1
|
Del Forno S, Cocchi L, Arena A, Pellizzone V, Lenzi J, Raffone A, Borghese G, Paradisi R, Youssef A, Casadio P, Raimondo D, Seracchioli R. Effects of Pelvic Floor Muscle Physiotherapy on Urinary, Bowel, and Sexual Functions in Women with Deep Infiltrating Endometriosis: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:67. [PMID: 38256327 PMCID: PMC10818504 DOI: 10.3390/medicina60010067] [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: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Endometriosis is a chronic and recurrent disease defined as the presence and proliferation of endometrial glands and stroma outside the uterine cavity. It affects up to 6-10% of women of reproductive age and can be classified into superficial, ovarian, and deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis can be associated with pain symptoms and pelvic floor muscle hypertone. Moreover, it may be responsible of bowel, urinary, and sexual dysfunctions with impairment of women's quality of life. Few studies have investigated the role of physiotherapy in women with DIE. Here, we aimed first to evaluate the effects of pelvic floor physiotherapy (PFP) on urinary, bowel, and sexual functions. Secondly, we aimed to evaluate the effects of ultrasound visual feedback during PFP on pelvic floor and subjective modifications in the frequency of sexual intercourse. Materials and Methods: This randomized controlled trial was conducted between June 2018 and December 2019 at our tertiary center. Nulliparous women with DIE and superficial dyspareunia were enrolled. At first examination, levator hiatal area (LHA) assessed with 3D/4D transperineal ultrasound, pain symptoms, urinary, bowel, and sexual functions were evaluated. Then, women were randomly assigned to no intervention (control group) or treatment with five individual sessions of PFP (experimental group), and after four months women underwent a second examination. Urinary, bowel, and sexual functions were assessed with validated questionnaires at first and second examinations. In particular, the Bristol Female Lower Urinary Tract Symptoms questionnaire was used to evaluate urinary symptoms, the Knowles-Eccersley-Scott-Symptom questionnaire to assess the presence of constipation, and the Female Sexual Function Index to investigate sexual function. Study outcomes were the comparisons among groups in terms of differences in actual changes in median of questionnaire scores between first and second examinations. Results: Thirty women (17 in the experimental group and 13 in the control group) completed the study. No significant differences were found between the two groups regarding urinary, bowel, and sexual functions, although women in the experimental group showed a tendency towards an improvement in constipation symptoms. Conclusion: In women with DIE, PFP does not appear to affect urinary, bowel, and sexual functions. Therefore, despite the improvement in superficial dyspareunia, chronic pelvic pain, and PFM relaxation with high treatment satisfaction, women should be informed about the unclear impact of PFP on urinary, bowel, and sexual functions. Larger studies are necessary to further investigate the impact of PFP on these functions.
Collapse
Affiliation(s)
- Simona Del Forno
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Laura Cocchi
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Valentina Pellizzone
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Giulia Borghese
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Roberto Paradisi
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Aly Youssef
- Obstetrics and Feto-Maternal Medicine Unit, IRCCS, Sant’Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy;
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy; (S.D.F.); (G.B.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
2
|
Lin C, Huang W, Li X, Wang L, Yan F, Zhou X, Jiang W, Zhao Y. Diagnostic value of combined pelvic floor ultrasound parameters for pelvic floor dysfunction and risk factors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:465-471. [PMID: 36464839 DOI: 10.1002/jcu.23397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of pelvic floor ultrasound parameters in combination for pelvic floor dysfunction (PFD), and to explore the risk factors. METHODS Forty PFD patients treated from April2019to December 2020(case group) and another 40 healthy women (control group) were enrolled. Their clinical data were collected, and both groups received three-dimensional (3D) ultrasound of the pelvic floor. The diagnostic value of pelvic floor ultrasound parameters for PFD was assessed by receiver operating characteristic (ROC) curves. The risk factors of PFD were evaluated by multivariate logistic regression analysis. RESULTS The area under the ROC curve (AUC), sensitivity, and specificity of the parameters in combination for predicting PFD were 0.851 [95% confidence interval (CI): 0.743-0.959], 0.901, and 0.812, respectively, indicating acceptable accuracy. Results of logistic regression analysis revealed that spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, posterior urethrovesical angle (PUA), bladder neck tilt angle, bladder neck distance (BND), levator hiatus area (LHA) (at anal contraction), R-LHA and V-LHA were risk factors for PFD (p < 0.05), while physical exercise was a protective factor (p < 0.05). ROC curve analysis revealed that the AUC, sensitivity, and specificity of the forest map model were 0.822 (95% CI: 0.759-0.885), 0.942, and 0.601, respectively, indicating acceptable accuracy of the model. Internal data validation of the model demonstrated consistence of the predicted occurrence of PFD with the actual one. CONCLUSIONS Spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, PUA, bladder neck tilt angle, BND, LHA (at anal contraction), R-LHA and V-LHA were risk factors for PFD.
