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Alshiek J, Murad-Regadas SM, Mellgren A, Glanc P, Khatri G, Quiroz LH, Weinstein MM, Rostaminia G, Oliveira L, Arif-Tiwari H, Ferrari L, Bordeianou L, Shobeiri SA. Consensus definitions and interpretation templates for dynamic ultrasound imaging of defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the american society of colon and rectal surgeons, the society of abdominal radiology, the international continence society, the American urogynecologic society, the international urogynecological association, and the society of gynecologic surgeons. Int Urogynecol J 2023; 34:603-619. [PMID: 36617601 DOI: 10.1007/s00192-022-05414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
- Urogynecology Unit, Technion Medical School, Hillel Yaffe Medical Center, Hadera, Israel
| | - Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Anders Mellgren
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Milena M Weinstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Northshore Hospital, Chicago, IL, USA
| | - Lucia Oliveira
- Department of Colorectal Surgery Hospital Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, VA, USA
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Asif Z, Tomashev R, Peterkin V, Wei Q, Alshiek J, Yael B, Shobeiri SA. Levator ani muscle volume and architecture in normal vs. muscle damage patients using 3D endovaginal ultrasound: a pilot study. Int Urogynecol J 2023; 34:581-587. [PMID: 36173426 DOI: 10.1007/s00192-022-05366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/20/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to compare the difference in levator ani muscle (LAM) volumes between 'normal' and those with sonographically visualized LAM defects. We hypothesized that the 'muscle damage' group would have a significantly lower muscle volume. METHODS The study included patients who had undergone a 3D endovaginal ultrasound. The normal (NM) and damage (DM) muscle groups' architectural changes were evaluated based on anterior-posterior (AP), left-right (LR) diameter, and minimal levator hiatus (MLH) area. The puboanalis-puboperinealis (PA), puborectalis (PR), and pubococcygeus-iliococcygeus (PC) were manually segmented using 2.5 vs. 1.0 mm to find the optimal sequence and to compare the volumes between NM and DM groups. POPQs were compared between the NM and DM groups. RESULTS The 1.0-mm segmentation volumes created superior volume analysis. Comparing NM to the DM group showed no significant difference in LAM volume. Respectively, the mean total LAM volumes were 17.27 cm3 (SD = 3.97) and 17.04 cm3 (SD = 4.32), p = 0.79. The mean MLH measurements for both groups respectively were 10.06 cm2 (SD = 2.93) and 12.18 cm2 (SD = 2.93), indicating a significant difference (p = 0.01). POPQ analysis demonstrated statistically significant differences at Ba and Bp parameters suggesting that the DM group had worse prolapse (p = 0.05, 0.01, respectively). CONCLUSIONS While LAM volumes are similar, there is a significant difference in the physical architecture of the LAM and the POPQ parameters in muscle-damaged patients compared to the normal group.
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Affiliation(s)
- Zara Asif
- Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Roni Tomashev
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA
| | - Veronica Peterkin
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA
| | - Baumfeld Yael
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Bioengineering, George Mason University, Fairfax, VA, USA. .,Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA.
