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Wang L, Cao Y, Li P, He P, Chen P. Relationship between pelvic floor muscle function and insulin resistance among non-diabetic females: a 3d ultrasound evaluation. J OBSTET GYNAECOL 2024; 44:2381569. [PMID: 39056468 DOI: 10.1080/01443615.2024.2381569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND To use the three-dimensional (3D) ultrasound for assessment of pelvic floor muscle function in non-diabetic females with insulin resistance (IR), and to evaluate its functional relationship with insulin levels. METHODS From October 2022 to November 2023, 216 non-diabetic females with insulin-resistant (IR group) and 118 normal females (control group) were sequentially recruited from our hospital for our study. The 3D ultrasound was used to assess the levator hiatus in resting state for all females regarding diameter lines, perimeters and areas; as well as the Valsalva manoeuvre (VM). The t-test and linear regression model were used to analyse the collected data. RESULTS The analysis indicates that there were significant differences in the resting state of the levator hiatus between the IR and the control groups (14.8 ± 5.8 cm2 and 11.6 ± 2.7 cm2, p < 0.05); and in the VM (18.2 ± 6.3 cm2 and 13.4 ± 3. 4 cm2, p < 0.05). In addition, the anterior-posterior (AP) diameters of the hiatus on VM were significantly increased in the IR group (40.0 ± 4.7 mm and 33.0 ± 4.4 mm, p < 0.05). With insulin levels as the dependent variable, multivariate regression analysis shows that insulin levels were significantly correlated with the levator hiatus area on VM (p < 0.05) and waist circumference (p < 0.05). The pelvic organ descent on VM in the IR group was significant (p < 0.05). CONCLUSIONS The areas of resting state levator hiatus and on VM were significantly larger in the IR than that in the control groups. In addition, the position of the pelvic organ on VM in the IR group was significantly descended. The insulin levels were correlated with the pelvic floor muscle function.
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Affiliation(s)
- Lei Wang
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyun Cao
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Li
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping He
- Departments of Ultrasound Diagnostics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Chen
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang Y, Ye Q, Zhang YQ. Effect evaluation and influencing factor analysis of vaginal carbon dioxide laser in the treatment of stress urinary incontinence. Lasers Med Sci 2023; 38:153. [PMID: 37393550 DOI: 10.1007/s10103-023-03776-4] [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: 10/20/2022] [Accepted: 04/16/2023] [Indexed: 07/04/2023]
Abstract
To evaluate the clinical efficacy of carbon dioxide laser in the treatment of female stress urinary incontinence and analyze the influencing factors. A total of 46 patients with stress urinary incontinence treated in the Affiliated Hospital of Nantong University from March 2021 to August 2022 were included through strict inclusion criteria and exclusion criteria. All patients were treated with transvaginal carbon dioxide laser therapy, and Patient Global Impression of Change (PGI-C) was used to evaluate patients' subjective satisfaction after treatment. The efficacy was evaluated by patient's subjective assessment of leakage, IngelmanSundberg scale, 1-h urine pad test, and international consultation on incontinence questionnaire short form (ICI-Q-SF) before and after treatment, and the adverse reactions after treatment were recorded. The treatment effect was divided into "significant effect group" and "no significant effect group" by subjective satisfaction and post-treatment-related scale evaluation. After laser treatment, patients' subjective symptom improved, the volume of 1-h urine pad test was reduced, and the ICI-Q-SF score was decreased, and the differences were statistically significant (P < 0.05). There was no significant difference in IngelmanSundberg scale before and after treatment (P = 1.00). Multivariate logistic regression analysis showed that pad test volume was significantly correlated with treatment effect (P = 0.007). Transvaginal carbon dioxide laser is a safe and effective method for the treatment of mild to moderate stress urinary incontinence in females. The less severe the urinary leakage, the better the treatment effect.
