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Sayed E, Mitwally A, Abdelmagied A, Fetih A, Fekry M. Transperineal Ultrasound Evaluation of Bladder Parameters in Patients with Apical Prolapse Undergoing Lateral Suspension or Sacropexy. J Obstet Gynaecol India 2024; 74:170-175. [PMID: 38707876 PMCID: PMC11065794 DOI: 10.1007/s13224-023-01912-2] [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: 03/24/2023] [Accepted: 11/14/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction and hypothesis.We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy. Methods We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits. Results In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling. Conclusion LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS. Clinical Trial Registration Clinical trial ID: NCT03772691.
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Affiliation(s)
- Ezzat Sayed
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Abubakr Mitwally
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Ahmed Abdelmagied
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Ahmed Fetih
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Mohamed Fekry
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
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Oktay C, Işık G. Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting: A Single-Center Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1327-1332. [PMID: 36478362 DOI: 10.1002/jum.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) is a frequent cause of admission to pediatric nephrology outpatient clinics. The aim of this study was to determine whether anatomical changes in lower urinary tract structures (retrovesical angulation [RVA] and bladder neck position [BNP]) are associated with UI in pediatric patients with daytime-wetting in comparison to healthy children. METHODS In this prospective study, patients with daytime UI diagnosed using the Dysfunctional Voiding Symptom Score of the International Children's Continence Society and 3-day-voiding/bowel diary were compared with an age- and sex-matched control group without incontinence. In addition to routine clinical evaluation, RVA and BNP were measured at rest using transabdominal ultrasound (TA-US). Intra-rater agreement was estimated. RESULTS A total of 88 children were included in the study, with 44 children (22 boys, 22 girls) each in patient and control groups. RVA was significantly greater and BNP was significantly lower in the patient group versus control group (RVA: 134.30 ± 10.05 vs 127.94 ± 13.15, P = .013; BNP: 11.88 ± 4.53 vs 17.20 ± 5.55, P < .001, respectively). Irrespective of the presence of incontinence, girls had a significantly greater RVA than boys (P < .001). However, there was no difference between sexes in BNP values (P = .630). Intra-rater agreement was very strong for RVA (P < .001, r = .897), and strong for BNP (P < .001, r = .774). CONCLUSIONS TA-US imaging is a non-invasive and practical procedure routinely performed in pediatric patients presenting with UI complaints. Our study demonstrated anatomical changes in lower urinary tract structures in pediatric patients with UI. These changes should be considered in the diagnosis, follow-up, and treatment of patients with UI.
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Affiliation(s)
- Cemil Oktay
- Department of Radiology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Güneş Işık
- Department of Pediatric Nephrology, Adıyaman University Medical Faculty, Adıyaman, Turkey
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Barakat B, Gauger U, Rehme C, Hadaschik B, Wolff I, Hijazi S. Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study). Int Urogynecol J 2023; 34:563-569. [PMID: 36098788 DOI: 10.1007/s00192-022-05340-0] [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: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate the sensitivity and specificity of pelvic floor ultrasound (PFUS) in the diagnostic work-up of female urethral diverticulum (UD) and to compare results of PFUS with voiding cystourethrogram (VCUG). METHODS We retrospectively reviewed our database of patients, who received VCUG and PFUS for the diagnosis of UD. A total of 196 consecutive female patients with a minimum of one symptom, such as a lower urinary tract symptom (LUTS), postmicturition dribble, dyspareunia and recurrent urinary tract infection (UTI) who underwent initial diagnostics with VCUG and PFUS were selected. Diagnostic performance of both procedures, which included size, complexity, echogenicity. and content were compared. RESULTS Recurrent UTI and LUTS were the most common symptoms, which were present in 165 (84%) and 163 patients (83%) respectively. Final diagnosis of UD was based on PFUS and VCUG findings in 69 (35%) and 58 (30%) cases respectively. Based on our study cohort, the sensitivity of PFUS in detecting UD was significantly higher than that of VCUG: 94% (IQR: 89-97) versus 78% (IQR: 73-85, p<0.01), with a trend toward higher specificity: 100% (IQR: 94-100) versus 84% (IQR: 78-84, p=0.05). Enabling direct UD visualisation, PFUS was associated with a positive predictive value (PPV) of 100% (IQR: 97-100) and a negative predictive value (NPV) of 88% (IQR: 78-95), whereas VCUG had an inferior accuracy with a PPV of 84 (IQR: 80-84) and a NPV of 68 (IQR: 62-79). CONCLUSIONS In clinical practice, VCUG has a lower sensitivity than PFUS. Based on these results, we recommend the usage of dynamic PFUS as part of a non-invasive work-up.
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Hoserkirchweg 63, 41747, Viersen, Germany.
| | | | - Christian Rehme
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
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Lamberg H, Shankar PR, Singh K, Caoili EM, George AK, Hackett C, Johnson A, Davenport MS. Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy. Radiology 2022; 303:99-109. [PMID: 35040671 PMCID: PMC8962824 DOI: 10.1148/radiol.210500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Urinary continence after radical prostatectomy (RP) is an important determinant of patient quality of life. Anatomic measures at prostate MRI have been previously associated with continence outcomes, but their predictive ability and interrater agreement are unclear in comprehensive clinical models. Purpose To evaluate the predictive ability and interrater agreement of MRI-based anatomic measurements of post-RP continence when combined with clinical multivariable models. Materials and Methods In this retrospective cohort study, continence outcomes were evaluated in men who underwent RP from August 2015 to October 2019. Preoperative MRI-based anatomic measures were obtained retrospectively by four abdominal radiologists. Before participation, these radiologists completed measure-specific training. Logistic regression models were developed with clinical variables alone, MRI variables alone, and combined variables for predicting continence at 3, 6, and 12 months after RP; some patient data were missing at each time point. Interrater agreement of MRI variables was assessed by using intraclass correlation coefficients (ICCs). Results A total of 586 men were included (mean age ± standard deviation: 63 years ± 7). The proportion of patients with incontinence was 0.2% (one of 589) at baseline, 27% (145 of 529) at 3 months, 14% (63 of 465) at 6 months, and 9% (37 of 425) at 12 months. Longer coronal membranous urethra length (MUL) improved the odds of post-RP continence at all time points (odds ratio per 1 mm: 0.86 [95% CI: 0.80, 0.93], P < .001; 0.86 [95% CI: 0.78, 0.95], P = .003; and 0.79 [95% CI: 0.67, 0.91], P = .002, respectively) in models that incorporated both clinical and MRI predictors. No other MRI variables were predictive. Age and baseline urinary function score were the only other predictive clinical variables at every time point. Interrater agreement was moderate (ICC, 0.62) for MUL among readers with measure-specific prostate MRI training and poor among those without the training (ICC, 0.38). Conclusion Preoperative MRI-measured coronal membranous urethra length was an independent predictor of urinary continence after prostatectomy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Hannah Lamberg
