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Caspers R, Stickeler E, Kennes LN, Krawutschke S, Wynands R, Wittenborn J, Lecker L, Schlayer F, Najjari L. Reliability and Reproducibility of Analyzing 3D Transperineal Ultrasound Volumes Obtained in the First Phase of Labor - A Pilot Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:623-630. [PMID: 36657459 DOI: 10.1055/a-1957-5383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The aim of this study was to investigate the reliability and reproducibility of transperineal ultrasound (TPUS) in the initial phase of labor. As TPUS is a common method, it could supplement vaginal palpation and even replace it in certain situations. In addition, we used a 4-dimensional method for the assessment of cervical effacement. MATERIALS AND METHODS 54 women in labor were included and underwent TPUS. The resulting images from the acquired 4D volumes were evaluated after the examination for the first time and a second time after 21 days. The measured values were cervical length, dilatation and effacement, the angle of progression (AoP), and head-perineum distance. RESULTS 54 patients were examined. TPUS images were unable to be evaluated in 12 patients because of cervical dilatation of more than 5 cm or poor image quality. Thus, 42 measurements were included. The concordance correlation coefficients according to Lin are satisfactory overall, with one exception for cervical effacement. The accuracy component of cervical length (CCCLin: 0.93; accuracy: 1.00), dilatation (CCCLin: 0.93; accuracy: 1.00), and AoP (CCCLin: 0.87; accuracy: 1.00) is excellent and still high for the head-perineum distance (CCCLin: 0.89; accuracy: 0.96) and cervical effacement (CCCLin: 0.77; accuracy: 0.97). CONCLUSION TPUS is a valuable noninvasive tool with good diagnostic accuracy for the AoP, cervical length, and dilatation. Our study provides support for the use of TPUS to complement a vaginal examination. It should not replace a digital examination but should serve as a suitable alternative method for monitoring labor progression in the future.
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Affiliation(s)
- Rebecca Caspers
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
| | - Lieven Nils Kennes
- Department of Economics and Business Administration, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Stefanie Krawutschke
- Department of Economics and Business Administration, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Rene Wynands
- Department of Economics and Business Administration, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Julia Wittenborn
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
| | - Linda Lecker
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
| | - Friederike Schlayer
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
| | - Laila Najjari
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
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Cao X, Qiu Y, Peng Z, Chen L, Zhou L, Lu A, Chen C, Liu P. Clinical application of a fixed reference line in the ultrasound quantitative diagnosis of female pelvic organ prolapse. BMC Med Imaging 2023; 23:170. [PMID: 37904129 PMCID: PMC10617056 DOI: 10.1186/s12880-023-01013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/06/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP). DESIGN A transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle. METHOD Points Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS). RESULTS One hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed. CONCLUSIONS Introital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.
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Affiliation(s)
- Xiaojuan Cao
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Yuwen Qiu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhiyong Peng
- Department of Anesthesiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Lan Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Li Zhou
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Anwei Lu
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518101, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital , Southern Medical University, Guangzhou, Guangdong, 510515, China.