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Affiliation(s)
- Yan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Qing Ye
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Yu-Quan Zhang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Chill HH, Guedalia J, Lipschuetz M, Shimonovitz T, Unger R, Shveiky D, Karavani G. Prediction model for obstetric anal sphincter injury using machine learning. Int Urogynecol J 2021; 32:2393-2399. [PMID: 33710431 DOI: 10.1007/s00192-021-04752-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a complication with substantial maternal morbidity. The aim of this study was to develop a machine learning model that would allow a personalized prediction algorithm for OASI, based on maternal and fetal variables collected at admission to labor. MATERIALS AND METHODS We performed a retrospective cohort study at a tertiary university hospital. Included were term deliveries (live, singleton, vertex). A comparison was made between women diagnosed with OASI and those without such injury. For formation of a machine learning-based model, a gradient boosting machine learning algorithm was implemented. Evaluation of the performance model was achieved using the area under the receiver-operating characteristic curve (AUC). RESULTS Our cohort comprised 98,463 deliveries, of which 323 (0.3%) were diagnosed with OASI. Applying a machine learning model to data recorded during admission to labor allowed for individualized risk assessment with an AUC of 0.756 (95% CI 0.732-0.780). According to this model, a lower number of previous births, fewer pregnancies, decreased maternal weight and advanced gestational week elevated the risk for OASI. With regard to parity, women with one previous delivery had approximately 1/3 of the risk for OASI compared to nulliparous women (OR = 0.3 (0.23-0.39), p < 0.001), and women with two previous deliveries had 1/3 of the risk compared to women with one previous delivery (OR = 0.35 (0.21-0.60), p < 0.001). CONCLUSION Our machine learning-based model stratified births to high or low risk for OASI, making it an applicable tool for personalized decision-making upon admission to labor.
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Affiliation(s)
- Henry Hillel Chill
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, Ein Kerem, Israel. .,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tzvika Shimonovitz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - David Shveiky
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem, Ein Kerem, Israel.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Tang JH, Zhong C, Wen W, Wu R, Liu Y, Du LF. Quantifying Levator Ani Muscle Elasticity Under Normal and Prolapse Conditions by Shear Wave Elastography: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1379-1388. [PMID: 32003904 DOI: 10.1002/jum.15232] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The primary purpose of this study was to determine whether elasticity quantification of the levator ani muscle (LAM) using shear wave elastography (SWE) is different between women with and without pelvic organ prolapse (POP) and to determine whether LAM elasticity is associated with the prolapse stage or the dimensions of the levator hiatus. The secondary aim was to evaluate the intraobserver and interobserver reliability of LAM elasticity measurements using SWE. METHODS The study participants included 20 women with normal pelvic support and 38 women with prolapse (stages I-III). The levator hiatus was imaged by transperineal 3-dimensional ultrasound, and LAM elasticity and the elastic modulus were measured by SWE at rest and while performing the Valsalva maneuver. RESULTS The elastic modulus increased significantly from rest to during to maximal Valsalva maneuver (29.2 versus 54.1 kPa; P < .05) in all women. Levator ani muscle elasticity was significantly higher under prolapse conditions than under normal conditions at rest (27.9 versus 31 kPa; P < .001) but was lower during the maximal Valsalva maneuver than under normal conditions (57.3 versus 53.1 kPa; P < .05). Levator ani muscle elasticity at rest was associated with the hiatus area during the Valsalva maneuver (Spearman r = 0.608; P < .001) and distensibility of the levator hiatus (r = 0.594; P < .001), and the hiatus area decreased as the LAM elastic modulus increased during the maximal Valsalva maneuver (r = -0.414; P < .05). Moreover, LAM elasticity was associated with the severity of prolapse (P < .001). CONCLUSIONS As a noninvasive quantitative method, SWE, may be used to assess the biomechanical properties of the pelvic floor muscle, providing some research basis for a thorough understanding of POP and its treatment and prevention.