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Prasad R. Shankar
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Karandeep Singh
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Elaine M. Caoili
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Arvin K. George
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Caitlin Hackett
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Anna Johnson
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Matthew S. Davenport
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
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Leombroni M, Buca D, Liberati M, Falò E, Rizzo G, Khalil A, Manzoli L, Flacco ME, Santarelli A, Makatsariya A, Frondaroli F, D'Antonio F. Post-partum pelvic floor dysfunction assessed on 3D rotational ultrasound: a prospective study on women with first- and second-degree perineal tears and episiotomy. J Matern Fetal Neonatal Med 2021; 34:445-455. [PMID: 31291792 DOI: 10.1080/14767058.2019.1609932] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To evaluate the morphology and biometry of pelvic floor structures 3 months after birth in women experiencing first- or second-degree perineal tears or undergoing episiotomy during labor.Material and methods: Prospective observational study including nulliparous women delivering at term with a clinical diagnosis of first- or second-degree perineal tears after birth or undergoing episiotomy. The role of Kristeller maneuver during labor in affecting pelvic structure and function is also explored. All women underwent 2D trans-perineal and 3D endovaginal or endoanal ultrasound 3 months after birth.Results: 115 women assessed 3 months after delivery were enrolled in the study. Compared with controls, women who experienced first-degree perineal tears had higher bladder neck-symphysis (versus 20.9 ± 4.9 versus 16.1 ± 4.9 mm, p = .017), bladder wall-pubic symphysis (22.4 ± 7.4 versus 14.2 ± 9.5 mm, p = .02) and anorectal angle-symphysis distance (12.5 ± 4.7 versus 9.3 ± 4.3 mm, p = .018). Furthermore, they have thicker internal and external anal sphincter. The incidence of partial right and left pubo-rectalis muscle avulsion was higher in women experiencing first-degree vaginal tear during labor (16.2 versus 0%, p = .004 for both). In women affected by second-degree tears, the occurrence of partial avulsion of the right and left pubo-rectalis muscle was 16.2%, while Oasis was detected in 10.8% of the cases. Women receiving Kristeller maneuver during labor had a higher incidence of either right or left puborectalis muscle avulsion.Conclusion: Women who had either first- and second-degree perineal tears or episiotomy show signs of abnormal pelvic morphometry on 3D rotational ultrasound 3 months after birth.
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Affiliation(s)
- Martina Leombroni
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Eleonora Falò
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Maternal Fetal Medicine, Ospedale Cristo Re Roma, University of Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Asma Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St. George's University of London, London, UK
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Alexander Makatsariya
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Franco Frondaroli
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Women´s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Sciences, Women'S Health and Perinatology Research Group, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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Clinical relevance of routine transvaginal ultrasound in women referred with pelvic organ prolapse. BMC WOMENS HEALTH 2021; 21:26. [PMID: 33441123 PMCID: PMC7805096 DOI: 10.1186/s12905-021-01173-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Background The aim of this study was to investigate the prevalence of incidental findings on transvaginal ultrasound scan in women referred with pelvic organ prolapse by a general practitioner and to investigate which further examinations and treatments were performed as a result of these findings. Methods This was a retrospective cohort study that investigated women with pelvic organ prolapse referred to the outpatient urogynaecological clinics at Randers Regional Hospital and Aarhus University Hospital, Denmark. Results A total of 521 women were included and all of them were examined with a routine transvaginal ultrasound scan and a gynaecological examination. Prolapse symptoms only and no specific indication for transvaginal ultrasound scan were seen in 507 women (97.3%), while 14 women (2.7%) received scans on indication. Among the latter women, five (35.7%) had cancer. In the women with solely prolapse symptoms, 59 (11.6%) had incidental findings on transvaginal ultrasound scan, but all were benign. However, two patients were later diagnosed with cancer unrelated to the initial ultrasound findings. The treatment was extended with further examinations not related to POP in 19 of the women (32.2%) with incidental ultrasound findings. Conclusion The prevalence of incidental ultrasound findings was not high in the women referred with pelvic organ prolapse and no additional symptoms, and all these findings were benign. However, it should be considered that these findings resulted in further investigations and changes to the patients’ initial treatment plans. A meticulous anamnesis and digital vaginal examination are crucial to rule out the need for vaginal ultrasound.
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Abstract
Pelvic floor disorders (PFDs) are a common and complex problem encompassing a broad spectrum of conditions such as urinary incontinence, voiding difficulties, pelvic organ prolapse, anal incontinence, and chronic pelvic pain. The initial assessment of women with PFDs is based on a detailed and focused history and a holistic clinical evaluation of the pelvic floor. Other investigations may be used in clinical practice for the determination of the pathophysiology and the severity of the PFDs. In the field of urogynecology, urodynamic studies, ultrasound, and magnetic resonance imaging of the pelvic floor are currently implemented in the diagnostic work-up of women with PFDs. These provide valuable information not only on the anatomic integrity but also on the function of the pelvic floor which may not be apparent from the clinical examination. The provision of such information is complementary to the patient's symptoms and degree of bother and enables the implementation of a targeted treatment plan, thus maximizing the likelihood of cure and minimizing the risk of treatment complications.
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Affiliation(s)
- T Grigoriadis
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
| | - S Athanasiou
- a Urogynecology Department , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
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Ultrasound imaging in urogynecology - state of the art 2016. MENOPAUSE REVIEW 2016; 15:123-132. [PMID: 27980522 PMCID: PMC5137478 DOI: 10.5114/pm.2016.63060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 01/03/2023]
Abstract
The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.
