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Youssef A, Del Magno A, Nedu B, Dapoto F, Brunelli E. Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two-dimensional transperineal ultrasound in nulliparous women with term pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:824-832. [PMID: 38308852 DOI: 10.1002/uog.27595] [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: 11/03/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES The aim of the present study was two-fold. Firstly, we aimed to develop and describe a technique for measurement of the transverse diameter (TD) of the levator ani muscle (LAM) hiatus in the coronal view using two-dimensional (2D) transperineal ultrasound (TPUS) in nulliparous women with a term pregnancy. Secondly, we aimed to evaluate the feasibility and reproducibility of 2D-TPUS assessment of LAM hiatal TD and assess intermethod agreement between 2D-TPUS and three-dimensional (3D) TPUS measurement of TD in the axial plane, which is considered the gold standard in nulliparous women with term pregnancy. METHODS We recruited a group of nulliparous women with term pregnancy before the onset of labor. The study was conducted in two phases: Phase 1 involved developing and describing the 2D-TPUS technique for measuring LAM hiatal TD, and Phase 2 focused on assessing the technique's feasibility, reproducibility and intermethod agreement with 3D-TPUS measurement of LAM hiatal TD. In Phase 1, we enrolled 30 women. Each woman underwent acquisition of a 3D-TPUS volume, which was analyzed using multiplanar mode to identify and determine the appearance of the lateral borders of the LAM in the coronal plane, at the level of the plane of minimal hiatal dimensions. These borders were used as landmarks for TD measurement. Additionally, we measured the distance between the plane used for TD measurement and the center of the urethra in the axial view. In Phase 2, we recruited 100 women. Each woman underwent acquisition of three 2D-TPUS videoclips in the coronal plane, each encompassing a sweep of the entire LAM hiatus, and a 3D volume, all obtained during rest. On the 2D videoclips, TD was measured twice by one operator and once by another operator. In the 3D volume, TD was measured once, by one operator, in the axial plane; this measurement was considered the gold standard. Each operator was blinded to all other measurements during their assessments. We analyzed intraobserver and interobserver reproducibility and performed an intermethod (2D vs 3D) comparison. Bland-Altman analysis was conducted, and Levene's W0 test and Student's t-test were performed to explore clinical factors that might contribute to systematic differences. RESULTS In Phase 1, we identified successfully the landmarks denoting the lateral borders of the LAM hiatal TD in the coronal view. These appeared as two symmetrical hypoechogenic indentations located at the inner border of the hyperechogenic structure of the LAM, at the point of maximum distance between the two sides of the LAM. The distance between the urethra and the plane where TD should be measured using 3D-TPUS in the axial plane had a median of 4 mm and varied from 0 to 9 mm. This enabled us to describe a method for assessing LAM hiatal TD in the coronal plane using 2D-TPUS. In Phase 2, LAM hiatal TD was measured successfully in all 2D and 3D acquisitions from the entire group of 100 women. The analyses for intraobserver and interobserver reproducibility and the intermethod comparison (2D vs 3D) revealed almost perfect agreement in TD measurements using 2D-TPUS, with intraclass correlation coefficients of 0.95 (95% CI, 0.92-0.96), 0.87 (95% CI, 0.78-0.92) and 0.85 (95% CI, 0.78-0.90), respectively. The average differences between measurements were 0.1 mm for intraobserver, 1.0 mm for interobserver and 0.2 mm for intermethod repeatability. No systematic differences were observed in any of the measurement sets, except in the interobserver analysis, although this difference was clinically not significant (38.2 vs 37.2 mm, P = 0.01). None of the examined clinical factors (maternal body mass index and maternal age) exhibited a statistically significant impact on intraobserver, interobserver or intermethod reliability. CONCLUSIONS Utilizing our technique, described herein, to measure the LAM hiatal TD in the coronal view using 2D-TPUS is not only feasible but also highly reproducible and accurate in nulliparous women with term pregnancy. Moreover, it yields measurements that are comparable to those obtained in the reconstructed axial plane generated by 3D-TPUS. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Del Magno
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Nedu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Dapoto
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Maluenda A, Santis-Moya F, Arévalo D, Pohlhammer D, Blumel B, Guzmán-Rojas R, Pizarro-Berdichevsky J. Levator Ani Avulsion in Ultrasound Increases Recurrence in Sacrospinous Fixation. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:505-510. [PMID: 38019478 DOI: 10.1097/spv.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
IMPORTANCE Pelvic floor translabial ultrasound (TLUS) can identify levator ani muscle (LAM) avulsion and ballooning, which some studies have shown to be possible risk factors for prolapse recurrence. Our group uses TLUS to counsel patients preoperatively. If any of these risk factors exist, we offer sacrocolpopexy over vaginal repair. However, some patients, even though they have these possible risk factors, prefer to undergo vaginal surgery. OBJECTIVE The objective of this study was to determine if TLUS LAM avulsion and/or ballooning are risk factors for composite outcome recurrence in patients undergoing sacrospinous ligament fixation for pelvic organ prolapse. STUDY DESIGN This was a retrospective observational study. All patients with vaginal apical repair with sacrospinous ligament fixation with preoperative TLUS were included. Demographics, clinical characteristics, and follow-up were analyzed. Multivariable logistic regression analysis was performed for composite outcome that included TLUS risk factors, age, Pelvic Organ Prolapse Quantification System measurements and stage, and variables with P < 0.1 in the univariate analysis. RESULTS Eighty-two patients were included. All patients had symptomatic vaginal bulge; 65.4% had stage III prolapse. Concomitant hysterectomy was performed in 54.3%. Median follow-up was 20 months (interquartile range, 8-35 months); 19.8% had LAM avulsion, and 43.2% had ballooning. Anatomic recurrence rate was 23.5%, symptomatic was 22.2%, and reoperation was 1.2%. The composite recurrence rate was 29.6%. In the multivariable logistic regression analysis, unilateral/bilateral avulsion in TLUS was found to be a significant risk factor for composite outcome with an odds ratio of 4.33 (confidence interval, 1.219-15.398; P = 0.023). CONCLUSIONS Composite outcome of recurrence in our study was 29.6%. Avulsion on TLUS increased the risk of recurrence of pelvic organ prolapse by fourfold.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Guzmán-Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo
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Bowen ST, Moalli PA, Abramowitch SD, Luchristt DH, Meyer I, Rardin CR, Harvie HS, Hahn ME, Mazloomdoost D, Iyer P, Carper B, Gantz MG. Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study. BJOG 2024; 131:267-277. [PMID: 37522240 PMCID: PMC10828105 DOI: 10.1111/1471-0528.17620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/10/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery. DESIGN Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study. SETTING Eight clinical sites in the US Pelvic Floor Disorders Network. POPULATION OR SAMPLE Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015. METHODS The MRI (rest, strain) obtained 30-42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI-based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three-dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position. MAIN OUTCOME MEASURES Vaginal angulation (upper, lower and upper-lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid-vagina) at rest. RESULTS Of the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid-vagina (p = 0.01) at rest than women with successful surgery. CONCLUSIONS Vaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.
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Affiliation(s)
- Shaniel T Bowen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pamela A Moalli
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Magee Women's Research Institute, Pittsburgh, Pennsylvania, USA
| | - Steven D Abramowitch
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas H Luchristt
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles R Rardin
- Division of Urogynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Heidi S Harvie
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael E Hahn
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Pooja Iyer
- Biostatistics Division, PPD Incorporated, San Francisco, California, USA
| | - Benjamin Carper
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA
| | - Marie G Gantz
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA
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Gong Q, Wang Y, Duan L, Lei L, Liu J, Yao J, Qi J, Xu Z, Nian Y, Wu Y. Comparative study of female pelvic floor among undeformed high-resolution thin-sectional anatomical (visible human) images and MRI and ultrasound images. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:208-218. [PMID: 38108620 DOI: 10.1002/jcu.23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Using visible human, MRI and ultrasound images, we aim to provide an anatomical basis for the identification and diagnosis of pelvic floor structure and disease by ultrasound imaging. METHODS One Chinese visible human (CVH) image, one American visible human image, 9 MRI images of normal volunteers, and 40 ultrasound images of normal volunteers or pelvic organ prolapse patients were used. Pelvic organs, pelvic floor muscles, and the connective tissue in CVH, VHP, MRI, and ultrasound images were selected for comparative study. RESULTS We successfully identified the boundary of the anal sphincter complex, including the subcutaneous, superficial, and deep parts of the external anal sphincter, conjoined longitudinal muscles and internal anal sphincter; the levator ani muscle (LAM), including the internal and external parts of the pubovisceral muscle and the superficial and deep parts of the puborectal muscle; the urethral sphincter complex, including the urethral sphincter proper and the urethral compressor; and the perineal body, the rectoperineal muscle and superficial transverse perineal muscle. CONCLUSIONS We successfully recognized and studied the location, subdivisions, 2D morphology and spatial relationships of the LAM, anal sphincter complex, urethral sphincter complex and perineal body in ultrasound images, thereby helping sonologists or clinicians accurately identify pelvic floor muscles and supporting structures in ultrasound images.