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Affiliation(s)
- Jin-Hua Tang
- Department of Medical Ultrasound, Shanghai General Hospital of NanJing Medical University, Shanghai, China
| | - Chen Zhong
- Departments of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Wen
- Departments of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lian-Fang Du
- Department of Medical Ultrasound, Shanghai General Hospital of NanJing Medical University, Shanghai, China
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Yin Y, Xia Z, Feng X, Luan M, Qin M. Three-Dimensional Transperineal Ultrasonography for Diagnosis of Female Occult Stress Urinary Incontinence. Med Sci Monit 2019; 25:8078-8083. [PMID: 31657360 PMCID: PMC6836640 DOI: 10.12659/msm.917086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background We evaluated the utility of three-dimensional transperineal ultrasonography in detecting occult stress urinary incontinence in women undergoing anterior pelvic floor reconstruction surgery for severe cystocele. Material/Methods We enrolled 207 women with stage III–IV cystocele without urinary stress incontinence. One week before the operation, the patients underwent pelvic floor ultrasonography. We measured the vertical distance between the bladder neck and posterior margin of the pubic symphysis, the posterior vesicourethral angle, the urethral rotation angle, the formation of funnel shape, the hiatus area, and the length of the urethra and the funnel shape. Postoperatively, the patients were evaluated for symptoms of stress urinary incontinence and with the 20-minute pad test. Results The posterior vesicourethral angle with Valsalva maneuver, the difference in the posterior vesicourethral angle between the resting state and with the Valsalva state, and the angle of the proximal urethra were larger in the incontinence-positive group than in the incontinence-negative group (P<0.05). Funnel shape urethra was longer in the incontinence-positive group than in the incontinence-negative group (P<0.05). The cutoff value was 137.5° for the posterior vesicourethral angle with Valsalva maneuver, 39.5° for the difference in the posterior vesicourethral angle, 44.5° for the angle of the proximal urethra, and 0.35 cm for the length of the funnel shape. Multivariate analysis revealed that the difference between the posterior vesicourethral angle in the resting state and with Valsalva, the angle of the proximal urethra, and the length of funnel shape were strongly correlated with occult stress urinary incontinence. Conclusions Ultrasonography is an effective method for identifying occult stress urinary incontinence.
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Affiliation(s)
- Yitong Yin
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Zhijun Xia
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Xiaoyu Feng
- Department of Ultrasound, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Meng Luan
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Meiying Qin
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
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Yang J, Wang H, He L, Wei B, Xu C, Xu Y, Zhang J, Li S. Reconstituted Fibril from Heterogenic Collagens-A New Method to Regulate Properties of Collagen Gels. Macromol Res 2019. [DOI: 10.1007/s13233-019-7160-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Nesbitt-Hawes EM, Dietz HP, Abbott JA. Morphometry of the nulliparous pelvic floor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:672-676. [PMID: 29700879 DOI: 10.1002/uog.19075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/08/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe morphometry of the pelvic floor in a large population of nulliparous women, comparing those with and those without pelvic pain. We also aimed to assess its association with characteristics such as age and body mass index (BMI). METHODS This was a prospective study performed between January 2013 and November 2015 in non-pregnant nulliparous women attending a general gynecology clinic. Following collection of demographic data, women were examined using translabial four-dimensional (4D) ultrasound. Dynamic volumes of pelvic floor muscle were obtained at rest, on maximal contraction and on Valsalva maneuver, and analyzed at a later date by an assessor blinded to demographic details. Standard measurements for each volume included levator hiatal area and anteroposterior and transverse diameters, and pubovisceral muscle length and width. Subanalysis was performed comparing women with and those without pelvic pain. Linear regression analysis was performed to assess the association between characteristics, including age and BMI, and levator hiatal area at rest. RESULTS Three hundred and sixty eight nulliparous women were examined using translabial 4D ultrasound. Median levator hiatal area was 10.62 cm2 at rest, 11.95 cm2 on Valsalva maneuver and 8.18 cm2 on maximal contraction. There was no difference between women with and those without pelvic pain when comparing biometric measurements of the pelvic floor musculature, except for in pubovisceral muscle width during the contraction phase. Regression analysis demonstrated that higher age and BMI were associated with increased levator hiatal area measurement. CONCLUSIONS Pelvic floor morphometry in nulliparous women is unchanged by pelvic pain, but levator hiatal area is increased in women with higher BMI and age. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E M Nesbitt-Hawes
