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Hainsworth A, Solanki D, Ferrari L, Igbedioh C, Johnston L, Morris SJ, Igualada-Martinez P, Schizas AMP, Williams AB. The association between levator plate integrity and pelvic floor defaecatory dysfunction. Neurourol Urodyn 2023; 42:690-698. [PMID: 36692383 DOI: 10.1002/nau.25119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023]
Abstract
AIMS Levator ani deficiency has been implicated in anterior pelvic floor pathology but its association with pelvic floor defaecatory dysfunction is less clear. The aim was to examine the relationship of levator ani deficiency with anatomical abnormalities (rectocoele, intussusception, enterocoele, perineal descent) and patient symptoms (bowel, vagina) in patients with pelvic floor defaecatory dysfunction. METHODS The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]). RESULTS The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency. CONCLUSIONS Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
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Affiliation(s)
- Alison Hainsworth
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Deepa Solanki
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Linda Ferrari
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carlene Igbedioh
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liam Johnston
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Samantha J Morris
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alexis M P Schizas
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew B Williams
- The Pelvic Floor Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Liu L, Bian X, Liu Y, Wang R, Huang Z, Hu J, Lv W, Ilyas N, Fu H. Synthesis and upconversion luminescence of α-Ba2ScAlO5 hosted compounds. J SOLID STATE CHEM 2021. [DOI: 10.1016/j.jssc.2021.122559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
This article discusses various pelvic floor ultrasonographic modalities and the clinical applications of ultrasonography of the pelvic floor. Ultrasonography provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variabilities and pathologic conditions, such as prolapse, fecal incontinence, urinary symptoms, vaginal wall cysts, synthetic implanted material, and pelvic pain, are assessed with pelvic floor ultrasonography. This imaging modality is an important adjunct to the evaluation and diagnosis of pelvic floor disorders.
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Affiliation(s)
- Trang X Pham
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences, 800 Stanton L. Young Boulevard, Suite 2400, Oklahoma City, OK 73104, USA
| | - Lieschen H Quiroz
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences, 800 Stanton L. Young Boulevard, Suite 2400, Oklahoma City, OK 73104, USA.
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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Taithongchai A, Pandeva I, Sultan AH, Thakar R. Association between 3D endovaginal and 2D perineal pelvic floor ultrasound findings and symptoms in women presenting with mid-urethral sling complications. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:639-646. [PMID: 32959432 DOI: 10.1002/uog.23130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To present the characteristics of women attending a tertiary urogynecology pelvic floor scan clinic with mid-urethral sling (MUS) complications and examine the association between patient symptoms and findings on two-dimensional (2D) perineal and three-dimensional (3D) endovaginal ultrasound. METHODS This was a cross-sectional study of all women with MUS complications referred to a specialist pelvic floor ultrasound clinic between October 2016 and October 2018. Detailed history was obtained regarding their symptoms and time of onset. All patients underwent 2D perineal and 3D endovaginal ultrasound assessment. The association between patient symptoms and ultrasound findings was evaluated using logistic regression analysis. Only symptomatic women with a single MUS, without other pelvic floor mesh, prior mesh excision or bulking agents, were included in the regression analysis. RESULTS A total of 311 women with a history of MUS surgery were seen during the study period. Vaginal and/or non-vaginal pain was reported by 80% of patients and this was the primary presenting complaint in 59% of the patients. One-third of the patients reported symptoms starting within 4 weeks after surgery. The data of 172 patients were included in the regression analysis. MUS position within the rhabdosphincter was significantly associated with voiding dysfunction (odds ratio (OR), 10.6 (95% CI, 2.2-50.9); P = 0.003). Voiding dysfunction was highest in those with C-shaped MUS both at rest and on Valsalva maneuver (OR, 3.2 (95% CI, 1.3-7.6); P < 0.001). MUS position in the distal third of the urethra was significantly associated with a higher rate of recurrent urinary tract infection (OR, 2.9 (95% CI, 1.3-6.3); P = 0.01). CONCLUSIONS Pelvic floor ultrasound can provide insight into the position and shape of the MUS, which could explain some patient symptoms and guide management or surgical planning. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Taithongchai
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - I Pandeva
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - A H Sultan
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - R Thakar
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
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Siahkal SF, Iravani M, Mohaghegh Z, Sharifipour F, Zahedian M, Nasab MB. Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review. Int Urogynecol J 2021; 32:2095-2109. [PMID: 33523259 DOI: 10.1007/s00192-020-04639-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS Pelvic organ prolapse (POP) is a very common and distressing problem that affects women's quality of life. This systematic review aimed to investigate the association of the dimensions of the genital hiatus and levator hiatus at rest and Valsalva with POP. METHODS The Cochrane Library, PubMed, Scopus, Embase and Web of Science were searched on 25 April 2020. All data were analyzed using Review Manager 5.3. RESULTS Of the 1288 papers reviewed, 21 (n = 5145: 2909 women with POP and 2236 controls) were considered for meta-analysis. Compared with the normal pelvic floor group, the urogenital hiatus size in the POP group was significantly higher at rest (mean difference: 0.49; 95% CI: [0.43, 0.55], P < 0.00001) and at Valsalva (mean difference: 0.79; 95% CI: [0.70, 0.89], P < 0.00001). Also, the levator ani hiatus size in the POP group was significantly higher at rest (mean difference: 0.52, 95% CI: [0.25, 0.78], P < 0.0001) and at Valsalva (mean difference: 1.01; 95% CI: [0.73,1.28], P < 0.00001) compared with that in the normal pelvic floor group. CONCLUSION This systematic review showed that the sizes of the urogenital hiatus and levator ani hiatus and area of the levator hiatus in the POP group were significantly higher than those in the normal pelvic floor groups in both positions (rest or Valsalva maneuver). Also, in the POP group, the levator hiatus length at rest was significantly lower than that in the Valsalva maneuver.