Collapse
Affiliation(s)
- Chunhong Lin
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Weiyan Huang
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Xianguo Li
- Medical Department, The Fifth People's Hospital of Hengshui, Hengshui, China
| | - Linlin Wang
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Fengqin Yan
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Xiaowen Zhou
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Weihong Jiang
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Yaoyao Zhao
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| |
Collapse
|
3
|
Arena A, Degli Esposti E, Cocchi L, Orsini B, Lenzi J, Del Forno S, Raimondo D, Youssef A, Seracchioli R. Three-Dimensional Ultrasound Evaluation of Pelvic Floor Muscle Contraction in Women Affected by Deep Infiltrating Endometriosis: Application of a Quick Contraction Scale. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2973-2979. [PMID: 35532292 DOI: 10.1002/jum.15996] [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: 10/16/2021] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Using transperineal 3D/4D ultrasound, we evaluated the prevalence of the various categories of a 4-point pelvic contraction scale among women affected by ovarian endometriosis (OE), deep infiltrating endometriosis (DIE), and healthy controls. METHODS This prospective study was conducted on nulliparous women scheduled for surgery to remove endometriosis, and nulliparous healthy volunteers who did not show any clinical or sonographic signs of endometriosis, who served as controls. Patients were subjected to 3D/4D transperineal ultrasound obtaining measurements of the antero-posterior diameter (APD), both at rest and during maximal pelvic floor muscle (PFM) contraction (PFMC). The difference of APD from rest to maximal PFMC was then calculated as percent change from baseline (ΔAPD) and patients were thus categorized using the 4-point pelvic contraction scale. RESULTS One hundred sixty-four patients were considered for the study. Mean difference in APD between relaxed state and maximal PFMC was 23.3 ± 7.9% (range 2.4-40.0) in controls, 20.5 ± 9.0% (range 0.0-37.3) in patients with OE, and 14.6 ± 10.4% (range 0.0-37.1) in patients with DIE (F-test = 19.5, P-value < .001). A significant negative correlation was found between the contraction scale and dyspareunia (rs = -0.17, P = .032), and it appeared to be stronger among patients with DIE (rs = -0.20, P = .076). CONCLUSIONS PFM function in endometriotic patients could be assessed reliably through this 4-point scale. The rapid identification of women suffering from PFM dysfunction, along with deep dyspareunia, could enable gynecologists to offer them additional therapies, such as PFM rehabilitation.
Collapse
Affiliation(s)
- Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Laura Cocchi
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Orsini
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aly Youssef
- Obstetrics and Prenatal Medicine Unit, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
4
|
Ghasemi F, Alemzadeh E, Allahqoli L, Alemzadeh E, Mazidimoradi A, Salehiniya H, Alkatout I. MicroRNAs Dysregulation as Potential Biomarkers for Early Diagnosis of Endometriosis. Biomedicines 2022; 10:biomedicines10102558. [PMID: 36289820 PMCID: PMC9599310 DOI: 10.3390/biomedicines10102558] [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: 09/18/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Endometriosis is a benign chronic disease in women that is characterized by the presence of active foci of the endometrium or endometrial tissue occurring outside of the uterus. The disease causes disabling symptoms such as pelvic pain and infertility, which negatively affect a patient's quality of life. In addition, endometriosis imposes an immense financial burden on the healthcare system. At present, laparoscopy is the gold standard for diagnosing the disease because other non-invasive diagnostic tests have less accuracy. In addition, other diagnostic tests have low accuracy. Therefore, there is an urgent need for the development of a highly sensitive, more specific, and non-invasive test for the early diagnosis of endometriosis. Numerous researchers have suggested miRNAs as potential biomarkers for endometriosis diagnosis due to their specificity and stability. However, the greatest prognostic force is the determination of several miRNAs, the expression of which varies in a given disease. Despite the identification of several miRNAs, the studies are investigatory in nature, and there is no consensus on them. In the present review, we first provide an introduction to the dysregulation of miRNAs in patients with endometriosis and the potential use of miRNAs as biomarkers in the detection of endometriosis. Then we will describe the role of the mir-200 family in endometriosis. Several studies have shown that the expression of the mir-200 family changes in endometriosis patients, suggesting that they could be used as a diagnostic biomarker and therapeutic target for endometriosis.