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Alshiek J, Murad-Regadas SM, Mellgren A, Glanc P, Khatri G, Quiroz LH, Weinstein MM, Rostaminia G, Oliveira L, Arif-Tiwari H, Ferrari L, Bordeianou LG, Shobeiri SA. Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2023; 66:200-216. [PMID: 36627252 DOI: 10.1097/dcr.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, Virginia
- Urogynecology Unit, Hillel Yaffe Medical Center, Technion Medical School, Hadera, Israel
| | - Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | - Anders Mellgren
- Department of Surgery, University of Illinois, Chicago, Illinois
| | - Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Milena M Weinstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Northshore Hospital, Chicago, Illinois
| | - Lucia Oliveira
- Department of Colorectal Surgery' Hospital Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, Arizona
| | - Linda Ferrari
- Pelvic Floor Unit, St. Thomas' Hospital, London, United Kingdom
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Health System, Fairfax, Virginia
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Alshiek J, Wei Q, Javadian P, Quiroz LH, Baumfeld Y, Shobeiri SA. The Correlation Between the Sonographic Course of Transobturator Slings and Sling-Related Pain. J Ultrasound Med 2023; 42:125-133. [PMID: 35388919 DOI: 10.1002/jum.15982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine whether transobturator slings follow a consistent path and whether there is an association between ultrasonographically visualized sling pattern or position with sling-related pain. METHODS This was a cross-sectional retrospective pilot study. We evaluated women who were presented to our clinic for pain or other urogynecologic symptoms following transobturator sling placement between 2009 and 2014. Patients had undergone a 3-dimensional endovaginal pelvic floor ultrasound, assessing minimal levator hiatus, antero-posterior diameter, left-right diameter, and the hiatal shape. The mesh patterns were categorized as seagull patterns (normal), lopsided, flat, and convoluted. RESULTS A total of 68 cases were reviewed. Fifty patients reported pain, and 18 did not. There were wide variations in the course of the slings. The sling center- minimal levator hiatus position ranged 14.8 mm below and 17.9 mm above the minimal levator hiatus. The lateral arm insertion points ranged between 17.1 mm below and 16.6 mm above the minimal levator hiatus. The right arm insertion points ranged between 9.6 mm below and 18.8 mm above the minimal levator hiatus. Thirty-five of 68 (70%) patients with pain and 13 of 18 (72.2%) without had abnormal sling patterns. The abnormal sling shape was not correlated with pain (P = 1). The levator shape trended toward a statistical significant correlation with sling shape abnormality (P = .084). CONCLUSIONS This population of women with transobturator sling complications demonstrated wide variations in anatomic paths. Neither the abnormal sling shape nor the distance of the center of the tape from the minimal levator hiatus level were correlated with pain.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Pouya Javadian
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Yael Baumfeld
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
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Xia W, Ameri G, Fakim D, Akhuanzada H, Raza MZ, Shobeiri SA, McLean L, Chen ECS. Automatic Plane of Minimal Hiatal Dimensions Extraction From 3D Female Pelvic Floor Ultrasound. IEEE Trans Med Imaging 2022; 41:3873-3883. [PMID: 35984794 DOI: 10.1109/tmi.2022.3199968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is an increasing interest in the applications of 3D ultrasound imaging of the pelvic floor to improve the diagnosis, treatment, and surgical planning of female pelvic floor dysfunction (PFD). Pelvic floor biometrics are obtained on an oblique image plane known as the plane of minimal hiatal dimensions (PMHD). Identifying this plane requires the detection of two anatomical landmarks, the pubic symphysis and anorectal angle. The manual detection of the anatomical landmarks and the PMHD in 3D pelvic ultrasound requires expert knowledge of the pelvic floor anatomy, and is challenging, time-consuming, and subject to human error. These challenges have hindered the adoption of such quantitative analysis in the clinic. This work presents an automatic approach to identify the anatomical landmarks and extract the PMHD from 3D pelvic ultrasound volumes. To demonstrate clinical utility and a complete automated clinical task, an automatic segmentation of the levator-ani muscle on the extracted PMHD images was also performed. Experiments using 73 test images of patients during a pelvic muscle resting state showed that this algorithm has the capability to accurately identify the PMHD with an average Dice of 0.89 and an average mean boundary distance of 2.25mm. Further evaluation of the PMHD detection algorithm using 35 images of patients performing pelvic muscle contraction resulted in an average Dice of 0.88 and an average mean boundary distance of 2.75mm. This work had the potential to pave the way towards the adoption of ultrasound in the clinic and development of personalized treatment for PFD.
