUS) volumes and to measure the potential reduction in variability and time taken for analysis in a clinical setting. The proposed tool automatically detects the C-plane (i.e., the plane of minimal hiatal dimensions) from a 3-D TPUS volume and subsequently uses the extracted plane to automatically segment the levator hiatus, using a convolutional neural network. The automatic pipeline was tested using 73 representative TPUS volumes. Reference hiatal outlines were obtained manually by two experts and compared with the pipeline's automated outlines. The Hausdorff distance, area, a clinical quality score, C-plane angle and C-plane Euclidean distance were used to evaluate C-plane detection and quantify levator hiatus segmentation accuracy. A visual Turing test was created to compare the performance of the software with that of the expert, based on the visual assessment of C-plane and hiatal segmentation quality. The overall time taken to extract the hiatal area with both measurement methods (i.e., manual and automatic) was measured. Each metric was calculated both for computer-observer differences and for inter-and intra-observer differences. The automatic method gave results similar to those of the expert when determining the hiatal outline from a TPUS volume. Indeed, the hiatal area measured by the algorithm and by an expert were within the intra-observer variability. Similarly, the method identified the C-plane with an accuracy of 5.76 ± 5.06° and 6.46 ± 5.18 mm in comparison to the inter-observer variability of 9.39 ± 6.21° and 8.48 ± 6.62 mm. The visual Turing test suggested that the automatic method identified the C-plane position within the TPUS volume visually as well as the expert. The average time taken to identify the C-plane and segment the hiatal area manually was 2 min and 35 ± 17 s, compared with 35 ± 4 s for the automatic result. This study presents a method for automatically measuring the levator hiatal area using artificial intelligence-based methodologies whereby the C-plane within a TPUS volume is detected and subsequently traced for the levator hiatal outline. The proposed solution was determined to be accurate, relatively quick, robust and reliable and, importantly, to reduce time and expertise required for pelvic floor disorder assessment.
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Affiliation(s)
- Helena Williams
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven; School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
| | - Laura Cattani
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven; Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
| | - Dominique Van Schoubroeck
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven; Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
| | - Mohammad Yaqub
- Department of Computer Vision, Mohamed bin Zayed University of Artificial Intelligence, Abu Dhabi, United Arab Emirates
| | - Carole Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Jan D'Hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven; Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
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Wermuth DE, Sheridan A, Oliver J, Glanc P, Khatri G, Bagley A, Patel N. Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications. Ultrasound Q 2021; 37:237-243. [PMID: 34478421 DOI: 10.1097/ruq.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.
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Affiliation(s)
| | - Alison Sheridan
- Department of Radiology, University of Colorado School of Medicine
| | - Janine Oliver
- Urology & Urodynamics Clinic, University of Colorado Hospital, Aurora, CO
| | - Phyllis Glanc
- Department of Imaging, University of Toronto Sunnybrook Health Science Center, Toronto, ON
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Anjuli Bagley
- Department of Radiology, University of Colorado School of Medicine
| | - Nayana Patel
- Department of Radiology, University of Colorado School of Medicine
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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: 4.0] [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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Liu LN, Liu XN, Liu C, Yao MY, Xu HX. Transperineal pelvic floor ultrasound for analyzing the outcomes of pelvic floor surgery for the treatment of anterior compartment prolapse: A comparative study of transvaginal mesh and native-tissue repair. Low Urin Tract Symptoms 2021; 13:456-462. [PMID: 34101374 DOI: 10.1111/luts.