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Royal Hospital for Women, Randwick, NSW, Australia
| | - H P Dietz
- Sydney University, Sydney, NSW, Australia
- Sydney Medical School Nepean, Penrith, NSW, Australia
| | - J A Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Royal Hospital for Women, Randwick, NSW, Australia
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Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review. Am J Obstet Gynecol 2018; 219:26-39. [PMID: 29630884 DOI: 10.1016/j.ajog.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The use of imprecise and inaccurate terms leads to confusion amongst anatomists and medical professionals. OBJECTIVE We sought to create recommended standardized terminology to describe anatomic structures of the anterior female pelvis based on a structured review of published literature and selected text books. STUDY DESIGN We searched MEDLINE from its inception until May 2, 2016, using 11 medical subject heading terms to identify studies reporting on anterior female pelvic anatomy; any study type published in English was accepted. Nine textbooks were also included. We screened 12,264 abstracts, identifying 200 eligible studies along with 13 textbook chapters from which we extracted all pertinent anatomic terms. RESULTS In all, 67 unique structures in the anterior female pelvis were identified. A total of 59 of these have been previously recognized with accepted terms in Terminologia Anatomica, the international standard on anatomical terminology. We also identified and propose the adoption of 4 anatomic regional terms (lateral vaginal wall, pelvic sidewall, pelvic bones, and anterior compartment), and 2 structural terms not included in Terminologia Anatomica (vaginal sulcus and levator hiatus). In addition, we identified 2 controversial terms (pubourethral ligament and Grafenberg spot) that require additional research and consensus from the greater medical and scientific community prior to adoption or rejection of these terms. CONCLUSION We propose standardized terminology that should be used when discussing anatomic structures in the anterior female pelvis to help improve communication among researchers, clinicians, and surgeons.
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Predictive role of measurement of pelvic floor muscle thickness with static MRI in stress and mixed urinary incontinence. Int Urogynecol J 2018; 30:271-277. [DOI: 10.1007/s00192-018-3663-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/04/2018] [Indexed: 10/16/2022]
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Silva M, Parente M, Brandão S, Mascarenhas T, Natal Jorge R. Characterization of the passive and active material parameters of the pubovisceralis muscle using an inverse numerical method. J Biomech 2018; 71:100-110. [DOI: 10.1016/j.jbiomech.2018.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 12/11/2017] [Accepted: 01/28/2018] [Indexed: 12/28/2022]
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Value of transperineal ultrasound on the observation of paravaginal support. Arch Gynecol Obstet 2018; 297:943-949. [DOI: 10.1007/s00404-018-4659-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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SILVA MET, BRANDÃO S, PARENTE MPL, MASCARENHAS T, NATAL JORGE RM. THE INFLUENCE OF PELVIC ORGAN PROLAPSE ON THE PASSIVE BIOMECHANICAL PROPERTIES OF PELVIC FLOOR MUSCLES. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The biomechanical properties of the female pelvic floor tissues, such as muscles, fascia or ligaments are relevant when explaining pelvic disorders, since these may result from changes in the properties of those tissues. The aim of this study is to understand the influence of pelvic organ prolapse (POP) on the passive biomechanical properties of the pelvic floor muscles. For this purpose, magnetic resonance images at Valsalva maneuver were used, and an inverse finite element analysis technique was applied. The numerical models of the pubovisceralis muscle and pelvic bones were built from axial magnetic resonance images acquired at rest. The numerical simulation was based on the finite element method (FEM), by which the material constants were determined for three different constitutive models (Neo-Hookean, Mooney–Rivlin and Yeoh). The ratio between the values of the material constants for women with and without prolapse was approximately 43% for the parameter [Formula: see text] in the Neo-Hookean constitutive model, 57% and 24% for [Formula: see text] and [Formula: see text] in the Mooney–Rivlin constitutive model, and 35%, 21% and 14% for [Formula: see text], [Formula: see text] and [Formula: see text] in the Yeoh constitutive model. For the three constitutive models, the mean values of the material properties related with stiffness were higher for the muscles of women with POP. These increases in stiffness are in line with other experimental works involving vaginal tissue, which showing that the elasticity module is significantly higher in the prolapsed tissue when compared with normal tissue. The present work presents a noninvasive methodology based on the application of the FEM, which allows the establishment of a relationship between the stiffness of the pelvic floor muscles of women with POP and without this pathology.