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Hamade S, Alshiek J, Javadian P, Ahmed S, McLeod FN, Shobeiri SA. Evaluation of the American College of Surgeons National Surgical Quality Improvement Program Risk Calculator to predict outcomes after hysterectomies. Int J Gynaecol Obstet 2022; 158:714-721. [PMID: 34929052 DOI: 10.1002/ijgo.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the American College of Surgeons (ACS) surgical risk calculator's reliability in predicting outcomes in hysterectomies. METHODS This is a prospective cohort study at a large community-based hospital. Twenty-one preoperative and postoperative criteria were abstracted from the electronic medical record and entered into the online ACS calculator to determine a risk score. Logistical regression was used to determine the association between risk score and actual outcome. The prediction capability was analyzed with c-statistic, Hosmer-Lemeshow, and Brier score. RESULTS A total of 634 hysterectomies were performed during the study period from January to April 2019. Patients were predominantly 55 years old, white (53%) and overweight (body mass index 30). Predicted perioperative adverse events were significantly higher than actual adverse events across all domains. In all, 54/634 (8.5%) patients experienced postoperative urinary tract infection. C-statistics for return to operating room, renal failure, and readmission were 0.607 (95% C Statistic index [CI] 0.370-0.845), 0.882 (95% CI 0.802-0.962), 0.637 (95% CI 0.524-0.750), respectively. Brier scores approached one in all categorical domains. CONCLUSION The ACS surgical risk calculator holds the promise of predicting postoperative complications or length of stay for patients undergoing hysterectomy. Further adjustment to this tool is required before it can be advocated for use in the clinical setting.
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Affiliation(s)
- Sara Hamade
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Jonia Alshiek
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
- Technion Medical School, Hillel Yafe Medical Center, Hadera, Israel
| | - Pouya Javadian
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Sushma Ahmed
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Francine N McLeod
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
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Alshiek J, Wei Q, Shobeiri SA. Correlation between pelvic floor ultrasound parameters and vaginal pressures in nulliparous women: a subanalysis of the SUM-AN study. Int Urogynecol J 2022; 33:1481-1487. [PMID: 35230482 DOI: 10.1007/s00192-022-05117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor ultrasound is used as a validated technique for measuring levator ani dimensions. Vaginal manometry has been used in the past as a method to assess levator ani muscle (LAM) strength. Whether the combination of both methods can contribute to our understanding of pelvic floor pathophysiology has not yet been described. We hypothesized that as female pelvic floor muscular hiatus increases, the vaginal pressure and strength decrease. METHODS We recruited 20 asymptomatic nulliparous women ages 18-85 years. Minimal levator hiatus (MLH) area, anteroposterior/left-right (AP/LR) diameter ratio, the distance between levator plate and the pubic symphysis (LP-PS) while at rest and squeeze were measured using endovaginal ultrasound (US). Vaginal pressure at rest, squeeze (Kegel) and Valsalva were measured using 3D manometry. Logistic and linear regression analysis was performed to assess correlations. RESULTS MLH area was negatively correlated with the sum of all the squeeze pressures produced on the four walls of the vagina (p = 0.049, R2 = 0.197). There was also a borderline negative correlation between MLH and the sum of rest pressures (p = 0.09, R2 = 0.15). AP/LR ratio was negatively correlated with the sum of squeeze pressures (p = 0.056, R2 = 0.197). LP-PS distances, both while at rest and during squeeze, were negatively correlated with the vaginal squeeze pressure (p = 0.046, R2 = 0.21; p = 0.011, R2 = 0.31, respectively). LP-V distance, both at rest and during squeeze, was negatively correlated with the sum of squeeze pressures on four vaginal walls (p = 0.02, R2 = 0.25; p = 0.005, R2 = 0.36, respectively). CONCLUSIONS Stronger levator ani muscles, smaller MLH area and a more oval shape of pelvic floor hiatus as assessed by pelvic floor ultrasound are associated with higher squeeze vaginal pressures as assessed by 3D manometry.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second floor South tower, Falls Church, VA, 22042-3307, USA.,Bioengineering, George Mason University, Fairfax, VA, USA
| | - Qi Wei
- Bioengineering, George Mason University, Fairfax, VA, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, 3300 Gallows Road, Second floor South tower, Falls Church, VA, 22042-3307, USA. .,Bioengineering, George Mason University, Fairfax, VA, USA.