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Kociszewski J, Fabian G, Grothey S, Kuszka A, Zwierzchowska A, Majkusiak W, Barcz E. Are complications of stress urinary incontinence surgery procedures associated with the position of the sling? Int J Urol 2016; 24:145-150. [DOI: 10.1111/iju.13262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/30/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Jacek Kociszewski
- Department of Gynecology and Obstetrics; Evangelical Hospital Hagen-Haspe; Hagen Germany
| | - George Fabian
- Department of Gynecology and Obstetrics; Evangelical Hospital Hagen-Haspe; Hagen Germany
| | - Susanne Grothey
- Department of Gynecology and Obstetrics; Evangelical Hospital Hagen-Haspe; Hagen Germany
| | - Andrzej Kuszka
- Department of Gynecology and Obstetrics; Evangelical Hospital Hagen-Haspe; Hagen Germany
| | - Aneta Zwierzchowska
- 1st Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | - Wojciech Majkusiak
- 1st Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | - Ewa Barcz
- 1st Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
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Albrich SB, Welker K, Wolpert B, Steetskamp J, Porta S, Hasenburg A, Skala C. How common is ballooning? Hiatal area on 3D transperineal ultrasound in urogynecological patients and its association with lower urinary tract symptoms. Arch Gynecol Obstet 2016; 295:103-109. [DOI: 10.1007/s00404-016-4200-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/06/2016] [Indexed: 12/01/2022]
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Osman NI, Li Marzi V, Cornu JN, Drake MJ. Evaluation and Classification of Stress Urinary Incontinence: Current Concepts and Future Directions. Eur Urol Focus 2016; 2:238-244. [PMID: 28723369 DOI: 10.1016/j.euf.2016.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/01/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Stress urinary incontinence (SUI) is a common and bothersome problem that frequently requires operative management. Over the past two decades, novel techniques have been introduced into clinical practice. With the greater variety of surgical options now available, there is an increasing focus on selecting the appropriate procedure for the individual patient based on the likely underlying pathophysiologic mechanism. OBJECTIVE To review the methods used in the evaluation of SUI and the proposed classification systems. EVIDENCE ACQUISITION A search of the PubMed database for the relevant search terms was conducted, and selected articles were retrieved and reviewed. EVIDENCE SYNTHESIS Standardised terminology for the description of SUI has been produced by the International Continence Society describing the problem in terms of symptoms, clinical signs, and urodynamic observations. The two major pathophysiologic theories that have emerged over the past 50 yr, urethral hypermobility and intrinsic sphincteric deficiency, have influenced the development and adoption of surgical techniques. It is now recognised that these two entities are not dichotomous but often coexist. The primary aim of the evaluation of the patient presenting with SUI is to confirm the diagnosis and assess symptom severity before instituting conservative treatments. Secondary evaluation consists of more sophisticated techniques that assess anatomy of the bladder neck and urethra under rest and stress (eg, videourodynamics, ultrasound) or direct or indirect physiologic measures of the integrity of the sphincter mechanism. CONCLUSIONS Classification of patients with SUI into distinct groups based on probable pathophysiologic mechanism could help guide the choice of surgical procedure, but current systems are likely too simplistic, and methods of assessment lack standardisation in techniques and sensitivity. PATIENT SUMMARY Urinary leakage on exertion, termed stress incontinence, is a common problem that affects many women. There is a need to develop better ways of categorising the underlying causes of leakage to ensure that patients receive the optimal treatments.
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Affiliation(s)
| | | | - Jean N Cornu
- Department of Urology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Marcus J Drake
- School of Clinical Sciences, University of Bristol, Bristol, UK
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Lo TS, Cortes EFM, Wu PY, Tan YL, Al-Kharabsheh A, Pue LB. Assessment of collagen versus non collagen coated anterior vaginal mesh in pelvic reconstructive surgery: prospective study. Eur J Obstet Gynecol Reprod Biol 2016; 198:138-144. [DOI: 10.1016/j.ejogrb.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 11/25/2015] [Accepted: 01/01/2016] [Indexed: 11/26/2022]
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de Tayrac R, Haylen B, Deffieux X, Hermieu J, Wagner L, Amarenco G, Labat J, Leroi A, Billecocq S, Letouzey V, Fatton B. Traduction française de la terminologie commune International Urogynecological Association (IUGA)/International Continence Society (ICS) sur les troubles de la statique pelvienne chez la femme initialement publiée dans Int Urogynecol J 2010;21(1):5–26. Prog Urol 2016; 26:197-225. [DOI: 10.1016/j.purol.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
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Lone F, Sultan AH, Stankiewicz A, Thakar R. Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy. Br J Radiol 2016; 89:20150704. [PMID: 26800394 DOI: 10.1259/bjr.20150704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. METHODS Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. RESULTS 158 females had PFUS assessment. Good-to-excellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. CONCLUSION Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. ADVANCES IN KNOWLEDGE We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.
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Affiliation(s)
- Farah Lone
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London, UK
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London, UK
| | | | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London, UK
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Wang XM, Chang X, Ding Y, Wang SZ, Zhen Y, Ding JX, Kong FB. Translabial three-dimensional ultrasound investigation of the levator hiatus in postpartum women. J Med Ultrason (2001) 2015; 42:373-8. [PMID: 26576789 DOI: 10.1007/s10396-014-0609-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE This study utilized translabial three-dimensional ultrasound to investigate the morphological characteristics of the levator hiatus and provide sonographic evidence for assessing pelvic floor dysfunction in postpartum women. METHODS Two-hundred and one singleton primiparae without any complications underwent translabial three-dimensional ultrasound at 6 and 18 weeks after delivery, with 12 participants lost to follow-up at 18 weeks. Fifty nulliparae were enrolled as the control group. Levator hiatal morphology at rest and on Valsalva maneuver was assessed by experienced sonographers, specifically evaluating the anteroposterior diameter, left-to-right diameter, and area. RESULTS In postpartum women at 6 weeks after delivery, all the levator hiatal parameters were significantly higher compared with those of the control group. At 18 weeks, the hiatal parameters were better than at 6 weeks but still higher than in the nulliparous controls. In all three groups, the hiatal parameters were significantly higher during the Valsalva maneuver than at rest. CONCLUSIONS Postpartum women are prone to develop pelvic floor dysfunction as shown by an enlarged levator hiatus. Translabial three-dimensional ultrasound can be used to effectively assess the morphology and structural alterations of the levator hiatus in postpartum women, providing reliable pelvic floor imaging for early screening, diagnosis, and prevention of pelvic floor dysfunction.
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Affiliation(s)
- Xue-Mei Wang
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xin Chang
- Huai'an First People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Su-Zhen Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yin Zhen
- Huai'an First People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Jing-Xin Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fan-Bin Kong
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Complications following Tension-Free Vaginal Tapes: Accurate Diagnosis and Complications Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:538391. [PMID: 25973423 PMCID: PMC4418011 DOI: 10.1155/2015/538391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
The sling procedures are the gold standard for SUI treatment. They are highly effective but not free from complications. The most common adverse effect for the surgery with the implant insertion is: overactive bladder occurring de novo after the surgery, voiding dysfunctions, urine retention, and unsatisfactory treatment outcome. The most important question that arises after 20 years of sling procedures is how to manage the complications and what can be offered to complicated patients. The above review summarises the ultrasound findings in complicated cases and shows the scheme of management of the clinical problems concerning the tape location in suburethral region.