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Affiliation(s)
- M. E. T. SILVA
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - S. BRANDÃO
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Department of Radiology, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M. P. L. PARENTE
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - T. MASCARENHAS
- Department of Gynecology and Obstetrics, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R. M. NATAL JORGE
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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Combination of tomographic ultrasound imaging and three-dimensional magnetic resonance imaging-based model to diagnose postpartum levator avulsion. Sci Rep 2017; 7:11235. [PMID: 28894152 PMCID: PMC5593956 DOI: 10.1038/s41598-017-08201-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/06/2017] [Indexed: 12/04/2022] Open
Abstract
Vaginal delivery may cause levator avulsion, which may increase the risk of pelvic floor dysfunction (PFD). To explore the morphological changes of the levator ani muscle (including the puborectalis and iliococcygeus) and levator avulsion after vaginal delivery, translabial tomographic ultrasound imaging (TUI) was used to examine 80 women 45–60 days after their vaginal delivery. Subsequently, magnetic resonance imaging (MRI) was performed if at least one-sided puborectalis avulsion was found on TUI. The incidence of puborectalis avulsion in these postpartum women was 13.75% in this study. Both MRI and TUI can detect puborectalis avulsion well, and their results have good consistency. Iliococcygeus muscle injury is difficult to detect using TUI. However, MRI is a good way to observe the morphological changes of the iliococcygeus, which may also be damaged during vaginal delivery. Interestingly, our study reveals that iliococcygeus muscle injury is often associated with severe puborectalis muscle tear.
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Saunders K. Recent Advances in Understanding Pelvic-Floor Tissue of Women With and Without Pelvic Organ Prolapse: Considerations for Physical Therapists. Phys Ther 2017; 97:455-463. [PMID: 28339839 DOI: 10.1093/ptj/pzx019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 11/13/2016] [Indexed: 11/12/2022]
Abstract
Pelvic organ prolapse is a fairly common condition that imposes significant symptoms, diminished quality of life, social burden, financial expense, and surgical risk on women. As evidence supporting the benefit of pelvic-floor muscle training in nonsurgical management of pelvic organ prolapse grows, physical therapists are becoming a provider of choice interacting with women affected by pelvic organ prolapse. This perspective article will review recent research on tissue characteristics of 3 key components of pelvic organ support: skeletal muscle, ligament, and vaginal wall. This information will be summarized as implications for physical therapists. An improved understanding of pelvic-floor tissue in women with and without pelvic organ prolapse will provide a more comprehensive appreciation of the interaction of multiple systems in the disorder.