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Affiliation(s)
- Qingfang Gong
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Yangyun Wang
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Li Duan
- Department of Ultrasound, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ling Lei
- Department of Gynecology and Obstetrics, People's Hospital of Anshun, Anshun City, Guizhou Province, China
| | - Jia Liu
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yao
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Jing Qi
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Zhou Xu
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Yongjian Nian
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
| | - Yi Wu
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Military Medical University (Third Military Medical University), Chongqing, China
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Abstract
Female pelvic organ prolapse (POP) is a common condition, which has a high recurrence rate after reconstructive surgery, and the risk factors for POP recurrence are unclear. The aim of this study was to perform a meta-analysis to determine risk factors for POP recurrence. A thorough search of PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and China Academic Journal Network Publishing Database was conducted for relevant publications until 29 October 2022, without language restrictions. A total of 29 studies involving 6597 patients were included, and the recurrence rate of POP after surgery was 37.7%. Significant OR and CI were found for levator avulsion (OR: 2.46, 95% CI: 1.80-3.36), preoperative stage ≥ III (OR: 1.87, 95% CI: 1.53-2.27), hiatal area on Valsalva manoeuvre (OR: 1.08, 95% CI: 1.03-1.12) and previous pelvic floor surgery (OR: 1.60, 95% CI: 1.07-2.39). Levator avulsion, preoperative stage ≥ III, hiatal area on Valsalva manoeuvre and previous pelvic floor surgery are significant risk factors for POP recurrence.IMPACT STATEMENTWhat is already known on this subject? It has been reported that genetic factors, parity, obesity, birth-induced injury during delivery, etc. are risk factors for POP development and recurrence after operation.What do the results of this study add? There are few literatures about the risk factors of POP recurrence at present. Our research has increased the information regarding risk factors for POP recurrence.What are the implications of these findings for clinical practice and/or further research? Our study provides an overview of the risk factors affecting POP recurrence and their contribution (OR, CI) to POP recurrence, which provides valuable evidence-based basis for clinical decision-making in POP treatment and prevention of POP recurrence.
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Affiliation(s)
- Wei Shi
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingling Guo
- Department of Acupuncture and Massage, Zibo Central Hospital, Shandong University, Zibo, China
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Cassadó J, Huguet E, Carmona A, Oteros B, Pessarrodona A, Porta O. Impact of Laparoscopic Prolapse Repair in the Levator Hiatus Area. J Minim Invasive Gynecol 2022; 29:1310-1316. [PMID: 35964943 DOI: 10.1016/j.jmig.2022.08.002] [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: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To determine whether laparoscopic surgery by sacrocolpopexy or sacrocervicopexy with posterior mesh attachment to levator ani to treat pelvic organ prolapse reduces the levator hiatus area, as measured by transperineal 3- and 4-dimensional ultrasound. The secondary objective was to assess the risk factors for prolapse recurrence. DESIGN This is a prospective cohort study. SETTING A university tertiary hospital. PATIENTS Women with symptomatic apical prolapse at a high risk of recurrence were included. High risk of recurrence was defined as age <60 years and levator injury (avulsion and/or ballooning) or stage III-IV prolapse Pelvic Organ Prolapse Quantification. INTERVENTIONS Women were treated with laparoscopic sacrocolpopexy or sacrocervicopexy. MEASUREMENTS AND MAIN RESULTS Women underwent clinical examination according to assessment by the Pelvic Organ Prolapse Quantification system and transperineal ultrasound for the levator hiatus area at Valsalva. We collected demographic, clinical, and ultrasound data before surgery from clinical records and performed a comparative analysis of the levator hiatus areas before and after surgery and univariate and multivariate analyses of the risk factors for recurrence. Among the 30 women who enrolled, the levator hiatus area at Valsalva decreased significantly after surgery by an average of 4.68 cm2 (p = .028). However, despite a recurrence rate of 13.3%, we found no risk factors associated with recurrence in either the univariate or the multivariate analyses. CONCLUSION Laparoscopic surgery by sacrocolpopexy or sacrocervicopexy for pelvic organ prolapse with mesh posterior attachment to levator ani significantly reduces the levator hiatus area measured by transperineal ultrasound. Further large-scale studies will be needed to confirm our results and identify risk factors for recurrence.
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Affiliation(s)
- Jordi Cassadó
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors).
| | - Eva Huguet
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | - Anna Carmona
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | - Beatriz Oteros
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | | | - Oriol Porta
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
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Yeung E, Malacova E, Maher C. Is levator ani avulsion a risk factor for prolapse recurrence? A systematic review and meta-analysis. Int Urogynecol J 2022; 33:1813-1826. [PMID: 35538253 PMCID: PMC9270296 DOI: 10.1007/s00192-022-05217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
Introduction and hypothesis Levator ani muscle avulsion as a risk factor for prolapse recurrence is not well established. This systematic review was aimed at evaluating the correlation between levator ani avulsion and postoperative prolapse recurrence with meta-analysis, specifically, the risk of subjective or objective prolapse recurrence and reoperation. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (registration number CRD42021256675). A systematic literature search was conducted using PubMed, EMBASE and Cochrane Database of Systematic Reviews to identify all peer-reviewed studies that described levator avulsion in women and investigated operative and postoperative outcomes. All peer-reviewed, English-language cohort studies in those with and without levator avulsion with a minimum of 3 months’ follow-up were included. Pooled unadjusted and adjusted odds ratios were calculated for subjective recurrence, objective recurrence and rates of re-operation. The Cochrane Collaboration Risk of Bias In Non-Randomized Studies (RoBINS) and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools were used to assess the quality of the studies included. Results Twelve studies with a total of 2,637 subjects and a follow-up period 0.3–6.4 years were identified. There were insufficient data to report a pooled adjusted risk for subjective recurrence and reoperation. On low to moderate quality-adjusted data, the pooled odds of objective recurrence was not significantly associated with levator ani avulsion (aOR 1.68; 95% CI 0.78–3.66). Conclusion Levator ani avulsion has not been confirmed as a risk factor for objective prolapse recurrence. Further evidence is needed to investigate the correlation between levator ani avulsion and the risk of subjective recurrence and reoperation. Supplementary information The online version contains supplementary material available at 10.1007/s00192-022-05217-2
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Affiliation(s)
- Ellen Yeung
- Department of Urogynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,The University of Queensland, Saint Lucia, QLD, Australia.
| | - Eva Malacova
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Christopher Maher
- Department of Urogynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,The University of Queensland, Saint Lucia, QLD, Australia
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Liu Z, Sharen G, Wang P, Chen L, Tan L. Clinical and pelvic floor ultrasound characteristics of pelvic organ prolapse recurrence after transvaginal mesh pelvic reconstruction. BMC Womens Health 2022; 22:102. [PMID: 35379231 PMCID: PMC8981864 DOI: 10.1186/s12905-022-01686-1] [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: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Recurrence of pelvic organ prolapse (POP) after transvaginal mesh (TVM) implantation pelvic floor reconstruction surgery remains an unresolved problem in clinical practice. In this retrospective observational study, clinical and pelvic floor ultrasound (PFUS) parameters were analyzed in order to identify high-risk factors of POP recurrence.