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Minagawa T, Ogawa T, Ishizuka O, Nishizawa O. Impact of Dynamic Transrectal Ultrasonography on Pelvic Organ Prolapse. J Urol 2015; 193:670-6. [PMID: 25219698 DOI: 10.1016/j.juro.2014.06.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Tomonori Minagawa
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
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Albrich S, Rommens K, Steetskamp J, Weyer V, Hoffmann G, Skala C, Zahn E. Prevalence of Levator Ani Defects in Urogynecological Patients. Geburtshilfe Frauenheilkd 2015; 75:51-55. [PMID: 27635090 PMCID: PMC5019347 DOI: 10.1055/s-0034-1396180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 11/02/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: Defects of the levator ani muscle complex could represent a pathophysiological link between vaginal birth trauma and urogynecological symptoms many years later. The aim of our study was to determine the prevalence of levator ani muscle defects using 3D or 4D ultrasound and palpation in urogynecological patients. Material and Methods: Urogynecological patients were retrospectively investigated using 3D or 4D ultrasound. Clinical examination consisted of palpation and 3D or 4D imaging of the levator ani muscle. Results: A total of 319 women were included in the analysis. Mean age was 64.9 years, average parity was 2.1. Stress incontinence was present in 50.8 %, overactive bladder symptoms in 69.3 % and pelvic organ prolapse in 42.3 % of patients. A levator ani defect was found on ultrasound in 76 patients (23.8 %) and on palpation in 64 women (20.0 %). In the group of patients with pelvic organ prolapse, levator ani defects were found in 32.6 % of patients using ultrasound and in 26.7 % of patients using palpation. The odds ratio (OR) for levator ani defects in women with pelvic organ prolapse was 2.3 (95 % CI [CI: confidence interval]: 1.36-3.88], p = 0.002). Conclusion: In a cohort of urogynecological patients seen at a tertiary urogynecological unit, the prevalence of levator ani defects was significantly higher in women with pelvic organ prolapse compared to women with stress incontinence or urge symptoms.
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Affiliation(s)
- S. Albrich
- Johannes-Gutenberg-University Mainz, Department of Obstetrics and
Gynecology, Mainz
| | - K. Rommens
- Johannes-Gutenberg-University Mainz, Department of Obstetrics and
Gynecology, Mainz
| | - J. Steetskamp
- Johannes-Gutenberg-University Mainz, Department of Obstetrics and
Gynecology, Mainz
| | - V. Weyer
- Johannes-Gutenberg-University Mainz, Institute of Medical Biostatistics,
Epidemiology and Informatics (IMBEI), Mainz
| | - G. Hoffmann
- Johannes-Gutenberg-University Mainz, Department of Obstetrics and
Gynecology, Mainz
| | - C. Skala
- Johannes-Gutenberg-University Mainz, Department of Obstetrics and
Gynecology, Mainz
| | - E. Zahn
- Klinikum Kempten, Obstetrics and Gynecology, Kempten
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Cruz DSLDC, D’Ancona CAL, Baracat J, Alves MAD, Cartapatti M, Damião R. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy. Int Braz J Urol 2014; 40:596-604. [DOI: 10.1590/s1677-5538.ibju.2014.05.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022] Open
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Viereck V, Kuszka A, Rautenberg O, Wlaźlak E, Surkont G, Hilgers R, Eberhard J, Kociszewski J. Do different vaginal tapes need different suburethral incisions? The one-half rule. Neurourol Urodyn 2014; 34:741-6. [DOI: 10.1002/nau.22658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Volker Viereck
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
- Department of Obstetrics and Gynecology; Georg August University Goettingen; Germany
| | - Andrzej Kuszka
- Department of Obstetrics and Gynecology; Lutheran Hospital Hagen-Haspe; Germany
| | - Oliver Rautenberg
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
| | - Edyta Wlaźlak
- Department of Obstetrics and Gynecology; Medical University of Lodz; Lodz Poland
| | - Grzegorz Surkont
- Department of Obstetrics and Gynecology; Medical University of Lodz; Lodz Poland
| | - Reinhard Hilgers
- Institute of Medical Statistics; Georg August University; Goettingen Germany
| | - Jakob Eberhard
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
| | - Jacek Kociszewski
- Department of Obstetrics and Gynecology; Lutheran Hospital Hagen-Haspe; Germany
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Lone F, Sultan AH, Stankiewicz A, Thakar R. The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study. Br J Radiol 2014; 87:20140145. [PMID: 24959953 DOI: 10.1259/bjr.20140145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies. METHODS Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently. RESULTS 158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition. CONCLUSION Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS. ADVANCES IN KNOWLEDGE PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.
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Affiliation(s)
- F Lone
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London, UK
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Lo TS, Tan YL, Khanuengkitkong S, Dass AK, Cortes EFM, Wu PY. Assessment of collagen-coated anterior mesh through morphology and clinical outcomes in pelvic reconstructive surgery for pelvic organ prolapse. J Minim Invasive Gynecol 2014; 21:753-61. [PMID: 24607796 DOI: 10.1016/j.jmig.2014.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse. DESIGN Evidence obtained from several timed series with intervention (Canadian Task Force classification II-3). SETTING Chang Gung Memorial Hospital, Taoyuan, Taiwan, China. PATIENTS Between April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System). INTERVENTION Anterior armed transobturator collagen-coated mesh. MEASUREMENT AND MAIN RESULTS Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01). CONCLUSIONS Ultrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China.
| | - Yiap Loong Tan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Siwatchaya Khanuengkitkong
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Anil Krishna Dass
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; Penang Hospital, Penang, Malaysia
| | - Eileen Feliz M Cortes
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China; De La Salle University Medical Center, Dasmariñas Cavite, Philippines
| | - Pei-Ying Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan, China
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Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair: reply to comment by Jacquetin. Int Urogynecol J 2014; 25:705. [PMID: 24566494 PMCID: PMC3997828 DOI: 10.1007/s00192-014-2334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Torella M, De Franciscis P, Russo C, Gallo P, Grimaldi A, Ambrosio D, Colacurci N, Schettino MT. Stress urinary incontinence: usefulness of perineal ultrasound. Radiol Med 2014; 119:189-94. [DOI: 10.1007/s11547-013-0317-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022]
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Soljanik I, Bauer RM, Becker AJ, Stief CG, Gozzi C, Solyanik O, Brocker KA, Kirchhoff SM. Is a wider angle of the membranous urethra associated with incontinence after radical prostatectomy? World J Urol 2014; 32:1375-83. [PMID: 24452450 DOI: 10.1007/s00345-014-1241-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/10/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate whether differences in the anatomy and dynamics of the pelvic floor (PF) in patients after radical prostatectomy (RP) depicted on magnetic resonance imaging (MRI) are associated with continence status. METHODS In the prospective designed study, 24 patients with post-prostatectomy stress urinary incontinence were enrolled. Additionally, 10 continent patients after RP were matched for age, body mass index and perioperative parameters. All patients underwent continence assessment and MRI (TrueFISP sequence; TR 4.57 ms; TE 2.29 ms; slice thickness 7 mm; FOV 270 mm) 12 months after RP. Images were analyzed for membranous urethra length (MUL), angle of the membranous urethra (AMU), severity of periurethral/urethral fibrosis, lifting of the levator ani muscle, lowering of the posterior bladder wall (BPW), bladder neck (BN) and external urinary sphincter (EUS), and symphyseal rotation of these structures during the Valsalva maneuver and voiding. RESULTS Compared to continent controls, incontinent patients showed a significant wider AMU during voiding (p = 0.002) and more pronounced lowering of the BN and EUS (p < 0.001). No differences between the groups were found in symphyseal rotation of the analyzed structures, MUL and severity of periurethral/urethral fibrosis. CONCLUSIONS The angle of the membranous urethra as a result of anchoring of the BN and EUS in the PF appears to be an important functional factor with an essential impact on continence after RP. Functional MRI seems to be a helpful imaging tool for morphologic and dynamic evaluation of the PF.