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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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Vergeldt TFM, Notten KJB, Stoker J, Fütterer JJ, Beets-Tan RG, Vliegen RFA, Schweitzer KJ, Mulder FEM, van Kuijk SMJ, Roovers JPWR, Kluivers KB, Weemhoff M. Comparison of translabial three-dimensional ultrasound with magnetic resonance imaging for measurement of levator hiatal biometry at rest. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:636-641. [PMID: 26177611 DOI: 10.1002/uog.14949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/19/2015] [Accepted: 07/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare translabial three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for the measurement of levator hiatal biometry at rest in women with pelvic organ prolapse, and to determine the interobserver reliability between two independent observers for ultrasound and MRI measurements. METHODS Data were derived from a multicenter prospective cohort study in which women scheduled for conventional anterior colporrhaphy underwent translabial 3D ultrasound and MRI prior to surgery. Intraclass correlation coefficients (ICCs) were calculated to estimate interobserver reliability between two independent observers and determine the agreement between ultrasound and MRI measurements. Bland-Altman plots were created to assess the agreement between ultrasound and MRI measurements. RESULTS Data from 139 women from nine hospitals were included in the study. The interobserver reliability of ultrasound assessment at rest, during Valsalva maneuver and during contraction and of MRI assessment at rest were moderate or good. The agreement between ultrasound and MRI for the measurement of levator hiatal biometry at rest was moderate, with ICCs of 0.52 (95%CI, 0.32-0.66) for levator hiatal area, 0.44 (95%CI, 0.21-0.60) for anteroposterior diameter and 0.44 (95%CI, 0.22-0.60) for transverse diameter. Levator hiatal biometry measurements were statistically significantly larger on MRI than on translabial 3D ultrasound. CONCLUSIONS The agreement between translabial 3D ultrasound and MRI for measurement of the levator hiatus at rest in women with pelvic organ prolapse was only moderate. The results of translabial 3D ultrasound and MRI should therefore not be used interchangeably in daily practice or in clinical research. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T F M Vergeldt
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K J B Notten
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Stoker
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J J Fütterer
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R G Beets-Tan
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R F A Vliegen
- Department of Radiology, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
| | - K J Schweitzer
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F E M Mulder
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S M J van Kuijk
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Weemhoff
- Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
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MRI changes of pelvic floor and pubic bone observed in primiparous women after childbirth by normal vaginal delivery. Arch Gynecol Obstet 2016; 294:285-9. [PMID: 26861464 PMCID: PMC4937070 DOI: 10.1007/s00404-016-4023-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 01/15/2016] [Indexed: 11/27/2022]
Abstract
Objective
To identify and characterize changes in the pelvic floor and pubic bone, using magnetic resonance imaging, in primiparous women with normal vaginal delivery, in comparison with nulliparous women.
Methods Pelvic MR images from ten primiparous women, 6–7 weeks after normal vaginal delivery, and ten nulliparous women were obtained from January to April 2014. The selected women were scanned using a multiplanar T2FRFSE sequence and T2fsFRFSE sequence. Changes in the pelvic floor and pubic bone in primiparous women, including tears of the levator ani fibers, pubic bone edema, and fractures, were assessed on the MR images in comparison with images from normal nulliparous women. Injury to the levator ani was evaluated and scored. The incidence, location and the extent of injury to the levator ani and pubic bone were characterized further. Results Eight out of ten primiparous women had imaging abnormalities after normal vaginal delivery. Three women had unilateral tears of the pubococcygeus, in which the defect in the muscle was located at or near its origin at the pubic bone, and one had a pubococcygeus tear accompanied by bilateral spilling of the vagina. Four women had partial tears of the iliococcygeus: one was a bilateral tear, and three were unilateral. None had a tear of the coccygeus. Eight women had pubic bone marrow edema; one was accompanied by a pubic bone fracture line. None of the nulliparous women had any abnormality of the pelvic floor and pubic bone. Conclusion Abnormalities of the pelvic floor and pubic bone were observed in primiparous women but not in nulliparous women. In primiparous women, most levator ani muscle tears are at or near the point of origin, and pubococcygeus injuries are usually accompanied by pubic bone marrow edema.