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Baumfeld Y, Wei Q, Chitnis P, Marroquin J, Shobeiri SA, Alshiek J. Does aging affect the elastic properties of the bladder and the urethra in nulliparous women: An ultrasound shear-wave elastography study. Neurourol Urodyn 2022; 41:797-805. [PMID: 35077600 DOI: 10.1002/nau.24877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate how aging and menopausal status in absence of pregnancy and childbirth affect the elasticity of the bladder and urethra. STUDY DESIGN A single-center prospective observational study including nulliparous 10 pre- and 12 postmenopausal women. Data collection included baseline characteristics, physical examination data, questionnaire scores, PDFI and the Pelvic Floor Impact Questionnaire, and pelvic floor sonographic measurements as well as elastography measurements. The shear wave elastography (SWE) of tissue was measured using Kilopascal (kPa). The elastography measurements were taken over the rhabdosphincter, the suburethra smooth muscle, and the trigonal areas. RESULTS A total of 22 nulliparous subjects were enrolled in the study. The cohort's mean age was 43.5 years, the mean body mass index (BMI) was 26.8, and 86% were of Caucasian ethnicity. The postmenopausal group was older and with higher BMI (p < 0.001 and p = 0.05). They also had higher scores in all the questionnaires (p < 0.05 for all) and did not demonstrate prolapse in any compartments. The SWE results for the whole group were 35.2 kPa in the rhabdosphincter measuring point, 40.2 kPa in the sub-urethra point, and 20.6 kPa in the trigone point. Comparing the premenopause and postmenopause groups, we found lower measurements in the rhabdosphincter area and equivocal measurements for the suburethral zone. No statistically significant differences were found between the groups CONCLUSIONS: The elastic properties of the different bladder components and the urethra change with age and menopause. Using elastic properties of the tissues, we can further explore both stress urinary incontinence and overactive bladder.
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Affiliation(s)
- Yael Baumfeld
- Department of Obstetrics and Gynecology, INOVA Women's Hospital Inova Health System, Falls Church, Virginia, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Paraq Chitnis
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital Inova Health System, Falls Church, Virginia, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital Inova Health System, Falls Church, Virginia, USA.,Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Jonia Alshiek
- Department of Obstetrics and Gynecology, INOVA Women's Hospital Inova Health System, Falls Church, Virginia, USA.,Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
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Yu S, Bhagavath B, Shobeiri SA, Eisenstein D, Levy B. Clinical and Patient Reported Outcomes Pre- and Post-Surgical Treatment of Symptomatic Uterine Leiomyomas: A 12-Month Follow-Up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation (LAP-RFA) and Myomectomy. J Minim Invasive Gynecol 2022; 29:726-737. [DOI: 10.1016/j.jmig.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Mohan Paspulati R, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2021; 64:1184-1197. [PMID: 34516442 DOI: 10.1097/dcr.0000000000002155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, California
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, Ohio
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, Illinois
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, New York
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, California
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, New York
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, Virginia
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
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11
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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Abstract
Background and Objectives Postoperative safety outcomes with laparoscopic intra-abdominal ultrasound-guided radiofrequency ablation, as performed by gynecologic surgeons new to the procedure, were evaluated and compared to the premarket, pivotal study. Post-procedure feedback from surgeons was reported. Methods This was a post-market, prospective, single-arm analysis with 4 to 8 weeks follow-up among surgeons (n = 29) with varying levels of laparoscopic surgery experience participating in the ongoing, multinational Treatment Results of Uterine Sparing Technologies randomized clinical trial. Patients were premenopausal adult women (n = 110) desiring uterine-conserving treatment for symptomatic fibroids. During run-in, surgeons received proctored training. Following training, and after performing ≥ 2 procedures, surgeons provided self-assessment and feedback using a standardized form. Results Surgeons performed 105 procedures with 100 per-protocol patients. The average number of proctored cases per surgeon was 2.48. No acute (≤ 48 hours) serious adverse events occurred (0/101, 0.0%) compared with 2 acute serious adverse events in the premarket study (2/137, 1.46%). Both studies reported 1 near-term (∼30 days) serious adverse event (< 1% for both). In this study, the near-term complication was fever of unknown origin requiring hospitalization related to uterine entry/manipulation. This was categorized as probably device-related; the patient was treated with antibiotics and discharged. Twenty-six surgeons completed the evaluation form; none reported experiencing problems with the procedure. Conclusion Minimally invasive gynecologic surgeons can learn laparoscopic intraabdominal ultrasound-guided radiofrequency ablation and perform it safely (in terms of acute and near-term serious adverse events) after ≥ 2 proctored cases. There were no significant differences in safety outcomes compared to the premarket, pivotal study.