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Affiliation(s)
- Irina Soljanik
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany,
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Translabial ultrasonography for evaluation of synthetic mesh in the vagina. Urology 2013; 83:68-74. [PMID: 24231215 DOI: 10.1016/j.urology.2013.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the clinical and surgical findings using translabial ultrasonography (US) in the evaluation of symptoms after transvaginal synthetic mesh placement. METHODS From 2009 through 2010, a retrospective observational study was conducted to evaluate patients presenting with complaints after transvaginal mesh implantation for the treatment of stress urinary incontinence or pelvic organ prolapse repair. The clinical and translabial US findings were compared with the intraoperative findings, with a focus on mesh location, erosion, and extrusion. RESULTS A total of 51 consecutive patients (mean age 59 years) were evaluated by history and physical examination, translabial US, and intraoperative findings. Using intraoperative findings as the reference standard, translabial US was able to predict the location of the sling in relationship to the urethra (6 distal, 25 mid-urethral, and 20 at the bladder neck), to differentiate between transobturator (n = 21) and retropubic (n = 30) slings, and to detect all anterior (n = 21) and posterior (n = 15) placed mesh. Translabial US was superior to physical examination in identifying mesh erosion into the periurethral fascia or sphincteric unit. US was inferior to physical examination in diagnosing vaginal extrusion but was superior for locating the mesh. CONCLUSION Translabial US can identify the mesh material used to treat stress urinary incontinence and pelvic organ prolapse. It provides additional information on sling type, mesh location, and morphology compared with the clinical findings and could help in surgical planning and counseling. Prospective clinical studies evaluating the reliability of this technique in larger patient populations are warranted.
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Duckett J, Chakani D. The effect of prolapse repair on urinary flow rates and the relationship to changes in the ultrasound appearance of the bladder neck. Eur J Obstet Gynecol Reprod Biol 2013; 171:372-5. [PMID: 24128924 DOI: 10.1016/j.ejogrb.2013.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/27/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess whether specific changes in bladder neck morphology, caused by an anterior repair operation, are associated with resolution of overactive bladder and improved urinary flow rates. STUDY DESIGN Sixty-four women with urgency documented on the urgency perception scale (UPS) underwent an anterior repair. Their preoperative flow studies were compared to those 8 weeks postoperatively. Flow rates were compared in those women who reported improved or cured urgency to those who reported no effect. Resolution of urgency was correlated with the change in bladder neck angulation (posterior urethrovesical angle-PUA). RESULTS 55% (35/64) women reported no urgency after the anterior repair. A further 19% (12/64) were improved and 26% (17/64) were no better. Patients who were cured or improved showed a significant increase in their flow rates after surgery (mean flow=15 before and 17.6 ml/s after) (Mann-Whitney p=0.04). There was a significant change (increase in the PUA angle/straightening of the angle between the bladder and urethra) from a mean value of 123 degrees (SD 49.3) preoperatively to a mean value of 146.8 (SD 29.2) post operatively (p<0.001). Despite an increase in PUA, this was not correlated with an increase in the maximum flow rate centile (p=0.45, r=0.10). CONCLUSIONS An anterior repair results in increased maximum urinary flow rates but this does not correlate to changes in the appearance of the bladder neck.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynaecology, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent ME5 7NY, UK.
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Rogowski A, Bienkowski P, Tosiak A, Jerzak M, Mierzejewski P, Baranowski W. Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair. Int Urogynecol J 2013; 24:2087-92. [PMID: 23749240 DOI: 10.1007/s00192-013-2131-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/14/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was to determine possible correlations between mesh retraction after anterior vaginal mesh repair and de novo stress urinary incontinence (SUI), overactive bladder (OAB), and vaginal pain symptoms. METHODS One hundred and three women with symptomatic prolapse of the anterior vaginal wall, stages 3 and 4 based on the Pelvic Organ Prolapse Quantification (POP-Q) system, underwent Prolift anterior™ implantation. At a 6-month follow-up, the patients were interviewed for de novo SUI, OAB, and vaginal pain, and underwent an introital/transvaginal ultrasound examination to measure the mesh length in the midsagittal plane. RESULTS Mesh retraction was significantly larger in a subgroup of patients (n = 20; 19.4 %) presenting de novo OAB symptoms on the follow-up assessment compared with those without this complication (5.0 cm vs. 4.3 cm; p < 0.05). Mesh retraction was also significantly larger in a subgroup of patients (n = 23; 22.3 %) reporting postoperative vaginal pain compared with the women who did not report any postoperative vaginal pain (5.3 cm vs. 4.2 cm; p < 0.01). A significant correlation was found between mesh retraction and the severity of vaginal pain (R = 0.4, p < 0.01). Mesh retraction did not differ between patients with de novo SUI symptoms and those without this complication. CONCLUSIONS Mesh retraction assessed on ultrasound examination after anterior vaginal mesh repair may correlate with de novo OAB symptoms and vaginal pain.
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Affiliation(s)
- A Rogowski
- Department of Gynecology and Oncological Gynecology, Military Institute of Medicine, 128 Szaserow Street, 04-141, Warsaw, Poland,
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Mousty E, Huberlant S, Pouget O, Mares P, de Tayrac R, Letouzey V. Prospective ultrasonographic follow-up of synthetic mesh in cohort of patients after vaginal repair of cystocele. Prog Urol 2013; 23:530-7. [PMID: 23725584 DOI: 10.1016/j.purol.2013.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/19/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to validate a sequence of ultrasonographic mesh measurements to determine the relevant time points in the postoperative monitoring of mesh size. METHODS Mesh was measured preoperatively ex vivo, prior to insertion, in 25 patients scheduled to undergo vaginal repair of cystocele involving insertion of a Ugytex™ transobturating polypropylene mesh. A 2D/3D perineal ultrasound scan was performed at the end of the surgical procedure (D0), then on third day after surgery (D3) and 6 weeks (W6) after the operation. Medio-sagittal view was used to measure mesh total length and the sagittal arc (length between the most distant points of the mesh). RESULTS Time-course changes in sagittal arc were marked by a 8% increase on D3 (with respect to D0) and a 20% decrease at W6 (with respect to D3). Mesh total length at W6 on average corresponded to 74% (±20) of mesh total length measured on D3. CONCLUSION This study showed the changes in the mesh ultrasonographic measurements following vaginal placement by vaginal route. The D3 ultrasound scan should appear to be suitable as a reference for subsequent ultrasonographic monitoring.