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Wu M, Wang X, Lin X, Fu Y, Chen H, Guan X, Huang W, Chen Y, Zhang L, Jing C, Wei J, Tian J, Zhang X. Cut-offs for defining uterine prolapse using transperineal ultrasound in Chinese women: prospective multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:127-132. [PMID: 33094536 DOI: 10.1002/uog.23524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut-off to define abnormal uterine descent on transperineal ultrasound in Chinese women. METHODS This prospective multicenter study recruited women who were examined in tertiary-level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) examination, and four-dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut-off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut-off for the prediction of prolapse symptoms and POP-Q stage was assessed and compared by means of the area under the receiver-operating-characteristics curve (AUC). RESULTS In total, 538 Chinese women, with a mean age of 39.4 (range, 18-81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P < 0.001) and POP-Q stage (P < 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP-Q stage for apical compartment prolapse (P < 0.001). The optimal cut-off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71-0.78)), while the optimal cut-off values in the prediction of prolapse of POP-Q Stage ≥ 1 and POP-Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80-0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82-0.88)), respectively. CONCLUSIONS The optimal cut-off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP-Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - X Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Lin
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Y Fu
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - H Chen
- Department of Ultrasound, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China
| | - X Guan
- Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - W Huang
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Y Chen
- Department of Medical Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - L Zhang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - C Jing
- Department of Ultrasound, Dalian Maternal and Child Health Care Hospital, Dalian, Liaoning Province, China
| | - J Wei
- Department of Ultrasound, Jiujiang City Maternal and Child Health Care Hospital, Jiujiang, Jiangxi Province, China
| | - J Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Hölscher M, Gräf C, Stickelmann AL, Stickeler E, Najjari L. Perianal ultrasound (PAUS): visualization of sphincter muscles and comparison with digital-rectal examination (DRE) in females. BMC WOMENS HEALTH 2021; 21:247. [PMID: 34144688 PMCID: PMC8214294 DOI: 10.1186/s12905-021-01387-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Background The aim of this study was to determine the reproducibility and tolerance of perianal ultrasound (PAUS) and detect differences in sphincter muscles between various measuring positions and different maneuvers. PAUS was compared to digital-rectal examination (DRE) to see if sphincter contraction is visible and gradable in ultrasound volumes.
Methods Fifty women underwent a medical history, DRU and PAUS by two uro-gynecologists in a prospective trial. PAUS volumes were measured via different parameters in different maneuvers. Examiners’ DRE impressions of sphincter tone were scaled with the DRESS-score. All patients completed a questionnaire. Results Thirty-five patients with complete PAUS and DRE were included in the study. Fifteen patients were excluded due to poor ultrasound volume quality or sphincter defects. Comparison of sphincter muscle thickness at different positions in PAUS showed significant differences between 6 and 12 o’clock positions (12 > 6 o’clock) and diameters (horizontal > vertical). No difference was found between the examiners. In comparison of rest and contraction only the vertical diameter changed. There was a negative but not significant correlation between PAUS measurements and DRESS-scores. Twenty-six patients completed the questionnaire that revealed women preferred PAUS over DRE. Conclusion PAUS is a reproducible and good tool to visualize the anal canal. It is comfortable for patients and easily handled by examiners. Sphincter muscle contraction is iso-volumetric. Vertical diameter changes during contraction leading the anal canal change its shape to oval due to external influence. PAUS is the ideal additional tool to visualize relevant structures that are palpable on DRE.
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Affiliation(s)
- Miriam Hölscher
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Charlotte Gräf
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Anna-Lena Stickelmann
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Laila Najjari
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Shao XH, Kong DJ, Zhang LW, Wang LL, Wang SM, Yu LJ, Dong XQ. Ultrasound analysis of the effect of second delivery on pelvic floor function in Chinese women. J OBSTET GYNAECOL 2021; 42:261-267. [PMID: 34078229 DOI: 10.1080/01443615.2021.1907554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In our study, patients who had a second delivery were categorised into the following 4 groups. Pelvic floor ultrasound data were compared during the 6th week after the second delivery. The incidence of cystoceles was highest in group A and lowest in group D. In addition, groups A and B had a higher rate of rectoceles or perineum descent. Similarly, the areas of the levator hiatus were higher in Groups A and B during Valsalva manoeuvres. The area of the levator hiatus from the resting state to the Valsalva manoeuvre effect had the greatest change in Group A. A comparison of the PR thickening rates among the four groups did not reveal significant differences. All second delivery methods can cause varying degrees of pelvic organ prolapse and decreased pelvic floor function; however, vaginal delivery as the second delivery mode may have a more significant effect in Chinese women.Impact StatementWhat is already known on this subject? Different modes of delivery have significantly different effects on female pelvic floor function. Pregnancy beyond 35 weeks of gestation has an effect on female pelvic floor function, irrespective of the mode of delivery.What do the results of this study add? This study analysed the impact of different delivery modes on Chinese female pelvic floor function. Parous women who underwent different modes of second delivery all demonstrated different degrees of pelvic organ prolapse, as well as pelvic floor function decline.What are the implications of these findings for clinical practice and/or further research? Our study will provide basic research of Chinese female pelvic floor function after a second delivery, which will be of clinical significance around the world, as well as in China. China will keep promoting further delivery as the aging population is increasing. If the developing countries want to promote the second delivery around the women, they have basic research and data to instruct the females.