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Cong Y, Zou H, Qiao G, Lin J, Wang X, Li X, Li Y, Zhu S. Bilateral mammary duct ectasia induced by sulpiride-associated hyperprolactinemia: A case report. Oncol Lett 2015; 9:2181-2184. [PMID: 26137036 DOI: 10.3892/ol.2015.3034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 02/17/2015] [Indexed: 11/05/2022] Open
Abstract
A 32 year old female diagnosed with schizophrenia was treated with sulpiride, trihexyphenidyl and alprazolam for 6 years. A physical examination revealed bilateral nipple retraction and a non-tender mass in the left breast, with little nipple discharge. Tests revealed high levels of carbohydrate antigen 125, serum prolactin and testosterone levels, and ultrasound revealed a number of masses in the bilateral breasts; the largest mass (2.2×1.3 cm) was located in the left breast. A rich blood flow signal was identified around the nodule. The ducts in the bilateral breasts exhibited cystic ectasia. Multiple enlarged lymph nodes were found in the bilateral axillae. Mammography revealed thickened breast tissue without an evident mass, and calcification. A segmental mastectomy was performed and subsequent histological examination revealed multiple dilated ducts, the largest of which contained eosinophilic material. The pathological diagnosis was of breast duct dilatation. Bacterial culture and drug sensitivity analysis of the secretions from the cystic cavity revealed no bacterial growth, and an acid fast bacillus stain was negative. Extravasation of the surgical wound occurred 1 month later, and Staphylococcus epidermidis was observed using a bacterial culture. This was treated with moxifloxacin for 1 week. It was suggested that the patient should switch to a prolactin sparing antipsychotic in view of the hyperprolactinemia, however, the patient refused. After a clinical follow-up of 16 months, the wound had healed well and no palpable mass was found in the breast.
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Affiliation(s)
- Yizi Cong
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Haidong Zou
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Guangdong Qiao
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Jun Lin
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Xingmiao Wang
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Xiaohui Li
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Yalun Li
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
| | - Shiguang Zhu
- Department of Breast Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264400, P.R. China
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Alt CD, Hampel F, Hallscheidt P, Sohn C, Schlehe B, Brocker KA. 3 T MRI-based measurements for the integrity of the female pelvic floor in 25 healthy nulliparous women. Neurourol Urodyn 2014; 35:218-23. [PMID: 25393071 DOI: 10.1002/nau.22697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/29/2014] [Indexed: 11/11/2022]
Abstract
AIMS Measurements indicating a loss of integrity of the levator ani muscle, which is an integral part of the pelvic floor, have been subject of recent studies using translabial ultrasound and 3D-MRI-models. We transferred these measurements into 2D-3 T-MR-images for clinical routine, as it is objective and does not need exhaustive post-processing. METHODS The trial was accepted by the local ethics committee. 25 healthy volunteers fulfilled the inclusion criteria and gave written informed consent. Using high-resolution T2-weighted images (TE 5030-7810 ms, TR 88-112 ms, matrix 512, FOV 280-300 mm, ST 2-3 mm), measurements of anteroposterior hiatus (APH), laterolateral hiatus (LLH), hiatal area (HA), hiatal circumference (HC), levator area (LA), maximum muscle thickness (MMT) and levator urethra gap (LUG) were transferred from ultrasound, iliococcygeus width (IW), puborectalis attachment width (PAW), and levator symphysis gap (LSG) were transferred from 3D-MRI-models. We compared our results to previous studies in the literature. RESULTS Mean value was 52.22 ± 6.97 mm for APH, 33.15 ± 4 mm for LLH, 13.22 ± 3.05 cm(2) for HA, 14.19 ± 1.61 cm for HC, 7.14 ± 1.85 cm(2) for LA, 6.45 ± 2.07 mm for MMT, 19.47 ± 2.38 mm for LUG, 45 ± 3.97 mm for IW, 33.94 ± 3.34 mm for PAW, 20.54 ± 5.29 mm for LSG. Our results for APH, HA, LUG, and with limitations LA, were comparable to the literature, while HC, LLH, and MMT showed anatomical variances. Results for IW and LSG were comparable, but challenging to measure. We newly proposed a cutoff value for PAW. CONCLUSIONS 2D-3 T-MRI combines high-resolution images with objective measurements of parameters regarding pelvic floor integrity, without resorting to exhaustive post-processing methods. Our results may provide a good foundation for further 2D-MR-studies.
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Affiliation(s)
- Céline D Alt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Franziska Hampel
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Peter Hallscheidt
- Radiological Department Darmstadt, Academic Teaching Practice of the University of Heidelberg Medical School, Darmstadt, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Bettina Schlehe
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
| | - Kerstin A Brocker
- Department of Obstetrics and Gynecology, University of Heidelberg Medical School, Heidelberg, Germany
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