Collapse
Affiliation(s)
- Fahimeh Ghasemi
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
- Department of Biotechnology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Effat Alemzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Esmat Alemzadeh
- Department of Biotechnology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand 9717853577, Iran
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Campus Kiel, University Hospitals Schleswig-Holstein, Ar-nold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
- Correspondence:
| |
Collapse
|
5
|
Diagnostic Value of Combined Detection of Pelvic Ultrasound and Serum LH, FSH, and E2 Levels in Children with Idiopathic Central Precocious Puberty. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7928344. [PMID: 35979007 PMCID: PMC9377888 DOI: 10.1155/2022/7928344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022]
Abstract
Objective To study the diagnostic value of combined detection of pelvic ultrasound and serum LH, FSH, and E2 levels in children with idiopathic central precocious puberty (ICPP). Methods 30 cases of children with ICPP admitted to our hospital from January 2019 to January 2021 were selected as the experimental group, and 30 healthy people during the same period were selected as the control group. Both groups received pelvic ultrasound and serum LH, FSH, and E2 detection; the two groups were compared in terms of serum indicators, combined diagnosis, specificity, and sensitivity. Results There were statistical differences in height, leptin, bone age, and areola diameter between the two groups (p < 0.05). The length of the uterus, the volume of the uterus, the area of the ovary, the volume of the ovary, and the maximum diameter of the follicle in the experimental group were larger than those in the control group (p < 0.05). The endometrial thickness of the experimental group was significantly greater than that of the control group (p < 0.05). The levels of serum LH, FSH, and E2 in the experimental group were significantly higher than those in the control group (p < 0.05). The area of the combined detection was significantly larger than that of the single detection. The combined detection was superior to the single detection with respect to the area, standard error a, asymptotic Sig. B, and asymptotic 95% confidence interval (p < 0.05). The sensitivity of the combined detection was significantly higher than that of the single detection. Conclusion The combined detection of pelvic ultrasound and serum LH, FSH, and E2 levels may be a preferred technique for the diagnosis of children with ICPP due to its benefits of high sensitivity and accuracy. It is worthy of clinical promotion and application.
Collapse
|
6
|
Raimondo D, Cocchi L, Raffone A, Del Forno S, Iodice R, Maletta M, Aru AC, Salucci P, Ambrosio M, Mollo A, Youssef A, Casadio P, Seracchioli R. Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis. Int J Gynaecol Obstet 2022; 159:505-512. [PMID: 34995357 DOI: 10.1002/ijgo.14088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the association between sonographic findings at transperineal ultrasound (TPU) and chronic constipation (CC) in women with endometriosis. METHODS An observational prospective cohort study was performed by enrolling all endometriosis women scheduled for surgery between September 2019 and October 2020. Women underwent TPU at rest and during Valsalva maneuver evaluating levator-hiatal-area (LHA), antero-posterior diameter (APD), levator-ani muscle (LAM)-coactivation. Ultrasound findings were compared between women with and without CC in the whole study population, and subsequently in two subgroups [only ovarian and deep infiltrating endometriosis (DIE)]. RESULTS 87 women were enrolled: 29 (33%) with CC and 58 (67%) without CC. Women with endometriosis and CC showed a smaller LHA during Valsalva, less LHA and APD enlargement from rest to maximum Valsalva, a higher prevalence of LAM-coactivation compared to women without CC. In ovarian-subgroup, women with CC had smaller LHA at Valsalva, less enlargement of LHA and APD from rest to maximum Valsalva and higher prevalence of LAM-coactivation compared to non-CC patients. In DIE-subgroup, TPU did not significantly differ between CC and non-CC patients. CONCLUSION TPU signs of pelvic floor muscle hypertone are more frequent in endometriosis patients with CC compared to those without constipation, particularly in women affected by isolated ovarian endometriosis.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Laura Cocchi
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy.,Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Simona Del Forno
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Raffaella Iodice
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Anna Chiara Aru
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Paolo Salucci
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Marco Ambrosio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Antonio Mollo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Aly Youssef
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero, Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Via Massarenti 13, Bologna, 40138, Italy
| |
Collapse
|
7
|
Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci 2021; 22:ijms221910554. [PMID: 34638893 PMCID: PMC8508982 DOI: 10.3390/ijms221910554] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a “mysterious” disease and its exact cause has not yet been established. Among the etiological factors, congenital, environmental, epigenetic, autoimmune and allergic factors are listed. It is believed that the primary mechanism of the formation of endometriosis foci is retrograde menstruation, i.e., the passage of menstrual blood through the fallopian tubes into the peritoneal cavity and implantation of exfoliated endometrial cells. However, since this mechanism is also observed in healthy women, other factors must also be involved in the formation of endometriosis foci. Endometriosis is in many women the cause of infertility, chronic pain and the deterioration of the quality of life. It also represents a significant financial burden on health systems. The article presents a review of the literature on endometriosis—a disease affecting women throughout the world.