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To compare the outcomes of transvaginal mesh (TVM) and native-tissue repair (NTR) for the repair of anterior compartment prolapse. METHODS This retrospective study involved 90 patients with anterior compartment prolapse who underwent pelvic organ prolapse surgery between January 2018 and October 2020. A TVM was used to treat 53 patients and 37 underwent NTR. All patients underwent a standardized interview, clinical examination, and four-dimensional pelvic floor ultrasound (PFUS) before and after the surgery. The primary outcome was anatomic recurrence evaluated by ultrasonic parameters. The secondary outcomes were subjective recurrence and complications. RESULTS Subjective recurrence was 9.43% (5/53) for TVM and 16.22% (6/37) for NTR (P = .522). Significant recurrence of prolapse on ultrasound occurred in five patients (9.43%) after TVM and 12 (32.43%) after NTR; there was a significant difference between the TVM and NTR groups (P = .006). In the TVM group, the mesh was visible on ultrasound in each patient. The mesh exposure rate was 1.89% (1/53). The postoperative hiatal area reduction in the TVM group, compared with the NTR group, was statistically significant (5.55 ± 4.71 cm2 vs 3.09 ± 5.61 cm2 , P = .027). The incidence of de novo stress urinary incontinence was higher in the TVM group (20.75% vs 2.70%, P = .03). After surgery, there were significant differences between the two groups based on bladder descent (12.02 ± 8.64 mm vs 22.41 ± 13.95 mm, P = .000) and urethral rotation angle (25.26 ± 13.92° vs 40.27 ± 23.72°, P = .001). CONCLUSION PFUS is effective for evaluating postoperative outcomes. TVM facilitates a better anatomic cure than NTR for anterior compartment prolapse.
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Affiliation(s)
- Lin-Na Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Xiu-Ni Liu
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Meng-Yan Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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García-Mejido J, Bonomi-Barby M, Armijo-Sánchez A, Borrero-Fernández C, Castro-Portillo L, Vargas-Broquetas M, Cañadas-Granados M, Sainz-Bueno J. Metodología para el estudio ecográfico transperineal del suelo pélvico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Karjalainen PK, Gillor M, Dietz HP. Predictors of occult stress urinary incontinence. Aust N Z J Obstet Gynaecol 2020; 61:263-269. [PMID: 33368207 DOI: 10.1111/ajo.13290] [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: 06/22/2020] [Revised: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Causes for occult stress urinary incontinence (SUI) are poorly recognised. AIMS To explore the mechanisms behind occult SUI. We hypothesised that cystocele type affects the risk of occult SUI. MATERIALS AND METHODS We conducted a retrospective, cross-sectional study on 878 consecutive women assessed at a tertiary urogynaecologic clinic between July 2016 and November 2018. The population of this study consisted of 424 women with urodynamic stress incontinence. Women with previous anti-incontinence surgery were excluded. All women underwent a standardised interview, clinical examination and urodynamic testing. Translabial ultrasound was used to categorise cystoceles into Green type II (cystocele with open retrovesical angle) and Green type III (cystocele with intact retrovesical angle). We compared women with overt SUI to those with occult SUI (defined as stress incontinence only observed after prolapse reduction) for demographic characteristics, urodynamic findings and functional anatomy. Predictors for occult SUI were identified with a multivariable logistic regression model. RESULTS Of 424 women, 362 (85%) had overt, and 62 (15%) occult SUI. There were 136 (32%) women who had a significant cystocele on imaging; 57 (42%) were classified as type II and 79 (58%) as type III. On multivariable regression, age and cystocele type were significantly associated with occult SUI. Odds for occult SUI was 10.9 times higher with type III (cystocele with an intact retrovesical angle) than with type II cystocele (cystocele with an open retrovesical angle; 95% CI 1.3-90.9). CONCLUSIONS Cystocele type affects the risk of occult SUI. Type III cystocele (intact retrovesical angle) associates with occult SUI.
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Affiliation(s)
- Päivi K Karjalainen
- Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Jyväskylä, Finland.,Pelvic Floor Unit, Monash Health, Melbourne, Australia
| | - Moshe Gillor
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Department of Obstetrics and Gynaecology, Kaplan Medical Centre, Rehovot, Israel
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Okeahialam NA, Thakar R, Sultan AH. Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI). Int Urogynecol J 2020; 32:1719-1726. [PMID: 33263781 PMCID: PMC8295136 DOI: 10.1007/s00192-020-04607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022]
Abstract
Introduction and hypothesis Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum. Conclusions Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.