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Affiliation(s)
- Shahla Faal Siahkal
- Department of Midwifery, Marand Branch, Islamic Azad University, Marand, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery and Reproductive Health Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zeynab Mohaghegh
- Unit of Family Health, Health Deputy of Tehran University of Medical Science, Tehran, Iran
| | - Foruzan Sharifipour
- Midwifery Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Zahedian
- Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Beheshti Nasab
- Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xing Q, Chitnis P, Sikdar S, Alshiek J, Shobeiri SA, Wei Q. M3VR-A multi-stage, multi-resolution, and multi-volumes-of-interest volume registration method applied to 3D endovaginal ultrasound. PLoS One 2019; 14:e0224583. [PMID: 31751356 PMCID: PMC6872108 DOI: 10.1371/journal.pone.0224583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Heterogeneity of echo-texture and lack of sharply delineated tissue boundaries in diagnostic ultrasound images make three-dimensional (3D) registration challenging, especially when the volumes to be registered are considerably different due to local changes. We implemented a novel computational method that optimally registers volumetric ultrasound image data containing significant and local anatomical differences. It is A Multi-stage, Multi-resolution, and Multi-volumes-of-interest Volume Registration Method. A single region registration is optimized first for a close initial alignment to avoid convergence to a locally optimal solution. Multiple sub-volumes of interest can then be selected as target alignment regions to achieve confident consistency across the volume. Finally, a multi-resolution rigid registration is performed on these sub-volumes associated with different weights in the cost function. We applied the method on 3D endovaginal ultrasound image data acquired from patients during biopsy procedure of the pelvic floor muscle. Systematic assessment of our proposed method through cross validation demonstrated its accuracy and robustness. The algorithm can also be applied on medical imaging data of other modalities for which the traditional rigid registration methods would fail.
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Affiliation(s)
- Qi Xing
- Department of Computer Science, George Mason University, Fairfax, Virginia, United States of America
- The School of Information Science and Technology, Southwest Jiaotong University, Sichuan, China
| | - Parag Chitnis
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - S. Abbas Shobeiri
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
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Gao Y, Zhao Z, Yang Y, Zhang M, Wu J, Miao Y. Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review. Int Urogynecol J 2019; 31:15-33. [DOI: 10.1007/s00192-019-04066-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/18/2019] [Indexed: 01/02/2023]
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9
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Lai W, Wen L, Li Y, Huang X, Qing Z. Concordance of tomographic ultrasound and multiplanar ultrasound in detecting levator ani muscle injury in patients with pelvic organ prolapse. PLoS One 2018; 13:e0199864. [PMID: 29979693 PMCID: PMC6034800 DOI: 10.1371/journal.pone.0199864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022] Open
Abstract
Aim To compare the evaluations of evaluate levator ani muscle injury (LAMI) by tomographic ultrasound imaging (TUI) and multiplanar (MP) ultrasound in patients with pelvic organ prolapse (POP). Method This retrospective analysis studied women who underwent International Continence Society POP quantification examination between October 2015 and June 2016. LAMI was assessed by both TUI and MP ultrasounds. Concordance of these two testing results was analyzed. Their correlations with clinical symptoms were also studied. Results A total of 135 women were included. All the patients with POP had a minimal LAMI depth ≥ 7 mm. Two examinations, TUI and MP, had satisfactory concordance (k = 0.71, P < 0.01). Depth of LAMI in the coronal plane demonstrated good agreement with TUI scores (r = 0.84; P < 0.01). After controlling for age, BMI, and parity, to have clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19–1.44) and 1.25 (95% CI 1.14–1.36), and for TUI scores were 1.72 (95% CI 1.37–2.17) and 1.63 (95% CI 1.31–2.03). Receiver operating characteristic curve analyses showed a cutoff depth of 7 mm of LAMI yielded a sensitivity of 62% and specificity of 80% for POP symptoms. Conclusions TUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP.
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Affiliation(s)
- Weisi Lai
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lieming Wen
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
| | - Yinbo Li
- Department of Drug Evaluation and ADR Monitoring, Food and Drug Administration, Changsha, Hunan, China
| | - Xinghua Huang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenzhen Qing
- Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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