Methods The clinical and PFUS data from September 2013 to November 2019 of patients who underwent TVM were retrospectively analyzed. The patients with prolapse recurrence on postoperative follow-up diagnosed by PFUS were selected as case group, the clinical and PFUS parameters of them were compared with the control group in which the patients had no sign of prolapse recurrence. Univariate and multivariate regression analyses were performed based on age, BMI, gravidity, parity, surgical history (non-POP hysterectomy and incontinence-or-POP surgery), preoperative POP stage, follow-up in years, levator avulsion and hiatal area (HA) on Valsalva. Results Altogether 102 patients entered the study and the median interval between PFUS and TVM surgery was 2.5 years. Univariate analysis showed that levator avulsion and HA were significantly different between case group and control; multivariate regression analysis showed that only HA was related to prolapse recurrence after TVM (OR = 1.202, 95% CI 1.100–1.313, P < 0.001). The area under the ROC curve was 0.775 (95% CI 0.684–0.867, P < 0.001). Conclusions Hiatal area on Valsalva was related to prolapse recurrence after TVM surgery and it is an important parameter for postoperative follow-up of TVM surgery.
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Affiliation(s)
- Zhenzhen Liu
- Department of Ultrasound Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Gaowa Sharen
- Department of Health Management, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Pan Wang
- Department of Ultrasound, The Sixth Hospital of Beijing, Beijing, China
| | - Liyuan Chen
- Department of Ultrasound, Bozhou People's Hospital Affiliated to Anhui University of Technology, Anhui Province, China
| | - Li Tan
- Department of Ultrasound Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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Wu S, Ren Y, Lin X, Huang Z, Zheng Z, Zhang X. Development and validation of a composite AI model for the diagnosis of levator ani muscle avulsion. Eur Radiol 2022; 32:5898-5906. [PMID: 35362748 DOI: 10.1007/s00330-022-08754-y] [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: 11/06/2021] [Revised: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility and reliability of a composite AI model for the diagnosis of levator ani muscle (LAM) avulsion of tomographic ultrasound imaging (TUI). METHODS Ultrasonic images of the pelvic floor from a total of 304 patients taken from January 2018 to October 2020 were included. All patients included underwent standardized interviews and transperineal ultrasound (TPUS). Transfer-learning and ensemble-learning methods were adopted to develop the proposed model on the basis of three classic convolutional neural networks (CNN). Confusion matrix (CM) and the ROC statistic were used to assess the effectiveness of the proposed model. Gradient-weighted class activation mappings (Grad-CAMs) were used to help enhance the interpretability of the proposed model. RESULTS Of the 304 patients included, 208 were in the derivation cohort (108 LAM avulsion and 100 normal) and 96 (39 LAM avulsion and 57 normal) were in the validation cohort. The proposed model in LAM avulsion diagnosis outperformed other models and a junior clinician in both the test set of derivation cohort and the validation cohort, with accuracies of 0.95 and 0.81, and AUCs of 0.98 and 0.86, respectively. According to the heatmap of Grad-CAMs, the proposed model mainly localizes areas between the pubic symphysis and the bilateral insertion point of LAM when making a diagnosis, which is exactly the region of interest in clinical practice. CONCLUSION The proposed model using ultrasonic images of the pelvic floor may be a promising tool in assisting the diagnosis of LAM avulsion in clinical practice. KEY POINTS • First AI-assisted model for levator ani muscle avulsion diagnosis • Diagnosis accuracy of less-experienced clinicians could be improved using the proposed model.
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Affiliation(s)
- Shuangyu Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Yong Ren
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong Province, China.,Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, Guangdong Province, China
| | - Xin Lin
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Zeping Huang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Zhijuan Zheng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China.
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Nyhus MØ, Mathew S, Salvesen KÅ, Volløyhaug I. The impact of levator ani muscle trauma and contraction on recurrence after prolapse surgery. Int Urogynecol J 2022; 33:2879-2885. [PMID: 35347367 PMCID: PMC9477913 DOI: 10.1007/s00192-022-05168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/02/2022] [Indexed: 12/01/2022]
Abstract
Introduction and hypothesis The objective was to explore the impact of levator ani muscle (LAM) trauma and pelvic floor contraction on symptoms and anatomy after pelvic organ prolapse (POP) surgery. Methods Prospective study including 200 women with symptomatic POP ≥ grade 2 examined 3 months prior to and 6 months after surgery. Prolapse in each compartment was graded using the Pelvic Organ Prolapse Quantification (POP-Q) system, and women answered yes/no to a question about bulge sensation. Pelvic floor muscle contraction was assessed with transperineal ultrasound measuring proportional change in levator hiatal anteroposterior diameter from rest to contraction. LAM trauma was diagnosed using tomographic ultrasound imaging. Statistical analysis was performed using multivariate logistic regression analysis. Results A total of 183 women (92%) completed the study. Anatomical recurrence (POP ≥ grade 2) was found in 76 women (42%), and a bulge sensation was reported by 35 (19%). Ninety-two women (50%) had LAM trauma, and this was associated with increased risk of anatomical recurrence (OR 2.1 (95% CI 1.1–4.1), p = 0.022), but not bulge sensation (OR 1.1 (95% CI 0.5–2.4), p = 0.809). We found a reduced risk of bulge sensation for women with absent to weak contraction compared with normal to strong contraction (OR 0.4 (95% CI 0.1–0.9), p = 0.031), but no difference in risk for POP ≥ 2 after surgery (OR 1.5 (95% CI 0.8–2.9), p = 0.223). Conclusions Levator ani muscle trauma was associated with increased risk of anatomical failure 6 months after POP surgery. Absent to weak pelvic floor muscle contraction was associated with reduced risk of bulge sensation after surgery.
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11
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Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse. Menopause 2022; 29:390-396. [DOI: 10.1097/gme.0000000000001939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/14/2021] [Indexed: 11/26/2022]
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12
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Coutinho F, Veiga M, Carvalho R, Mineiro S, Nunes F. Pelvic organ prolapse repair-relapse risk factors: A 10-year retrospective study. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Schmidt P, Chen L, DeLancey JO, Swenson CW. Preoperative level II/III MRI measures predicting long-term prolapse recurrence after native tissue repair. Int Urogynecol J 2022; 33:133-141. [PMID: 34043048 PMCID: PMC8626527 DOI: 10.1007/s00192-021-04854-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To identify preoperative level II/III MRI measures associated with long-term recurrence after native tissue prolapse repair. METHODS Women who previously participated in pelvic floor research involving MRI prior to undergoing primary native tissue prolapse repair were recruited to return for repeat examination and MRI. Recurrence was defined by POP-Q (Ba/Bp > 0 or C > -4), repeat surgery, or pessary use. Preoperative MR images were used to perform five level II/III measurements including a new levator plate (LP) shape analysis at rest and maximal Valsalva. Principal component analysis (PCA) was used to evaluate LP shape variations. Principal component scores calculated for two independent shape variations were noted. RESULTS Thirty-five women were included with a mean follow-up of 13.2 ± 3.3 years. Nineteen (54%) were in the success group. There were no statistical differences between success versus recurrence groups in demographic, clinical, or surgical characteristics. Women with recurrence had a larger preoperative resting levator hiatus [median 6.4 cm (IQR 5.7, 7.1) vs. 5.8 cm (IQR 5.3, 6.3), p = 0.03]. This measure was associated with increased odds of recurrence (OR 8.2, CI 1.4-48.9, p = 0.02). Using PCA, preoperative LP shape PC1 scores were different between success and recurrence groups (p = 0.02), with a more dorsally oriented LP shape associated with recurrence. CONCLUSIONS Larger preoperative levator hiatus at rest and a more dorsally oriented levator plate shape were associated with prolapse recurrence at long-term follow-up. For every 1 cm increase in preoperative resting levator hiatus, the odds of long-term prolapse recurrence increases 8-fold.