Collapse
|
8
|
Zając B, Sulowska-Daszyk I, Mika A, Stolarczyk A, Rosłoniec E, Królikowska A, Rzepko M, Oleksy Ł. Reliability of Pelvic Floor Muscle Assessment with Transabdominal Ultrasound in Young Nulliparous Women. J Clin Med 2021; 10:3449. [PMID: 34362232 PMCID: PMC8348606 DOI: 10.3390/jcm10153449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the reliability of pelvic floor muscles evaluation via transabdominal ultrasonography in young nulliparous women and to present the methodology for quantitative assessment of the ultrasound image of the pelvic floor muscles visible as displacement of the posterior wall of the bladder, caused by action of the pelvic floor muscles. The study comprised 30 young, Caucasian, nulliparous women (age 22-27; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) without pelvic floor muscle dysfunctions. The intra-rater, test-retest and inter-rater reliability of pelvic floor muscles evaluation was performed using transabdominal ultrasound at rest and during voluntary contraction. The reliability was assessed at three points of the image (at the middle, on the right and left side). The reliability of the three-point measurement of the pelvic floor muscles transabdominal ultrasound is excellent in the case of intra-rater assessments, both at rest (ICC = 0.98-0.99) and during contraction (ICC = 0.97-0.98); moderate at rest (ICC = 0.54-0.62) and poor during contraction (ICC = 0.22-0.50) in the case of test-retest assessment; excellent at rest (ICC = 0.95-0.96), and good during contraction (ICC = 0.81-0.87) in the case of inter-rater assessment. Transabdominal ultrasound is a reliable method of pelvic floor muscle evaluation. The three-points of assessment used in our study allowed for broader and more comprehensive imaging of the pelvic floor muscle, e.g., for quantitative detection contractility imbalances between the left and right side Due to the fact that understanding mechanisms of pelvic floor muscle functioning is crucial in the therapy of pelvic floor dysfunctions, therefore, reliable, valid tests and instruments are important.
Collapse
Affiliation(s)
- Bartosz Zając
- Laboratory of Functional Diagnostics, Central Scientific and Research Laboratory, University of Physical Education in Kraków, 31-571 Kraków, Poland;
| | - Iwona Sulowska-Daszyk
- Institute of Clinical Rehabilitation, University of Physical Education in Kraków, 31-571 Kraków, Poland; (A.M.); (E.R.)
| | - Anna Mika
- Institute of Clinical Rehabilitation, University of Physical Education in Kraków, 31-571 Kraków, Poland; (A.M.); (E.R.)
| | - Artur Stolarczyk
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (A.S.); (Ł.O.)
| | - Ewelina Rosłoniec
- Institute of Clinical Rehabilitation, University of Physical Education in Kraków, 31-571 Kraków, Poland; (A.M.); (E.R.)
| | - Aleksandra Królikowska
- Department of Sports Medicine, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | - Marian Rzepko
- Institute of Physical Culture Sciences, Rzeszów University, 35-310 Rzeszów, Poland;
| | - Łukasz Oleksy
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (A.S.); (Ł.O.)