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Affiliation(s)
- E Mousty
- Service de gynécologie-obstétrique, CHU de Montpellier 1, place Professeur-Robert-Debré, 30000 Nîmes, France.
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Stellenwert der Sonographie bei der Diagnostik von Funktionsstörungen des weiblichen Beckenbodens. Urologe A 2013; 52:533-40. [PMID: 23483273 DOI: 10.1007/s00120-013-3143-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lone F, Thakar R, Sultan AH, Stankiewicz A. Prospective evaluation of change in levator hiatus dimensions using 3D endovaginal ultrasound before and 1 year after treatment for female pelvic organ prolapse. Int Urogynecol J 2012; 24:1287-93. [PMID: 23052628 DOI: 10.1007/s00192-012-1938-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/20/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to determine the change in levator hiatal (LH) dimensions using 3D high-frequency endovaginal ultrasound (EVUS) before and 1 year after treatment for pelvic organ prolapse (POP). METHODS Women with prolapse attending the urogynecology clinic between July and October 2009 were recruited. EVUS was performed using multifrequency (9-16 MHz) 360° rotational probe with a built-in 3D automatic acquisition system (Type 2052, ProFocus Ultra view, B-K Medical, Herlev, Denmark). The levator hiatal dimensions that were measured comprised anteroposterior (AP), left-to-right width, and area. Patients were followed up at 1 year, when EVUS was repeated. RESULTS Eighty-nine women had symptomatic prolapse. Of these, 43 opted for surgery and 46 for nonsurgical treatment. Levator hiatal dimensions decreased in AP, width, and area at 12 months after surgery compared with baseline (p <0.05). However, there was no change in any of the dimensions after nonsurgical treatment. CONCLUSION In contrast to conservative management, there is a significant decrease in levator hiatal dimensions 12 months following surgery for POP.
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Affiliation(s)
- Farah Lone
- Department of Obstetrics and Gynecology, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, Surrey, UK
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Duckett J, Lautmann K. Ultrasound changes in the relationship between the urethra and bladder neck caused by prolapse repair: feasibility and reliability of measurements. J OBSTET GYNAECOL 2012; 32:672-5. [PMID: 22943715 DOI: 10.3109/01443615.2012.711390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to assess whether intraoperative transperineal ultrasound can be used to assess changes in the relationship between the urethra and bladder caused by a prolapse repair operation. The reliability of the measurements was also assessed. A total of 25 women having an anterior colporrhaphy operation had pre- and post-repair imaging using a standard bladder volume. There was a statistically significant change (p ≤ 0.04) in the posterior urethrovesical angle (PUA) from 115° (SD 37) before surgery, to 135° (SD 30) after surgery. There was no significant change (p = 0.93) in the anterior urethrovesical angle before 73° (SD 14) after surgery 73° (SD 14). Interclass correlation coefficients showed good reproducibility for all measurements. Ultrasound can be used to measure changes in the relationship of the urethra and bladder produced by anterior colporrhaphy. Clinically, the effect of these changes is to reduce the angulation of the urethra in relation to the bladder.
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Affiliation(s)
- J Duckett
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, UK.
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Midurethral sling incision: indications and outcomes. Int Urogynecol J 2012; 24:645-53. [PMID: 22875405 PMCID: PMC3606519 DOI: 10.1007/s00192-012-1895-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 07/08/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Controversy continues over the effectiveness of sling incision, which is the most common operative approach to treating complications following suburethral sling insertion. This retrospective analysis assessed the indications for sling incision and patient outcomes regarding resolution of complications and stress urinary incontinence. METHODS A review was conducted of the medical records of women who underwent sling incision between 2003 and 2010. Data such as surgical indications, ultrasound findings and medical outcomes were extracted from 198 records, and descriptive and inferential statistical methods of analysis were used. RESULTS In the 198 patients eligible for study inclusion, the primary reasons for sling incision were overactive bladder (68 %), voiding dysfunction (61 %), and recurrent urinary tract infections (53 %). Additional complications included dyspareunia (18 %), chronic pelvic pain (17 %), and sling exposure (15 %). Sling incision led to immediate postoperative cure of voiding dysfunction in 97 % of patients. Cure rates for overactive bladder and dyspareunia were 60 % and 94 % respectively. Chronic pelvic pain was resolved in 82 % of cases and all cases of sling exposure were cured. Eighty-five (61 %) of the 140 patients who were continent before sling incision developed recurrent stress urinary incontinence (SUI) postoperatively. CONCLUSIONS These findings indicate that sling incision can be highly successful in improving voiding dysfunction and dyspareunia, and moderately successful in curing overactive bladder and chronic pain. However, SUI may recur in more than 60 % of the patients undergoing sling incision. Consequently, patients being considered for a sling incision procedure should be informed about this possible complication.
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Accuracy of assessing Pelvic Organ Prolapse Quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse. Int Urogynecol J 2012; 23:1555-60. [DOI: 10.1007/s00192-012-1779-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/25/2012] [Indexed: 12/31/2022]
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Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:372-383. [PMID: 22190408 DOI: 10.1002/uog.11080] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Levator ani muscle (LAM) injuries occur in 13-36% of women who have a vaginal delivery. Although these injuries were first described using magnetic resonance imaging, three-dimensional transperineal and endovaginal ultrasound has emerged as a more readily available and economic alternative to identify LAM morphology. Injury to the LAM is attributed to vaginal delivery resulting in reduced pelvic floor muscle strength, enlargement of the vaginal hiatus and pelvic organ prolapse. There is inconclusive evidence to support an association between LAM injuries and stress urinary incontinence and there seems to be a trend towards the development of fecal incontinence. Longitudinal studies with long-term follow-up assessing the LAM before and after childbirth are lacking. Furthermore, the consequence of LAM injuries on quality of life due to prolapse and/or urinary and fecal incontinence have not been evaluated using validated questionnaires. Direct comparative studies using the above-mentioned imaging modalities are needed to determine the true gold standard for the diagnosis of LAM injuries. This would enable consistency in definition and classification of LAM injuries. Only then could high-risk groups be identified and preventive strategies implemented in obstetric practice.