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Affiliation(s)
- Payton Schmidt
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Luyun Chen
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Rusavy Z, Paymova L, Kozerovsky M, Veverkova A, Kalis V, Kamel RA, Ismail KM. Levator ani avulsion: a Systematic evidence review (LASER). BJOG 2021; 129:517-528. [PMID: 34245656 DOI: 10.1111/1471-0528.16837] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors. OBJECTIVE To explore the incidence rate of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. SEARCH STRATEGY We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. STUDY ELIGIBILITY CRITERIA A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included. DATA COLLECTION AND ANALYSIS RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses. RESULTS We included 37 primary non-randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum-assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum. CONCLUSIONS LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis. TWEETABLE ABSTRACT Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
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Affiliation(s)
- Z Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynaecology, University Hospital, Pilsen, Czech Republic
| | - L Paymova
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynaecology, University Hospital, Pilsen, Czech Republic
| | - M Kozerovsky
- Department of Obstetrics and Gynaecology, University Hospital, Pilsen, Czech Republic
| | - A Veverkova
- Department of Obstetrics and Gynaecology, University Hospital, Pilsen, Czech Republic
| | - V Kalis
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Obstetrics and Gynaecology, University Hospital, Pilsen, Czech Republic
| | - R A Kamel
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Cairo University, Cairo, Egypt
| | - K M Ismail
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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15
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Kamisan Atan I, Lin S, Dietz HP, Herbison P, Wilson PD. Levator ani muscle avulsion: Digital palpation versus tomographic ultrasound imaging. Int J Gynaecol Obstet 2021; 156:270-275. [PMID: 33900622 DOI: 10.1002/ijgo.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of digital palpation of levator ani muscle (LAM) avulsion compared with translabial tomographic ultrasound imaging (TUI). METHODS A cross-sectional study, incorporating 195 women involved in a longitudinal cohort study. Palpation for levator integrity was performed, followed by a four-dimensional translabial ultrasound. LAM avulsion defects were diagnosed in the presence of puborectalis muscle detachment from its insertion. Post-processing analysis of ultrasound volumes for LAM integrity on TUI was performed blinded against palpation findings. Agreement between methods was assessed using Cohen's κ. RESULTS In all, 388 paired assessments of LAM bilaterally, were available. Sixteen (8.2%) unilateral avulsion defects were detected on palpation. Sonographically, 31 (16%) were diagnosed with avulsions: 4.6% bilateral and 11.3% unilateral. An overall agreement of 91% was observed between digital palpation and TUI, yielding a Cohen's κ of 0.32 (95% confidence interval 0.15-0.48) demonstrating "fair agreement": and implying 25% sensitivity, 98% specificity, 63% positive predictive value, and 92% negative predictive value. Analysis of the first and last 20 palpations showed no change in performance during the 13-day study period. CONCLUSION Assessment of LAM avulsion defects by digital palpation is feasible but may require substantial training. Confirmation by imaging is crucial, especially if the diagnosis of avulsion may influence clinical management.
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Affiliation(s)
- Ixora Kamisan Atan
- Department of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia.,Department of Obstetrics & Gynecology, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Sylvia Lin
- Department of Obstetrics & Gynaecology, Women's Health Waikato DHB, Hamilton, New Zealand.,Department of Obstetrics & Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hans Peter Dietz
- Department of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
| | - Peter Herbison
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Donald Wilson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Wong NKL, Cheung RYK, Lee LL, Wan OYK, Choy KW, Chan SSC. Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:631-638. [PMID: 32898286 DOI: 10.1002/uog.23109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/29/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Mesh repair surgery for pelvic organ prolapse (POP) has been suspended in some countries owing to concerns about its associated complications. However, mesh repair has been shown to reduce the risk of prolapse recurrence after surgery. In view of this controversy, our aim was to assess the incidence of subjective and objective recurrence of POP following mesh repair surgery vs native-tissue repair in women with Stage-III or Stage-IV POP. METHODS This was a prospective observational study of women who presented with Stage-III or Stage-IV POP and received primary prolapse surgery between 2013 and 2018. Transperineal ultrasound was performed before the operation and volumes were analyzed offline to assess the presence of levator ani muscle (LAM) avulsion. All women were counseled on either mesh repair or native-tissue reconstruction. The mesh-repair group was followed up for up to 5 years and the native-tissue-repair group for up to 2 years after the operation. Prolapse symptoms and POP quantification (POP-Q) staging were assessed at follow-up. Subjective recurrence of POP was defined as symptoms of prolapse (vaginal bulge sensation or dragging sensation) reported by the patient. Objective recurrence was defined as POP-Q ≥ Stage II. The subjective and objective recurrences of prolapse were compared between women with and those without mesh use. Multivariate regression analysis was used to identify risk factors for the recurrence of POP. RESULTS A total of 154 Chinese women with Stage-III or Stage-IV prolapse were recruited. Of these, 104 (67.5%) underwent mesh repair (transabdominal in 57 women and transvaginal in 47 women) and 50 (32.5%) had native-tissue repair surgery. Ninety-five (61.7%) women had LAM avulsion. Both the subjective POP recurrence rate (4.8% vs 20.0%; P = 0.003) and the objective recurrence rate (20.2% vs 46.0%; P = 0.001) were significantly lower in the mesh-repair group than in the native-tissue-repair group. On multivariate logistic regression analysis, mesh repair was associated significantly with a reduced risk of subjective recurrence (odds ratio (OR), 0.20 (95% CI, 0.07-0.63)) and of objective recurrence (OR, 0.16 (95% CI, 0.07-0.55)) of prolapse. On subgroup analysis of women with LAM avulsion, mesh repair significantly reduced the risk of subjective recurrence (OR, 0.24 (95% CI, 0.07-0.87)) and objective recurrence (OR, 0.23 (95% CI, 0.09-0.57)) of POP. The incidence of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. CONCLUSIONS Mesh repair surgery, compared with native-tissue repair, was associated with a 5-fold reduction in the risk of subjective recurrence and a 6-fold reduction in the risk of objective recurrence of prolapse in women with Stage-III or Stage-IV POP. In women with concomitant LAM avulsion, mesh repair surgery was associated with a 4-fold reduction in both objective and subjective recurrence of POP. The rate of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. The benefit of mesh surgery for these high-risk women appears to outweigh the risks of mesh complications, and it could be a treatment option for this group of women. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N K L Wong
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - R Y K Cheung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - L L Lee
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - O Y K Wan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - K W Choy
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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18
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Santis-Moya F, Pineda R, Miranda V. Preoperative ultrasound findings as risk factors of recurrence of pelvic organ prolapse after laparoscopic sacrocolpopexy. Int Urogynecol J 2020; 32:955-960. [PMID: 32852573 DOI: 10.1007/s00192-020-04503-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study is to evaluate levator ani muscle avulsion (LAMA) and ballooning as risk factors for recurrence of pelvic organ prolapse (POP) after laparoscopic sacrocolpopexy (SCP). We hypothesize that these ultrasound findings are associated with a higher risk of POP recurrence. METHODS Retrospective cohort study of patients who underwent laparoscopic SCP between January 2015 and December 2018. Baseline translabial 3D ultrasound of the pelvic floor was performed. Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were applied. Both univariate and multivariate analyses were carried out. RESULTS One hundred thirty-four patients were included. On ultrasound, 32% of patients had levator ani muscle avulsion, and 36.5% had ballooning. Mean follow-up time was 16 months. There was a 13.4% anatomic recurrence; five of them (3.7%) also had symptomatic recurrence. After multivariate analysis we found that LAMA and ballooning were not significant: OR 0.99 (95% CI 0.098-10.1; p = 0.99) and OR 1.1 (95% CI 0.99-1.2; p = 0.06), respectively. CONCLUSIONS LAMA and ballooning on pelvic floor US are not significant risk factors for anatomic POP recurrence after laparoscopic SCP. Laparoscopic SCP has a 13.4% and 3.4% anatomic and symptomatic recurrence rate, respectively, and the majority of patients reported significant improvement in quality of life.