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Affiliation(s)
- Steve Yu
- Department of OB/GYN, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA
| | | | - Bala Bhagavath
- Department of OB/GYN, University of Rochester, Rochester, NY
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Alshiek J, Marroquin J, Shobeiri SA. Vaginal ultrasound-guided Pouch of Douglas robotic entry in a live ovine model and human female cadaveric specimens. J Robot Surg 2021; 16:73-79. [PMID: 33576913 DOI: 10.1007/s11701-021-01203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We aimed to determine whether intraoperative ultrasound is a feasible tool for visualization of the pouch of Douglas (POD) to facilitate a safe vaginal entry for direct robotic vaginal trocar insertion for pelvic floor surgery. Endovaginal ultrasound-guided needle insertion of a trocar into the POD was performed in six fresh frozen female cadavers and a live sheep animal model. Using an endovaginal probe the POD was identified as a fluid-filled space clear of bowel or adhesions, then a Veress needle was also used to confirm POD localization. Access to the POD was achieved using a robotic trocar designed for this purpose. The animal study was approved by the Ethics Committee of Asaf-Harofe hospital. Direct visualization during laparoscopy in cadavers and open cadaveric dissections confirmed safe POD entry and accurate trocar placement. This method was found feasible in the development of a safe vaginal entry in both the animal and cadaveric model, possibly negating the need for laparoscopic umbilical observation.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Hillel Yafe Hospital, Hadera, Israel.,Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA.,Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA. .,Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Alshiek J, Marroquin J, Shobeiri SA. The Fresh Frozen Cadaveric Study of Direct Pouch of Douglas Laparoscopic and Robotic Trocar Insertion for Vaginal Natural Orifice Transluminal Endoscopic Surgery. J Minim Invasive Gynecol 2020; 28:320-324. [PMID: 32540501 DOI: 10.1016/j.jmig.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. DESIGN Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. SETTING Inova Advanced Simulation and Technology Evaluation Center. PATIENTS Fresh frozen cadavers with intact reproductive organs. INTERVENTIONS Vaginal POD trocar insertion. MEASUREMENTS AND MAIN RESULTS Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. CONCLUSION A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia; Department of Obstetrics & Gynecology, Hillel Yafe Hospital, Technion Medical School, Hadera, Israel (Dr. Alshiek)
| | - Joanna Marroquin
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors)
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia.
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Xing Q, Chitnis P, Sikdar S, Alshiek J, Shobeiri SA, Wei Q. M3VR-A multi-stage, multi-resolution, and multi-volumes-of-interest volume registration method applied to 3D endovaginal ultrasound. PLoS One 2019; 14:e0224583. [PMID: 31751356 PMCID: PMC6872108 DOI: 10.1371/journal.pone.0224583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Heterogeneity of echo-texture and lack of sharply delineated tissue boundaries in diagnostic ultrasound images make three-dimensional (3D) registration challenging, especially when the volumes to be registered are considerably different due to local changes. We implemented a novel computational method that optimally registers volumetric ultrasound image data containing significant and local anatomical differences. It is A Multi-stage, Multi-resolution, and Multi-volumes-of-interest Volume Registration Method. A single region registration is optimized first for a close initial alignment to avoid convergence to a locally optimal solution. Multiple sub-volumes of interest can then be selected as target alignment regions to achieve confident consistency across the volume. Finally, a multi-resolution rigid registration is performed on these sub-volumes associated with different weights in the cost function. We applied the method on 3D endovaginal ultrasound image data acquired from patients during biopsy procedure of the pelvic floor muscle. Systematic assessment of our proposed method through cross validation demonstrated its accuracy and robustness. The algorithm can also be applied on medical imaging data of other modalities for which the traditional rigid registration methods would fail.