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Kociszewski J, Rautenberg O, Kuszka A, Eberhard J, Hilgers R, Viereck V. Can we place tension-free vaginal tape where it should be? The one-third rule. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:210-214. [PMID: 21793084 DOI: 10.1002/uog.10050] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The tension-free vaginal tape (TVT) insertion technique generally does not take into account individual urethral length. In this study we investigated whether preoperative sonographic measurement of individual urethral length allows for reliable TVT positioning under the midurethra, which is a critical segment for the continence mechanism. METHODS Urethral length was measured by preoperative introital ultrasonography in 102 consecutive female patients with stress urinary incontinence. TVT procedures were performed as recommended by the manufacturer. The suburethral incisions were initiated at one-third of the sonographically measured urethral length. TVT position and tape-urethra distance were followed up 6 months postoperatively. RESULTS At 6-month examination of the 102 study participants, 93.1% were cured and 6.9% showed improved continence. TVTs were found in the target range of 50-70% of the urethral length in 88.2% of the cohort. Women with the TVT in the 50-70% urethral length range and a 3-5-mm tape-longitudinal smooth muscle distance had a greater likelihood of being cured without complications (P < 0.001). CONCLUSIONS Preoperative sonographic measurement of urethral length, combined with the one-third rule, may aid in reliable midurethral TVT positioning.
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Affiliation(s)
- J Kociszewski
- Department of Gynecology and Obstetrics, Lutheran Hospital, Hagen-Haspe, Germany
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Scheiner DA, Betschart C, Wiederkehr S, Seifert B, Fink D, Perucchini D. Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings. Int Urogynecol J 2011; 23:197-206. [DOI: 10.1007/s00192-011-1543-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 08/10/2011] [Indexed: 11/29/2022]
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Pelvic floor disorders: role of new ultrasonographic techniques. World J Urol 2011; 29:615-23. [PMID: 21671056 DOI: 10.1007/s00345-011-0708-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/25/2011] [Indexed: 02/03/2023] Open
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Tubaro A, Koelbl H, Laterza R, Khullar V, de Nunzio C. Ultrasound imaging of the pelvic floor: where are we going? Neurourol Urodyn 2011; 30:729-34. [PMID: 21661021 DOI: 10.1002/nau.21136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the outcome of conservative treatment and reconstructive surgery. Published papers fall into the remits of diagnostic studies but often fail to comply with the recommendations of the STARD initiative. Most published evidence remains the product of a single institution effort and confirmatory studies are rarely found. Imaging studies in patients with UI did not provide evidence of any clinical benefit in the management of patients. In patients with POP, interesting correlations have been identified such as between childbirth, dimension of levator hiatus, avulsion of levator ani and risk of prolapse, but the non clinical benefit of pelvic floor imaging could still not be identified. Research on pelvic floor imaging requires a coordinated, international, multicentre effort to improve internal and external validity of imaging techniques, confirm observations published by single institutions and provide health technology assessment of imaging in the management of UI or POP patients.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, 2nd School of Medicine, La Sapienza University of Rome, Italy.
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Kirschner-Hermanns R, Najjari L, Brehmer B, Blum R, Zeuch V, Maass N, Heidenreich A. Two- and three-/four dimensional perineal ultrasonography in men with urinary incontinence after radical prostatectomy. BJU Int 2011; 109:46-51. [PMID: 21489119 DOI: 10.1111/j.1464-410x.2011.10191.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, Stankiewicz A, Bartram C. State of the art: an integrated approach to pelvic floor ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:381-396. [PMID: 20814874 DOI: 10.1002/uog.8816] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor-urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome-is evaluated critically.
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Affiliation(s)
- G A Santoro
- Pelvic Floor Unit, I°Department of Surgery, Regional Hospital, Treviso, Italy.
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Pizzoferrato AC, Fauconnier A, Bader G. [Value of ultrasonographic measurement of bladder neck mobility in the management of female stress urinary incontinence]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 39:42-8. [PMID: 21185762 DOI: 10.1016/j.gyobfe.2010.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
Transvaginal ultrasound is the first line imaging investigation in gynaecology. It was thus introduced for the exploration of female stress urinary incontinence at the beginning of the 1980s. Various techniques and parameters of ultrasound examination have been used for the assessment of bladder neck mobility. The aim of this literature review was to suggest the adequate ultrasound technique to study bladder neck mobility. We reviewed articles indexed in MEDLINE dealing with urogenital ultrasound and published between 1998 and 2008. The bladder-symphysis distance measured by transperineal ultrasound is a reliable and reproductive tool to study female stress urinary incontinence. Despite a lack of standardization of Valsalva manoeuvre, normal bladder neck mobility is estimated between 15 and 20 mm. Furthermore, in case of complications from stress urinary incontinence surgery, ultrasound is considered as the first line imaging test. Perineal ultrasound is an interesting investigation for preoperative assessment of stress urinary incontinence or in case of surgery failure or complications. This suggests the need for wider diffusion of this technique in urogynecology teams.
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Affiliation(s)
- A-C Pizzoferrato
- Université Versailles/St-Quentin, CHI de Poissy/Saint-Germain-en-Laye, France
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The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kinesiol 2010; 21:166-77. [PMID: 20833070 DOI: 10.1016/j.jelekin.2010.07.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/21/2010] [Accepted: 07/30/2010] [Indexed: 11/20/2022] Open
Abstract
This study was undertaken to determine the effect of changing standing lumbopelvic posture on pelvic floor muscle (PFM) activation amplitude and timing and the resultant vaginal manometry values recorded during static and dynamic tasks. Sixteen nulliparous, continent women between the ages of 22 and 41 years performed five tasks (quiet standing, maximal effort cough, Valsalva manoeuvre, maximum voluntary contraction (MVC) of the PFMs, and a load-catching task) in three different standing postures (normal lumbopelvic posture, hyperlordosis and hypolordosis). Electromyographic (EMG) data were recorded from the PFMs bilaterally using a Periform™ vaginal probe coupled to Delsys™ Bagnoli-8 EMG amplifiers. In separate trials, vaginal manometry was obtained using a Peritron™ perineometer. Lumbopelvic angle was recorded simultaneously with EMG and vaginal manometry using an Optotrak™ 3D motion analysis system to ensure that subjects maintained the required posture throughout the three trials of each task. All data were filtered using a moving 100 ms RMS window and peak values were determined for each trial and task. Repeated-measures analyses of variance were performed on the peak PFM EMG, intra-vaginal pressure amplitudes, and lumbopelvic angles as well as activation onset data for the cough and load-catching tasks. There was significantly higher resting PFM activity in all postures in standing as compared to supine, and in the standing position, there was higher resting PFM activity in the hypo-lordotic posture as compared to the normal and hyperlordotic postures. During the MVC, cough, Valsalva, and load-catching tasks, subjects generated significantly more PFM EMG activity when in their habitual posture than when in hyper- or hypo-lordotic postures. Conversely, higher peak vaginal manometry values were generated in the hypo-lordotic posture for all tasks in all cases. These results clearly indicate that changes in lumbopelvic posture influence both the contractility of the PFMs and the amount of vaginal pressure generated during static postures and during dynamic tasks. Lumbopelvic posture does not, however, appear to have a significant effect on the timing of PFM activation during coughing or load-catching tasks.