- Oleksy Medical & Sports Sciences, 37-100 Łańcut, Poland
| |
Collapse
|
9
|
Pérez-López FR, Ornat L, Pérez-Roncero GR, López-Baena MT, Sánchez-Prieto M, Chedraui P. The effect of endometriosis on sexual function as assessed with the Female Sexual Function Index: systematic review and meta-analysis. Gynecol Endocrinol 2020; 36:1015-1023. [PMID: 32880200 DOI: 10.1080/09513590.2020.1812570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To systematically compare sexual function between non-treated women with and without endometriosis. METHODS A systematic review was performed on PubMed/Medline, Scopus, EMBASE, Web of Science and Cochrane Library databases searching studies that analyzed sexual function (assessed with the 19-item Female Sexual Function Index [FSFI]), and dyspareunia, chronic pelvic pain and dysmenorrhea (assessed with a visual analogue scale [VAS]) in women with and with endometriosis. RESULTS In 4 studies, non-treated women with endometriosis presented a higher risk of female sexual dysfunction (mean total FSFI score ≤ 26.55; OR = 2.38; 95% confidence interval [CI] = 1.12, 5.04). Although mean total FSFI scores were not significantly different between women with and without endometriosis (mean difference [MD] = -2.15; 95% CI -4.96, 0.67); all FSFI domain scores were significantly lower in women with endometriosis (n = 4 studies): desire (MD = -0.43; 95% CI -0.57, -0.19); arousal (MD = -0.66; 95% CI -1.15, -0.17); lubrication (MD = -0.41; 95% CI -0.79, -0.02); orgasm (MD = -0.40; 95% CI -0.73, -0.06); satisfaction (MD = -0.45; 95% CI -0.72, -0.18); and pain (MD = -1.03; 95% CI -1.34, -0.72). Women with endometriosis displayed differences (more severity) in terms of VAS scores (2 studies) for dyspareunia (MD = 1.88; 95% CI 0.38, 3.37) and chronic pelvic pain (MD = 2.92; 95% CI 1.26, 4.58); but not for dysmenorrhea. CONCLUSION Non-treated women with endometriosis displayed altered sexual function as evidenced by lower scores in all FSFI domains, and severity of dyspareunia and chronic pelvic pain.
Collapse
Affiliation(s)
- Faustino R Pérez-López
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Lía Ornat
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | | | | | - Manuel Sánchez-Prieto
- Departament of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| |
Collapse
|
10
|
Combined vaginal-laparoscopic approach vs. laparoscopy alone for prevention of bladder voiding dysfunction after removal of large rectovaginal endometriosis. J Visc Surg 2020; 158:118-124. [PMID: 32747305 DOI: 10.1016/j.jviscsurg.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To assess whether the combined vaginal-laparoscopic route may reduce the risk of postoperative bladder atony, when compared to an exclusively laparoscopic approach, in patients presenting with deeply infiltrating rectovaginal endometriosis with extensive vaginal infiltration. DESIGN Retrospective comparative cohort study using data prospectively recorded in the CIRENDO database. SETTING Academic Tertiary Care Centre. PATIENTS One hundred and thirty-two consecutive patients who underwent surgery of rectovaginal endometriosis with vaginal infiltration measuring greater than 3cm diameter. INTERVENTIONS Combined vaginal-laparoscopic versus laparoscopic approach. MEASUREMENT AND MAIN RESULTS Sixty-two patients underwent excision of endometriosis via a combined vaginal-laparoscopic approach (study group, or cases), while 71 patients underwent surgery via an exclusively laparoscopic route (controls). Rates of preoperative cyclical voiding difficulty and sensation of incomplete bladder emptying were comparable between the two groups. Preoperative urodynamic assessment was carried out in 18% of cases and 38% of controls, with abnormal results in 27.3% and 11.1% of cases and controls respectively. Early postoperative voiding difficulty (post-void residual>100mL) occurred in 14.7% and 24.3% of cases and controls respectively. There was a significant reduction in risk of intermittent self-catheterisation of 13% at time of discharge in the study cases. Three months postoperatively, one case and 6 controls had persistent voiding dysfunction requiring prolonged self-catheterisation. CONCLUSION The combined vaginal-laparoscopic approach for large rectovaginal endometriotic nodules could reduce the risk of postoperative bladder dysfunction, when compared to an exclusively laparoscopic approach, most likely due to a reduced risk of damage to the pelvic splanchnic nerves at the paravaginal level.
Collapse
|