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Affiliation(s)
- Qi Xing
- Department of Computer Science, George Mason University, Fairfax, Virginia, United States of America
- The School of Information Science and Technology, Southwest Jiaotong University, Sichuan, China
| | - Parag Chitnis
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - S. Abbas Shobeiri
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
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Alshiek J, Jalalizadeh M, Wei Q, Chitnis P, Shobeiri SA. Ultrasongraphic age‐related changes of the pelvic floor muscles in nulliparous women and their association with pelvic floor symptoms: A pilot study. Neurourol Urodyn 2019; 38:1305-1312. [DOI: 10.1002/nau.23979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/14/2019] [Accepted: 03/03/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
| | - Mehrsa Jalalizadeh
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
| | - Qi Wei
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
| | - Parag Chitnis
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
| | - S. Abbas Shobeiri
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
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Affiliation(s)
- J Alshiek
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, 3300 Gallows Rd, 2nd floor, Falls Church, VA, 22042, USA
| | - S A Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, 3300 Gallows Rd, 2nd floor, Falls Church, VA, 22042, USA.
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Alshiek J, Bar-El L, Shobeiri SA. Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojog.2019.98108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shobeiri SA, Kerkhof MH, Minassian VA, Bazi T. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J 2018; 30:371-376. [PMID: 30523374 DOI: 10.1007/s00192-018-3830-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022]
Abstract
This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Falls Church, VA, USA.
- Department of Biomedical Engineering, George Mason University, Fairfax, VA, USA.
| | - M H Kerkhof
- Curilion Female Health Clinic, Haralem, Netherlands
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tony Bazi
- Department of Obstetrics and Gynecology, The American University of Beirut, Beirut, Lebanon
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Egorov V, Lucente V, Shobeiri SA, Takacs P, Hoyte L, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions. EC Gynaecol 2018; 7:431-446. [PMID: 31093608 PMCID: PMC6513001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into the pathophysiology of pelvic organ prolapse (POP). Vaginal tactile imaging is an innovative approach to the biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns through the vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. OBJECTIVE The objective of this study is to explore an extended set of 52 biomechanical parameters of the female pelvis for the differentiation and characterization of uterine prolapse relative to normal pelvic floor conditions. METHODS Sixty subjects were included in the data analysis from observational and case-controlled studies. Out of these 60, forty-two subjects had normal pelvic floor conditions and 18 subjects had uterine prolapse (no anterior, no posterior prolapse). The VTI, model 2S, was used with an analytical software package to automatically calculate 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). RESULTS The ranges, mean values, and standard deviations for all 52 VTI parameters were established. Twenty-two of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the development of uterine prolapse. Among these 21 parameters, 6 parameters show changes (decrease) in tissue elasticity, 5 parameters show deteriorations in pelvic support, and 10 parameters show weakness in muscle functions for uterine prolapsed versus normal conditions. CONCLUSION The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing uterine prolapse versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under the prolapse conditions may be useful in future research and practical applications.
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Affiliation(s)
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, United States
| | | | - Peter Takacs
- Eastern Virginia Medical School, Norfolk, United States
| | - Lennox Hoyte
- The Pelvic Floor Institute, Tampa, United States
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21
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Egorov V, Shobeiri SA, Takacs P, Hoyte L, Lucente V, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions. ACTA ACUST UNITED AC 2018; 8:900-924. [PMID: 31080695 PMCID: PMC6508651 DOI: 10.4236/ojog.2018.810093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies; 42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters show deteriorations in pelvic support and 14 parameters show weakness in muscle functions for POP versus normal conditions. Conclusions: The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing POP versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under POP may be used in future research and practical applications.