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Santoro GA, Wieczorek AP, Shobeiri SA, Mueller ER, Pilat J, Stankiewicz A, Battistella G. Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic floor anatomy. Int Urogynecol J 2010; 22:53-9. [DOI: 10.1007/s00192-010-1233-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 07/21/2010] [Indexed: 02/03/2023]
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Raizada V, Bhargava V, Jung SA, Karstens A, Pretorius D, Krysl P, Mittal RK. Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles. Am J Obstet Gynecol 2010; 203:172.e1-8. [PMID: 20462564 DOI: 10.1016/j.ajog.2010.02.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 12/14/2009] [Accepted: 02/10/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We used a novel technique, high-definition manometry (HDM) that utilizes 256 tactile sensitive microtransducers to define the characteristics of vaginal high-pressure zone. STUDY DESIGN Sixteen nullipara asymptomatic women were studied using HDM, transperineal 2-dimensional dynamic ultrasound and dynamic magnetic resonance (MR) imaging. RESULTS Vaginal high-pressure zone revealed higher contact pressures in anterior and posterior directions compared with lateral directions, both at rest and squeeze. At rest, anterior pressure cluster is located 10 mm cephalad to posterior pressure cluster; with squeeze the latter moves in the cranial direction by 7 mm. Ultrasound and MR images revealed that the anorectal angle moves cephalad and ventrally during squeeze. Cephalad movement of posterior pressure cluster during squeeze is similar to the cranial movement of anorectal angle. CONCLUSION We propose that the vaginal high-pressure zone represents the constrictor function and cranial movement of the posterior pressure cluster represents the elevator function of pelvic floor. HDM may be used to measure the constrictor and elevator functions of pelvic floor muscles.
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Affiliation(s)
- Varuna Raizada
- Pelvic Floor Function and Disease Group, Division of Gastroenterology, University of California, San Diego, San Diego, CA, USA
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Ultrasound measurement of bladder wall thickness in different forms of detrusor overactivity. Int Urogynecol J 2010; 21:1405-11. [DOI: 10.1007/s00192-010-1194-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 05/27/2010] [Indexed: 01/04/2023]
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Velemir L, Amblard J, Fatton B, Savary D, Jacquetin B. Transvaginal mesh repair of anterior and posterior vaginal wall prolapse: a clinical and ultrasonographic study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:474-480. [PMID: 20209502 DOI: 10.1002/uog.7485] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To investigate whether ultrasonography coupled with clinical examination can help in understanding the mechanism of recurrence after transvaginal mesh repair of anterior and posterior vaginal wall prolapse. METHODS Ninety-one patients who had undergone surgery for anterior and/or posterior vaginal wall prolapse with the Prolift system had a clinical examination and introital/endovaginal two-dimensional ultrasonography a minimum of 1 year later. The retraction of anterior and posterior meshes was estimated relative to the original length of the mesh by transvaginal palpation. Patients with no, moderate (< 50%) or severe (> or = 50%) mesh retraction were compared. Anterior recurrence of prolapse was defined according to the International Continence Society by a Ba value > or = -1 and posterior recurrence by a Bp value > or = -1 (where Ba represents the most distal position of the anterior vaginal wall and Bp the most distal position of the posterior vaginal wall). On ultrasonography, two distances were measured in the midsagittal plane: Distance 1, from the distal margin of the anterior mesh to the bladder neck, and Distance 2, from the distal margin of the posterior mesh to the rectoanal junction. RESULTS Seventy-five anterior and 62 posterior meshes were studied at a mean follow-up of 17.9 months. Patients with anterior recurrence presented significantly more often with severe anterior mesh retraction compared with patients without anterior recurrence (5/8 vs. 2/67, P < 0.001) and also had an increased Distance 1 (P < 0.001). Patients with posterior recurrence presented significantly more often with severe posterior mesh retraction compared with patients without posterior recurrence (3/4 vs. 3/58, P < 0.01) and also had an increased Distance 2 (P < 0.01). CONCLUSIONS Recurrence of prolapse after transvaginal mesh repair appears to be associated with severe mesh retraction and loss of mesh support on the distal part of the vaginal walls.
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Affiliation(s)
- L Velemir
- CHU Clermont-Ferrand, Maternité, Service de Gynécologie Obstétrique, Hôtel-Dieu, Clermont-Ferrand, France.
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Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010; 29:4-20. [PMID: 19941278 DOI: 10.1002/nau.20798] [Citation(s) in RCA: 1644] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two international organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
- Bernard T Haylen
- University of New South Wales, Sydney, New South Wales, Australia.
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Tape functionality: position, change in shape, and outcome after TVT procedure--mid-term results. Int Urogynecol J 2010; 21:795-800. [PMID: 20204326 PMCID: PMC2876268 DOI: 10.1007/s00192-010-1119-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/26/2010] [Indexed: 10/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study evaluates the relevance of the tape position and change in shape (tape functionality) under in vivo conditions for mid-term outcome. METHODS Changes in the sonographic tension-free vaginal tape (TVT) position relative to the percentage urethral length and the tape-urethra distance were determined after 6 and 48 months in 41 women with stress urinary incontinence. RESULTS At 48 months, 76% (31/41) of women were cured, 17% (7/41) were improved, and 7% (3/41) were failures. Disturbed bladder voiding was present in 12% (5/41), de novo urge incontinence in 7% (3/41). The median TVT position was at 63% of urethral length. Median tape-urethra distance was 2.7 mm, ranging from 2.9 mm in continent patients without complications to 1.1 mm in those with obstructive complications. Patients with postoperative urine loss had a median distance of 3.9 mm. The tape was stretched at rest and C-shaped during straining in 15 of 41 women (37%) at 48 months (all continent). Patients with this tape functionality at 6 months were also cured at 48 months in 86% of cases (19/22), and only 14% (3/22) showed recurrent incontinence. CONCLUSIONS Mid-term data suggest an optimal outcome if the tape is positioned at least 2 mm from the urethra at the junction of the middle and distal thirds. Patients with optimal tape functionality at 6 months are likely to show mid-term therapeutic success.
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