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Affiliation(s)
- Fernanda Santis-Moya
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile.
| | - Rodrigo Pineda
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile
| | - Victor Miranda
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile
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20
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Diez-Itza I, Avila M, Uranga S, Belar M, Lekuona A, Martin A. Factors involved in prolapse recurrence one year after anterior vaginal repair. Int Urogynecol J 2020; 31:2027-2034. [PMID: 32757023 DOI: 10.1007/s00192-020-04468-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to identify which factors are associated with anatomic and symptomatic prolapse recurrence in the anterior compartment 1 year after traditional anterior vaginal repair. Our study hypothesis was that major defects in pelvic floor support structures before surgery are associated with higher recurrence rates. METHODS This was a prospective multicenter study including women with symptomatic anterior compartment prolapse who underwent primary vaginal surgery. Prolapse examination was performed using the Pelvic Organ Prolapse Quantification (POP-Q) system, prolapse symptoms were described using the Pelvic Floor Distress Inventory short form (PFDI-20), and levator ani avulsion and hiatal area were identified by translabial 3D ultrasonography. RESULTS During the inclusion period, 455 patients were recruited and 442 (97.1%) attended the 1-year follow-up. In three cases, ultrasound data were not available, and the remaining 439 formed the study group. Anatomic and symptomatic recurrence rates were 45.1% and 6.8%, respectively. Levator avulsion increased the risk of anatomic (OR: 1.96) and symptomatic (OR: 2.60) recurrence; abnormal distensibility of the levator hiatal area increased the risk of anatomic (OR: 2.51) and symptomatic (OR: 2.43) recurrence; advanced prolapse increased the risk of anatomic recurrence: POP-Q stage 3 (OR: 2.34) and POP-Q stage 4 (OR: 5.47). CONCLUSIONS Major defects in pelvic floor support structures before surgery are associated with higher recurrence rates 1 year after native tissue vaginal repair. Advanced stage of prolapse increases the risk of anatomic recurrence, while levator avulsion and abnormal distensibility of the levator hiatus area increase the risk of both anatomic and symptomatic recurrence.
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Affiliation(s)
- Irene Diez-Itza
- Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain. .,Departamento de Especialidades Médico-Quirúrgicas, Universidad del País Vasco / Euskal Herriko Unibertsitatea, Leioa, Spain. .,IIS Biodonostia, San Sebastián, Spain.
| | - Marisa Avila
- Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain
| | - Sabiñe Uranga
- Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain.,Departamento de Especialidades Médico-Quirúrgicas, Universidad del País Vasco / Euskal Herriko Unibertsitatea, Leioa, Spain
| | - Maria Belar
- Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain.,IIS Biodonostia, San Sebastián, Spain
| | - Arantza Lekuona
- Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain.,Departamento de Especialidades Médico-Quirúrgicas, Universidad del País Vasco / Euskal Herriko Unibertsitatea, Leioa, Spain.,IIS Biodonostia, San Sebastián, Spain
| | - Alicia Martin
- Servicio de Obstetricia y Ginecología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
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Zhou M, Du H, Ying T, Shui W, Dou C. Value of high-frequency two-dimensional ultrasound on evaluating puborectalis muscle. Arch Gynecol Obstet 2020; 301:1347-1352. [PMID: 32266525 DOI: 10.1007/s00404-020-05523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the value of high-frequency two-dimensional (2D) ultrasound on demonstrating the morphology of puborectalis muscle and detect muscle avulsion. METHODS High-frequency 2D ultrasound and tomographic ultrasound image (TUI) were peformed to demonstrate puborectalis muscle and detect muscle avulsion respectively among 158 women with or without significant pelvic organ prolapse (POP) (POP quantification grade 2 or higher). Mean values were compared using student's t test between women with or without avulsion defects. We performed Cohen's Kappa analysis to examine the test agreement between high-frequency 2D ultrasound and TUI mode. Pearson correlation analysis was performed to explore the relationship between the thickness of puborectalis muscle and the measurements of levator-urethra gap (LUG). RESULTS The result of high-frequency 2D ultrasound in detecting muscle avulsion agreed well with TUI mode (Kappa 0.88, P < 0.05). Women with muscle avulsion had thinner muscles and larger LUG measurements than those with normal muscle insertion (P < 0.05). Pearson correlation analysis revealed the negative relationship between the thickness of puborectalis muscle and LUG measurements (r = - 0.73). CONCLUSION The study confirmed that it was feasible to observe the morphology of puborectalis muscle and detect muscle avulsion by high-frequency 2D ultrasound.
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Affiliation(s)
- Minzhi Zhou
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Haiwen Du
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Wen Shui
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Chaoran Dou
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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23
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A pilot study on surgical reduction of the levator hiatus—the puborectalis sling. Int Urogynecol J 2019; 30:2127-2133. [DOI: 10.1007/s00192-019-04062-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022]
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Xuan Y, Friedman T, Dietz HP. Does levator ani hiatal area configuration affect pelvic organ prolapse? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:124-127. [PMID: 30584675 DOI: 10.1002/uog.20210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/09/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Levator ani trauma and hiatal overdistension have been shown to be associated with female pelvic organ prolapse (POP); however, the role of the shape of the levator hiatus in POP has not been examined to date. The aim of this study was to investigate the association between the configuration of the levator ani hiatus and POP. METHODS This was a retrospective study of 547 women who attended a tertiary urogynecological center for symptoms of pelvic floor and lower urinary tract dysfunction between October 2014 and August 2016. All women underwent a standardized interview and prolapse assessment using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) method and four-dimensional translabial ultrasound (TLUS). Measurements of the hiatal anteroposterior diameter (APD), coronal diameter (CD) and hiatal area (HA), at rest and on maximal Valsalva maneuver, and those of organ descent were performed offline at a later date by an investigator blinded to all other data. Hiatal configuration was defined as the ratio APD/CD. Associations between HA and HA adjusted by APD/CD at rest and on maximal Valsalva and symptoms and signs of prolapse were analyzed statistically using logistic regression modelling. RESULTS The mean age of the women was 54 ± 13.6 (range, 16-89) years. Of the 547 women included, 241 (44%) presented with prolapse symptoms. Clinically significant POP was detected in 406 (74%) patients and significant prolapse on TLUS was detected in 331 (61%). Hiatal ballooning was observed in 310 (57%) women and this was strongly associated with signs and symptoms of POP. HA at rest and on Valsalva was associated with significant POP both on clinical examination and on TLUS. Adjusted odds ratios for hiatal shape showed no effect of the hiatal configuration on the association between HA and POP. CONCLUSION Hiatal shape does not seem to influence the association between HA and symptoms and signs of prolapse. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Y Xuan
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Sydney Medical School Nepean, University of Sydney, Penrith, Australia
| | - T Friedman
- Sydney Medical School Nepean, University of Sydney, Penrith, Australia
| | - H P Dietz
- Sydney Medical School Nepean, University of Sydney, Penrith, Australia
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Mastwyk S, McClelland J, Rosamilia A, Frawley H. The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review. Neurourol Urodyn 2019; 38:1467-1481. [DOI: 10.1002/nau.24025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sally Mastwyk
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Jodie McClelland
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourne Victoria Australia
| | - Anna Rosamilia
- Department of Obstetrics and GynaecologyMonash UniversityClayton Victoria Australia
- Monash HealthClayton Victoria Australia
| | - Helena Frawley
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourne Victoria Australia
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Oversand SH, Staff AC, Volløyhaug I, Svenningsen R. Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery. Acta Obstet Gynecol Scand 2019; 98:1046-1054. [PMID: 30859546 DOI: 10.1111/aogs.13604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Levator ani muscle avulsions potentially increase recurrence after anterior colporrhaphies. We aimed at evaluating the impact of avulsions on anatomical and patient-reported outcomes 1 year after the Manchester procedure for primary anterior compartment pelvic organ prolapse. MATERIAL AND METHODS Prospective cohort study of 189 women undergoing the Manchester procedure between October 2014 and January 2017. Avulsions were diagnosed by transperineal ultrasound. Women with and without avulsions were compared for 1-year postoperative outcomes; Pelvic Organ Prolapse Quantification measurements, subjective satisfaction (1-worse to 4-cured), failure (new prolapse treatment), response to validated questionnaires on pelvic floor distress and sexual function, and a composite outcome (subjectively cured and optimal anterior compartment outcome (stage 0-I)). Optimal mid-compartment outcome was defined as cervix ≥5 cm above the hymen. Factors potentially associated with poor anatomical outcomes (anterior compartment stage ≥II) or pelvic floor distress were analyzed using regression analyses. RESULTS Fewer women with avulsions (present in 50.8%) obtained optimal mid-compartment outcomes (88.2% vs 77.1%; P = 0.05). The groups were otherwise similar in terms of mid-compartment reduction, anterior compartment results, failure rate, subjective satisfaction, pelvic floor/sexual symptoms, and combined optimal subjective and anatomical outcome. Only preoperative anterior compartment stage ≥III was associated with poor anatomical outcome (P < 0.01). A high preoperative symptom score was associated with a high postoperative symptom score (P < 0.001). CONCLUSIONS Although fewer women with avulsions obtained optimal mid-compartment results, avulsions had no impact on other anatomical or symptomatic outcomes 1 year after the Manchester procedure for primary anterior compartment prolapse.