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Affiliation(s)
| | | | | | | | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, USA
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Rostaminia G, Machiorlatti M, Shobeiri SA, Quiroz LH. Variability of the pubic arch architecture and its influence on the minimal levator hiatus area. Int J Gynaecol Obstet 2016; 134:217-20. [PMID: 27177513 DOI: 10.1016/j.ijgo.2015.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the association between the minimal levator hiatus (MLH) area at rest with its surrounding soft-tissue and bony structures in nulliparous asymptomatic women with a normal levator ani muscle. METHODS A subanalysis was undertaken of a prospective study of the appearance of the levator ani in asymptomatic nulliparous women conducted between September 2010 and September 2011. The subanalysis included women with a normal levator ani muscle. Three-dimensional ultrasonography volumes were used to obtain pelvic floor measurements. RESULTS The analysis included 56 women with mean age of 43.0±13.4years. The mean MLH area was 13.1±1.8cm(2) (range 9.0-17.3). The pubic arch angle had no influence on the MLH area (Pearson correlation coefficient r=0.13). Height and pubic arch length were positively correlated with the MLH area (r=0.26 [P=0.52] and r=0.50 [P<0.001], respectively). CONCLUSION The MLH size of nulliparous women varied widely and was positively correlated with the height and pubic arch length of the women. Therefore, caution is warranted when interpreting the MLH area as an indicator of a levator ani defect or a predictor of pelvic organ prolapse without taking a woman's pelvic bone characteristics into account.
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Affiliation(s)
- Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Inova FairFax Hospital, Falls Church, VA, USA
| | - Michael Machiorlatti
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Santoro GA, Shobeiri SA, Petros PP, Zapater P, Wieczorek AP. Perineal body anatomy seen by three-dimensional endovaginal ultrasound of asymptomatic nulliparae. Colorectal Dis 2016; 18:400-9. [PMID: 26382090 DOI: 10.1111/codi.13119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/06/2015] [Indexed: 02/08/2023]
Abstract
AIM The perineal body (PB) plays an important role in supporting the pelvic floor and the posterior vaginal wall, but its attachments and relationships are still debated. This study aimed to assess the normal anatomy of the PB using high-resolution three-dimensional endovaginal ultrasound (3D-EVUS) in asymptomatic nulliparae. METHOD To validate the identification of perineal structures, 3D-EVUS was initially performed on nulliparous cadavers. Fresh frozen pelves were prepared and echogenic structures thought to be the PB, the external anal sphincter, the superficial and deep transverse perineii, pubovaginalis, puboperinealis, puboanalis, puborectalis and iliococcygeus muscles were tagged with biopsy needles, and marked with indigo carmine dye for localization during dissection. In the second part of the study, consecutive asymptomatic nulliparae were prospectively imaged with the same ultrasound modality. Interrater reproducibility was assessed off-line from stored 3D US volumes using a standardized technique. RESULTS Five fresh frozen pelves and 44 asymptomatic nulliparae were assessed with 3D-EVUS. The PB was seen as an ovoid structure of mixed echogenicity between the rectum and vagina. It appeared to be divided into a superficial level, in contact with the external anal sphincter, the bulbospongiousus and the superficial transverse perineii muscle and a deep level, in contact with puboperinealis and puboanalis muscles. Interobserver repeatability was excellent for the measurements of PB height [intraclass correlation coefficient (ICC) 0.927], PB depth (ICC 0.969) and PB width (ICC 0.932). CONCLUSION The PB is divided into two levels with different anatomical relationships with the pelvic floor muscles. 3D-EVUS yields reproducible assessment of this complex structure.