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Affiliation(s)
- Xiao-Hui Shao
- PET/CT Center, Harbin Medical University Cancer Hospital, Heilongjiang Province, Harbin, P. R. China.,Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - De-Jiao Kong
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Li-Wei Zhang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Lu-Lu Wang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Si-Ming Wang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Li-Juan Yu
- PET/CT Center, Harbin Medical University Cancer Hospital, Heilongjiang Province, Harbin, P. R. China.,Nuclear Medicine Department, Hainan Cancer Hospital, Hainan Province, Haikou, P. R. China
| | - Xiao-Qiu Dong
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
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Gao Y, Zhao Z, Yang Y, Zhang M, Wu J, Miao Y. Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review. Int Urogynecol J 2019; 31:15-33. [DOI: 10.1007/s00192-019-04066-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/18/2019] [Indexed: 01/02/2023]
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[Cystocele and perineal ultrasound : Comparison of reliability and patient satisfaction]. Urologe A 2016; 55:1595-1600. [PMID: 27352272 DOI: 10.1007/s00120-016-0101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pelvic organ prolapse is a common medical finding. The use of perineal ultrasound for diagnosis of cystoceles is gaining in importance. OBJECTIVES The purpose of this work was to test whether perineal ultrasound can be used to diagnose a cystocele before surgery and for follow-up examination. Furthermore, patient satisfaction during speculum examination and perineal ultrasound was compared. MATERIALS AND METHODS 33 women with cystocele were examined before and after anterior colporrhaphy. Symptoms and satisfaction were documented with questionnaires. RESULTS Ultrasound measurements of both examiners were correlated before and after colporrhaphy. Also, the degree of cystocele and ultrasound were correlated during Valsalva after surgery. There was no clear relation between typical symptoms of the cystocele and ultrasound measurements. The patient's comfort is higher during ultrasound than during speculum examination (r = 0.45; p = 0.04. t = 4,418; p < 0.01). CONCLUSION The results of the perineal ultrasound are reproducible before and after colporrhaphy. Patients prefer ultrasound to the speculum examination. A sonographic scale of the cystocele would extend the use of perineal ultrasound.
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Soljanik I, Brocker K, Solyanik O, Stief CG, Anding R, Kirschner-Hermanns R. [Imaging for urinary incontinence]. Urologe A 2015; 54:963-71. [PMID: 26162272 DOI: 10.1007/s00120-015-3872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasonography and functional cine magnetic resonance imaging (MRI) are noninvasive and x-ray free tools, which are currently widely used in clinical diagnostics and scientific research of male and female urinary incontinence. The increasing use and improving techniques of modern imaging tools are closely linked to rapid development of minimally invasive surgery in patients with urinary incontinence and insights gained in continence mechanisms. METHODS Whereas ultrasonography is a cost-efficient and readily available diagnostic tool for a routine use, the more expensive functional MRI, as a tool with more precise visualization of functional interactions and spatial representation of anatomical structures of the pelvic floor, is suitable for complex diagnostic purposes and scientific research. Both tools are already well established for evaluations of the female pelvic floor. For evaluation of the male pelvic floor, and in particular postprostatectomy incontinence, perineal ultrasonography and functional cine MRI are becoming increasingly evident. CONCLUSION Further development of both imaging tools will contribute to new insights into the continence mechanism and improve the techniques of radical prostatectomy and minimally invasive surgery of male and female urinary incontinence in the future.
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Affiliation(s)
- I Soljanik
- Neuro-Urologie, Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland,
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