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Affiliation(s)
- Sissel H Oversand
- Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne C Staff
- Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
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The impact of variations in obstetric practice on maternal birth trauma. Int Urogynecol J 2019; 30:917-923. [DOI: 10.1007/s00192-019-03887-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
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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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Cohen SA. Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brocker KA, Mokry T, Alt CD, Kauczor HU, Lenz F, Sohn C, DeLancey JO, Chen L. 3D reconstruction of MR-visible Fe 3 O 4 -mesh implants: Pelvic mesh measurement techniques and preliminary findings. Neurourol Urodyn 2018; 38:369-378. [PMID: 30387537 DOI: 10.1002/nau.23868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022]
Abstract
AIMS To develop MR-based measurement technique to evaluate the postoperative dimension and location of implanted magnetic resonance (MR)-visible meshes. METHODS This technique development study reports findings of six patients (A-F) with cystoceles treated with anterior vaginal MR-visible Fe3 O4 -polypropylene implants. Implanted meshes were reconstructed from 3 months and/or 1 year postsurgical MR-images using 3D Slicer®. Measurements including mesh length, distance to the ischial spines, pudendal, and obturator neurovascular bundles and urethra were obtained using software Rhino® and a custom Matlab® program. The range of implanted mesh length and their placements were reported and compared with mesh design and implantation recommendations. With the anterior/posterior-mesh-segment-ratio mesh shrinkage localization was evaluated. RESULTS Examinations were possible for patients A-D 3 months and for A, C, E, and F 1 year postsurgical. The mesh was at least 40% shorter in all patients 3 months and/or 1 year postoperatively. A, B showed shrinkage in the anterior segment, D, E in the posterior segment (Patients C, F not applicable due to intraoperative mesh trimming). Patient E presented pain in the area of mesh shrinkage. In Patient C posterior mesh fixations were placed in the iliococcygeal muscle rather than sacrospinous ligaments. Arm placement less than 20 mm from the pudendal neurovascular bundles was seen in all cases. The portion of the urethra having mesh underneath it ranged from 19% to 55%. CONCLUSIONS MRI-based measurement techniques have been developed to quantify implanted mesh location and dimension. Mesh placement variations possibly correlating with postoperative complications can be illustrated.
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Affiliation(s)
- Kerstin A Brocker
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Céline D Alt
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf, Duesseldorf, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Lenz
- Department of Obstetrics and Gynecology, St. Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University Medical School Heidelberg, Ludwigshafen am Rhein, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - John O DeLancey
- Pelvic Floor Research Group, Obstetrics and Gynecology Department, University of Michigan, Ann Arbor, Michigan
| | - Luyun Chen
- Pelvic Floor Research Group, Biomedical Engineering Department, University of Michigan, Ann Arbor, Michigan
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Caudwell-Hall J, Kamisan Atan I, Guzman Rojas R, Langer S, Shek KL, Dietz HP. Atraumatic normal vaginal delivery: how many women get what they want? Am J Obstet Gynecol 2018; 219:379.e1-379.e8. [PMID: 30063899 DOI: 10.1016/j.ajog.2018.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Trauma to the perineum, levator ani complex, and anal sphincter is common during vaginal childbirth, but often clinically underdiagnosed, and many women are unaware of the potential for long-term damage. OBJECTIVE In this study we use transperineal ultrasound to identify how many women will achieve a normal vaginal delivery without substantial damage to the levator ani or anal sphincter muscles, and to create a model to predict patient characteristics associated with successful atraumatic normal vaginal delivery. STUDY DESIGN This is a retrospective, secondary analysis of data sets gathered in the context of an interventional perinatal imaging study. A total of 660 primiparas, carrying an uncomplicated singleton pregnancy, underwent an antepartum and postpartum interview, vaginal exam (Pelvic Organ Prolapse Quantification), and 4-dimensional translabial ultrasound. Ultrasound data were analyzed for levator trauma and/or overdistention and residual sphincter defects. Postprocessing analysis of ultrasound volumes was performed blinded against clinical data and analyzed against obstetric data retrieved from the local maternity database. Levator avulsion was diagnosed if the muscle insertion at the inferior pubic ramus at the plane of minimal hiatal dimensions and within 5 mm above this plane on tomographic ultrasound imaging was abnormal, ie the muscle was disconnected from the inferior pubic ramus. Hiatal overdistensibility (microtrauma) was diagnosed if there was a peripartum increase in hiatal area on Valsalva by >20% with the resultant area ≥25 cm2. A sphincter defect was diagnosed if a gap of >30 degrees was seen in ≥4 of 6 tomographic ultrasound imaging slices bracketing the external anal sphincter. Two models were tested: a first model that defines severe pelvic floor trauma as either obstetric anal sphincter injury or levator avulsion, and a second, more conservative model, that also included microtrauma. RESULTS A total of 504/660 women (76%) returned for postpartum follow-up as described previously. In all, 21 patients were excluded due to inadequate data or intercurrent pregnancy, leaving 483 women for analysis. Model 1 defined nontraumatic vaginal delivery as excluding operative delivery, obstetric anal sphincter injuries, and sonographic evidence of levator avulsion or residual sphincter defect. Model 2 also excluded microtrauma. Of 483 women, 112 (23%) had a cesarean delivery, 103 (21%) had an operative vaginal delivery, and 17 (4%) had a third-/fourth-degree tear, leaving 251 women who could be said to have had a normal vaginal delivery. On ultrasound, in model 1, 27 women (6%) had an avulsion and 31 (6%) had a residual defect, leaving 193/483 (40%) who met the criteria for atraumatic normal vaginal delivery. In model 2, an additional 33 women (7%) had microtrauma, leaving only 160/483 (33%) women who met the criteria for atraumatic normal vaginal delivery. On multivariate analysis, younger age and earlier gestation at time of delivery remained highly significant as predictors of atraumatic normal vaginal delivery in both models, with increased hiatal area on Valsalva also significant in model 2 (all P ≤ .035). CONCLUSION The prevalence of significant pelvic floor trauma after vaginal child birth is much higher than generally assumed. Rates of obstetric anal sphincter injury are often underestimated and levator avulsion is not included as a consequence of vaginal birth in most obstetric text books. In this study less than half (33-40%) of primiparous women achieved an atraumatic normal vaginal delivery.
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Affiliation(s)
- Jessica Caudwell-Hall
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia
| | - Ixora Kamisan Atan
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia; Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Rodrigo Guzman Rojas
- Departamento de Ginecología y Obstetricia, Clínica Alemana de Santiago-Universidad del Desarrollo, Chile; Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Susanne Langer
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia
| | - Ka Lai Shek
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia; Liverpool Clinical School, Western Sydney University, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia.
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Wang X, Ren M, Liu Y, Zhang T, Tian J. Perineal Ultrasound Versus Magnetic Resonance Imaging (MRI) Detection for Evaluation of Pelvic Diaphragm in Resting State. Med Sci Monit 2018; 24:4449-4454. [PMID: 29952373 PMCID: PMC6054773 DOI: 10.12659/msm.906648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the consistency differences between ultrasound and MRI detection methods and the reliability between 2 independent observers. MATERIAL AND METHODS Under 2 kinds of states - the resting state and muscle contractions state - intra-class correlation coefficients (ICCs) were calculated and the consistency of 2 diagnostic methods was evaluated by 2 independent observers. We also assessed the interscorer reliability of the 2 observers. RESULTS In terms of the evaluation of biological parameters of the pelvic diaphragm, the consistency of the 2 diagnostic methods was moderate. The ICC of pelvic diaphragm area was 0.55 (95% CI 0.35-0.71), anteroposterior diameter was 0.48 (95% CI 0.28-0.64), and transverse diameter was 0.43 (95% CI 0.25-0.63). The ultrasound detection values of the perineal ultrasound were significantly smaller than those of the MRI. In addition, these differences were increased with the rise of the pelvic diaphragm area. CONCLUSIONS By evaluating the pelvic diaphragm in patients with pelvic organ prolapse in the resting state, it was preliminarily confirmed that the consistency of ultrasound and MRI was only moderate. The comparison of these 2 diagnostic methods under the dynamic muscle contraction state needs to be further explored.