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Affiliation(s)
- Nicola Adanna Okeahialam
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK
| | - Ranee Thakar
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK.,St George's, University of London, London, UK
| | - Abdul H Sultan
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK. .,St George's, University of London, London, UK.
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Duckett J, Thakar R, Shah V, Stephenson J, Balachandran A. The Use of Imaging for Synthetic Midurethral Slings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1497-1506. [PMID: 32125008 DOI: 10.1002/jum.15254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Ultrasound and magnetic resonance imaging can be used to image midurethral slings, which have may have complications such as pain. There is considerable misunderstanding regarding the utility of the different modalities. This article aims to review the current literature to identify the benefits and limitations of each imaging modality and identify the place that each should have for patients with midurethral sling complications. A literature search was performed, and all relevant articles were identified and reviewed. Different imaging modalities are complementary, but more research is required in this area.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynecology, Medway Maritime Hospital, Gillingham, Kent, England
| | - Ranee Thakar
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
| | - Vikas Shah
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - James Stephenson
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - Aswini Balachandran
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
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Cattani L, Van Schoubroeck D, Housmans S, Callewaert G, Werbrouck E, Verbakel JY, Deprest J. Exo-anal imaging of the anal sphincter: a comparison between introital and transperineal image acquisition. Int Urogynecol J 2019; 31:1107-1113. [PMID: 31802159 DOI: 10.1007/s00192-019-04122-5] [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: 07/09/2019] [Accepted: 09/05/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Three-dimensional exoanal ultrasound imaging of the anal sphincter may be obtained transperineally with a convex probe, or at the introitus with a transvaginal probe. We hypothesised that introital acquisition would yield better quality and more reproducible evaluation. METHODS We acquired three 3D volumes of the anal sphincter (one transperineal transverse with a 4- to 8-MHz convex probe and two introital with a 5- to 9-MHz probe in transverse and mid-sagittal view) in 20 representative women attending the gynaecology clinic. Each 3D dataset was anonymised and hence blinded for clinical data and for acquisition method. Images were analysed off-line by two expert specifically trained ultrasonographers in a random order to assess image quality, sphincter integrity and sphincteric measurements. We assessed the intra- and interrater agreement by the Cohen's kappa (κ) and by the intraclass correlation coefficient for categorical and continuous variables respectively. RESULTS The mid-sagittal introital acquisition had most inconclusive images owing to unsatisfactory quality, on which raters agreed (К = 0.80). Subsequently, agreement in the anal sphincter evaluation between transverse introital and transperineal acquisitions was compared. Agreement on internal anal sphincter gap was excellent for both transverse introital (К = 0.87) and transperineal acquisition (К = 0.93). Agreement on external anal sphincter discontinuity was excellent for the transperineal acquisition (К = 0.87) and good for the transverse introital acquisition (К = 0.73). Intra- and interrater agreement of external and internal anal sphincteric measurements were best for transperineal acquisitions. CONCLUSIONS In our hands, transperineal acquisition with a 4- to 8-MHz probe performed better than introital acquisition with a 5- to 9-MHz probe in the assessment of the anal sphincter complex.
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Affiliation(s)
- Laura Cattani
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Dominique Van Schoubroeck
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Susanne Housmans
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Geertje Callewaert
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Erika Werbrouck
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Deprest
- Department Development and Regeneration, Cluster Urogenital Surgery and Department of Gynaecology and Obstetrics, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, London, UK.
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Taithongchai A, Sultan AH, Wieczorek PA, Thakar R. Clinical application of 2D and 3D pelvic floor ultrasound of mid-urethral slings and vaginal wall mesh. Int Urogynecol J 2019; 30:1401-1411. [DOI: 10.1007/s00192-019-03973-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
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