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Affiliation(s)
- Xudong Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Min Ren
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Yujie Liu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Tiecheng Zhang
- Department of Magnetic Resonance Imaging, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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Dietz HP. Ultrasound in the assessment of pelvic organ prolapse. Best Pract Res Clin Obstet Gynaecol 2018; 54:12-30. [PMID: 30082146 DOI: 10.1016/j.bpobgyn.2018.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/20/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
Imaging is increasingly being used in urogynaecology. Because of low cost and universal availability, ultrasound (US) is the most commonly used diagnostic modality, which allows the observation of manoeuvres such as Valsalva and pelvic floor muscle contraction in real time. The ability to see beyond surface anatomy is particularly important in the posterior compartment and in obstructed defecation where this method may replace defecation proctography. Imaging is especially useful in the form of 3D/4D multiplanar and tomographic translabial US, as these modalities give access to the axial plane and the levator ani. This allows assessment of both avulsion, i.e. major maternal birth trauma, and hiatal overdistension, i.e. ballooning. Both are major risk factors for both prolapse and prolapse recurrence. This review will outline current clinical utility, introduce recent research in the respective field and provide an overview of likely future utility of imaging in the investigation of pelvic organ prolapse.
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Affiliation(s)
- Hans Peter Dietz
- Sydney Medical School Nepean, University of Sydney, 62 Derby St, Kingswood, NSW, 2747, Australia.
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It is the first birth that does the damage: a cross-sectional study 20 years after delivery. Int Urogynecol J 2018; 29:1637-1643. [DOI: 10.1007/s00192-018-3616-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/26/2018] [Indexed: 12/31/2022]
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Caudwell-Hall J, Kamisan Atan I, Brown C, Guzman Rojas R, Langer S, Shek KL, Dietz HP. Can pelvic floor trauma be predicted antenatally? Acta Obstet Gynecol Scand 2018; 97:751-757. [DOI: 10.1111/aogs.13315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/25/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Jessica Caudwell-Hall
- Sydney Medical School Nepean; University of Sydney; Nepean Hospital; Penrith NSW Australia
| | - Ixora Kamisan Atan
- Sydney Medical School Nepean; University of Sydney; Nepean Hospital; Penrith NSW Australia
- Universiti Kebangsaan Malaysia Medical Center; Kuala Lumpur Malaysia
| | - Chris Brown
- NHMRC Clinical Trials Center; University of Sydney; Sydney NSW Australia
| | - Rodrigo Guzman Rojas
- Department of Gynecology and Obstetrics; Clínica Alemana de Santiago-Universidad del Desarrollo; Santiago Chile
- Department of Obstetrics and Gynecology; Hospital Clínico de la Universidad de Chile; Santiago Chile
| | - Susanne Langer
- Sydney Medical School Nepean; University of Sydney; Nepean Hospital; Penrith NSW Australia
| | - Ka L. Shek
- Sydney Medical School Nepean; University of Sydney; Nepean Hospital; Penrith NSW Australia
- Liverpool Clinical School; Western Sydney University; Sydney NSW Australia
| | - Hans P. Dietz
- Sydney Medical School Nepean; University of Sydney; Nepean Hospital; Penrith NSW Australia
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Abstract
PURPOSE OF REVIEW There is increasing awareness of the importance of intrapartum events for future pelvic floor morbidity in women. In this review, we summarize recent evidence and potential consequences for clinical practice. RECENT FINDINGS Both epidemiological evidence and data from perinatal imaging studies have greatly improved our understanding of the link between childbirth and later morbidity. The main consequences of traumatic childbirth are pelvic organ prolapse (POP) and anal incontinence. In both instances the primary etiological pathways have been identified: levator trauma in the case of POP and anal sphincter tears in the case of anal incontinence. As most such trauma is occult, imaging is required for diagnosis. SUMMARY Childbirth-related major maternal trauma is much more common than generally assumed, and it is the primary etiological factor in POP and anal incontinence. Both sphincter and levator trauma can now be identified on imaging. This is crucial not only for clinical care and audit, but also for research. Postnatally diagnosed trauma can serve as intermediate outcome measure in intervention trials, opening up multiple opportunities for clinical research aimed at primary and secondary prevention.
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Cheung RYK, Lee JHS, Lee LL, Chung TKH, Chan SSC. Levator ani muscle avulsion is a risk factor for expulsion within 1 year of vaginal pessary placed for pelvic organ prolapse. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:776-780. [PMID: 28078670 DOI: 10.1002/uog.17407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether the presence of levator ani muscle (LAM) avulsion is associated with expulsion within 1 year of a vaginal pessary placed for pelvic organ prolapse (POP). METHODS This was a prospective observational study of consecutive women with symptomatic POP, who had not received treatment for the condition before the consultation and opted for vaginal pessary placement in our center. Volume acquisition was performed before pessary insertion and offline analysis of the 3D/4D transperineal ultrasound volume data was performed. LAM was assessed on maximum pelvic floor muscle contraction (PFMC) and hiatal dimensions were assessed at rest, on PFMC and on maximum Valsalva. Results were compared between women in whom the pessary was retained for 1 year and those in whom the pessary was expelled within 1 year. RESULTS The datasets of 255 women were analyzed including 147 (57.6%) women who had a vaginal pessary continuously in place over 1 year and 108 (42.4%) with pessary expulsion. Mean age was 63.2 (SD, 9.9) years and median parity was 3 (2-4). Eighteen (7.1%) had Stage I, 164 (64.3%) Stage II, 67 (26.3%) Stage III and six (2.4%) Stage IV POP. Women with vaginal pessary expulsion within 1 year had significantly larger hiatal dimensions at rest and on Valsalva, larger hiatal area during rest, PFMC and Valsalva and higher rate of LAM avulsion (53.7% vs 27.2%, P < 0.01) compared with women in whom the pessary was retained for 1 year. After controlling for potential confounders, LAM avulsion remained a risk factor (OR, 3.18, P < 0.01) of vaginal pessary expulsion within 1 year. CONCLUSIONS Women in whom a vaginal pessary was expelled within 1 year of placement for POP had a larger hiatus. Presence of LAM avulsion was associated with a three-fold increase in the risk of expulsion of a vaginal pessary within 1 year. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Y K Cheung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - J H S Lee
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - L L Lee
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - T K H Chung
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - S S C Chan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Risk factors for prolapse recurrence: systematic review and meta-analysis. Int Urogynecol J 2017; 29:13-21. [DOI: 10.1007/s00192-017-3475-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022]
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Youssef A, Cavalera M, Pacella G, Salsi G, Morganelli G, Montaguti E, Cataneo I, Pilu G, Rizzo N. Is curved three-dimensional ultrasound reconstruction needed to assess the warped pelvic floor plane? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:388-394. [PMID: 27642724 DOI: 10.1002/uog.17304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/12/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Caudal distension of the female pelvic floor is common and results in perineal descent and a caudally curved levator hiatus (warping). Image reconstruction of the pelvic floor using currently available ultrasound techniques involves a linear approach (flat-plane reconstruction). We aimed to evaluate the feasibility, reproducibility and potential usefulness of a new three-dimensional (3D) technique capable of reconstructing a curved plane of the levator hiatus. METHODS Primiparous women were recruited to undergo a 3D/four-dimensional transperineal ultrasound examination 3-6 months after delivery. Levator ani muscle warping was evaluated on Valsalva maneuver by measuring the distance between the plane extending from the pubic rami to the anorectal angle and the plane of minimal hiatal dimensions on the coronal plane. Warping distance was used to reconstruct a curved plane of the levator hiatus using the curved OmniView volume contrast imaging (VCI) technique (C-OV). Intra- and interobserver reproducibility of the C-OV technique were assessed, as was intermethod agreement between the C-OV technique and the linear OmniView-VCI (L-OV) technique, for the measurement of levator hiatal area on Valsalva maneuver. RESULTS Measurement of the levator hiatal area using C-OV was feasible in all 84 women recruited. The warping distance ranged from -3.5 to 9.7 mm, confirming that the 1-2-cm slice thickness traditionally used for linear reconstruction was adequate for proper assessment of levator hiatal area in our population. C-OV showed excellent intra- and interobserver reproducibility, as well as excellent agreement with the L-OV technique for measuring levator hiatal area. No systematic difference was demonstrated in any of the reproducibility studies performed. CONCLUSIONS 3D reconstruction of the warped levator hiatal plane is feasible and highly reproducible. In our population, reconstruction of a curved plane to correct for levator hiatal warping did not offer any benefit over the traditionally performed linear reconstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Cavalera
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pacella
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - I Cataneo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Wong V, Shek K. Response to Transvaginal mesh - let's not repeat the mistakes of the past. Aust N Z J Obstet Gynaecol 2017; 57:219. [PMID: 28401559 DOI: 10.1111/ajo.12630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Vivien Wong
- Nepean Hospital, Nepean Clinical School, Sydney, New South Wales, Australia
| | - KaLai Shek
- Nepean Hospital, Nepean Clinical School, Sydney, New South Wales, Australia
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Caudwell-Hall J, Kamisan Atan I, Martin A, Guzman Rojas R, Langer S, Shek K, Dietz HP. Intrapartum predictors of maternal levator ani injury. Acta Obstet Gynecol Scand 2017; 96:426-431. [PMID: 28117880 DOI: 10.1111/aogs.13103] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/17/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Damage to the pelvic floor during vaginal childbirth is common, and may take the form of levator avulsion or irreversible overdistension of the levator hiatus (microtrauma). Such trauma is a major risk factor for pelvic organ prolapse later in life. In this study we aimed to identify intrapartum risk factors for levator trauma. MATERIAL AND METHODS This is a retrospective analysis of data obtained in two perinatal studies on primiparous women. Between 2005 and 2014, 1148 women carrying an uncomplicated singleton pregnancy in the late third trimester were seen for 4D pelvic floor ultrasound and an interview. They were invited for a repeat assessment at three months postpartum. RESULTS Of 1148 women, 871 (76%) returned for assessment at a mean of five months postpartum. The datasets of 844 women were analyzed due to missing data or concurrent pregnancy in 27. In all, 452 (54%) had a normal vaginal delivery, 102 (12%) a vacuum, 55 (6%) a forceps, and 235 (28%) a cesarean section. On multivariate analysis forceps, length of second stage and obstetric anal sphincter tears were significantly associated with levator avulsion. There were no significant predictors identified for irreversible overdistension. CONCLUSIONS The use of forceps, a prolonged second stage, and obstetric anal sphincter tears were associated with levator avulsion. There were no associated intrapartum predictors for hiatal overdistension.
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Affiliation(s)
- Jessica Caudwell-Hall
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Ixora Kamisan Atan
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Center, University of Sydney, Sydney, New South Wales, Australia
| | - Rodrigo Guzman Rojas
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Susanne Langer
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Kalai Shek
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.,Liverpool Clinical School, University of Western Sydney, Sydney, New South Wales, Australia
| | - Hans P Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Wong V, Shek KL. The mesh debate: Transvaginal anterior anchored mesh should not be abandoned. Aust N Z J Obstet Gynaecol 2017; 57:105-107. [DOI: 10.1111/ajo.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/08/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Vivien Wong
- Sydney Medical School Nepean; Nepean Hospital; University of Sydney; Sydney New South Wales Australia
| | - Ka Lai Shek
- Sydney Medical School Nepean; Nepean Hospital; University of Sydney; Sydney New South Wales Australia
- Liverpool Clinical School; Western Sydney University; Sydney New South Wales Australia
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Chen L, Lenz F, Alt CD, Sohn C, De Lancey JO, Brocker KA. MRI visible Fe 3O 4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures. Int Urogynecol J 2017; 28:1131-1138. [PMID: 28124074 DOI: 10.1007/s00192-017-3263-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To demonstrate mesh magnetic resonance imaging (MRI) visibility in living women, the feasibility of reconstructing the full mesh course in 3D, and to document its spatial relationship to pelvic anatomical structures. METHODS This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MRI-visible Fe3O4 polypropylene implant for pelvic floor reconstruction. High-resolution sagittal T2-weighted (T2w) sequences, transverse T1-weighted (T1w) FLASH 2D, and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4 polypropylene mesh MRI visibility and overall post-surgical pelvic anatomy 3 months after reconstructive surgery. Full mesh course in addition to important pelvic structures were reconstructed using the 3D Slicer® software program based on T1w and T2w MRI. RESULTS Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MRI-visible anterior vaginal mesh with six fixation arms and showed no recurrent cystocele at the 3-month follow-up examination. The course of mesh in the pelvis was visible on MRI in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel nerve bundles in 3D. CONCLUSIONS The use of MRI-visible Fe3O4 polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting that it might be a useful tool for evaluating mesh complications more precisely and a valuable interactive feedback tool for surgeons and mesh design engineers.
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Affiliation(s)
- Luyun Chen
- Pelvic Floor Research Group, Biomedical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI, 48103, USA
| | - Florian Lenz
- Department of Obstetrics and Gynecology, St Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University Medical School Heidelberg, Salzburgerstrasse 15, 67067, Ludwigshafen am Rhein, Germany
| | - Céline D Alt
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christof Sohn
- Medical School, Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - John O De Lancey
- Obstetrics and Gynecology Department, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, 48103, USA
| | - Kerstin A Brocker
- Medical School, Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Diagnostic Accuracy and Clinical Implications of Translabial Ultrasound for the Assessment of Levator Ani Defects and Levator Ani Biometry in Women With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2017; 23:420-428. [DOI: 10.1097/spv.0000000000000402] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Predicting levator avulsion from ICS POP-Q findings. Int Urogynecol J 2016; 28:907-911. [DOI: 10.1007/s00192-016-3214-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/14/2016] [Indexed: 02/08/2023]
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Shek KL, Dietz HP. Assessment of pelvic organ prolapse: a review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:681-692. [PMID: 26865209 DOI: 10.1002/uog.15881] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Affiliation(s)
- K L Shek
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Western Sydney University, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
- Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Sydney, Australia
| | - H P Dietz
- Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Sydney, Australia
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Ilhan TT, Ilhan TS, Ucar MG, Kebapçılar A, Kıvrık M, Çelik Ç. Can the suburethral mesh angle be used to predict trans-obturator tape results? Arch Gynecol Obstet 2016; 295:361-366. [PMID: 27832349 DOI: 10.1007/s00404-016-4230-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/03/2016] [Indexed: 11/27/2022]
Abstract
ABSRACT PURPOSE: The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence. METHODS This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans-obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence. RESULTS The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10°, with 61% sensitivity and 96% specificity. CONCLUSIONS Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.
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Affiliation(s)
- Tolgay Tuyan Ilhan
- Department of Gynecology and Obstetrics, Selcuk University, Aladdin Keykubat Campus, Konya, Turkey.
| | | | - Mustafa Gazi Ucar
- Department of Gynecology and Obstetrics, Selcuk University, Aladdin Keykubat Campus, Konya, Turkey
| | - Ayşegül Kebapçılar
- Department of Gynecology and Obstetrics, Selcuk University, Aladdin Keykubat Campus, Konya, Turkey
| | | | - Çetin Çelik
- Department of Gynecology and Obstetrics, Selcuk University, Aladdin Keykubat Campus, Konya, Turkey
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Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MIJ. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27:165-94. [PMID: 26755051 DOI: 10.1007/s00192-015-2932-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report. METHODS This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.
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Affiliation(s)
- Bernard T Haylen
- University of New South Wales, Suite 904, St Vincent's Clinic, 438 Victoria Street, Darlinghurst, 2010, N.S.W, Australia.
| | | | | | | | - Vani Dandolu
- University of Nevada, Las Vegas, Las Vegas, NV, USA.
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It is a Bigger Question Than What to Do With the Uterus. Female Pelvic Med Reconstr Surg 2016; 22:397-398. [PMID: 27636209 DOI: 10.1097/spv.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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