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Affiliation(s)
- G A Santoro
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - S A Shobeiri
- Section of Female Pelvic Medicine and Reconstructive Surgery, Division of Obstetric and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - P P Petros
- Academic Department of Surgery, St Vincent's Hospital Clinical School, Sydney, New South Wales, Australia
| | - P Zapater
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - A P Wieczorek
- Department of Paediatric Radiology, Medical University of Lublin, Lublin, Poland
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Towner RA, Wisniewski AB, Wu DH, Van Gordon SB, Smith N, North JC, McElhaney R, Aston CE, Shobeiri SA, Kropp BP, Greenwood-Van Meerveld B, Hurst RE. A Feasibility Study to Determine Whether Clinical Contrast Enhanced Magnetic Resonance Imaging can Detect Increased Bladder Permeability in Patients with Interstitial Cystitis. J Urol 2016; 195:631-8. [PMID: 26307161 PMCID: PMC4760854 DOI: 10.1016/j.juro.2015.08.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome is a bladder pain disorder associated with voiding symptomatology and other systemic chronic pain disorders. Currently diagnosing interstitial cystitis/bladder pain syndrome is complicated as patients present with a wide range of symptoms, physical examination findings and clinical test responses. One hypothesis is that interstitial cystitis symptoms arise from increased bladder permeability to urine solutes. This study establishes the feasibility of using contrast enhanced magnetic resonance imaging to quantify bladder permeability in patients with interstitial cystitis. MATERIALS AND METHODS Permeability alterations in bladder urothelium were assessed by intravesical administration of the magnetic resonance imaging contrast agent Gd-DTPA (Gd-diethylenetriaminepentaacetic acid) in a small cohort of patients. Magnetic resonance imaging signal intensity in patient and control bladders was compared regionally and for entire bladders. RESULTS Quantitative assessment of magnetic resonance imaging signal intensity indicated a significant increase in signal intensity in anterior bladder regions compared to posterior regions in patients with interstitial cystitis (p <0.01) and significant increases in signal intensity in anterior bladder regions (p <0.001). Kurtosis (shape of probability distribution) and skewness (measure of probability distribution asymmetry) were associated with contrast enhancement in total bladders in patients with interstitial cystitis vs controls (p <0.05). Regarding symptomatology interstitial cystitis cases differed significantly from controls on the SF-36®, PUF (Pelvic Pain and Urgency/Frequency) and ICPI (Interstitial Cystitis Problem Index) questionnaires with no overlap in the score range in each group. ICSI (Interstitial Cystitis Symptom Index) differed significantly but with a slight overlap in the range of scores. CONCLUSIONS Data suggest that contrast enhanced magnetic resonance imaging provides an objective, quantifiable measurement of bladder permeability that could be used to stratify bladder pain patients and monitor therapy.
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Affiliation(s)
- Rheal A Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
| | - Amy B Wisniewski
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Dee H Wu
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Samuel B Van Gordon
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Justin C North
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Rayburt McElhaney
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Christopher E Aston
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Bradley P Kropp
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Robert E Hurst
- Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Department of Biochemistry and Molecular Biology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
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Javadian P, O'Leary D, Rostaminia G, North J, Wagner J, Quiroz LH, Shobeiri SA. How does 3D endovaginal ultrasound compare to magnetic resonance imaging in the evaluation of levator ani anatomy? Neurourol Urodyn 2015; 36:409-413. [PMID: 26669505 DOI: 10.1002/nau.22944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/19/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To compare magnetic resonance imaging (MRI) to 3D endovaginal ultrasound (EVUS) in the evaluation of major levator ani defects in women with pelvic floor disorders. METHODS A total of 21 subjects with pelvic floor with complaints of pelvic floor disorders were included in this study. EVUS imaging of the levator ani muscle (LAM) was performed in all subjects, and the LA muscle groups of interest evaluated were the puboanalis (PA), puborectalis (PR), and pubovisceralis (PV) muscles. The right and left subdivisions were evaluated separately, and classified as (i) normal, normal with only minor irregularities, grossly abnormal, or absent, or (ii) by the levator ani deficiency (LAD) score and classified by no defect (complete attachment of muscle to the pubic bone), <50% detachment or loss, >50% detachment or loss, and completely detached or complete muscle loss. Paired data were analyzed with McNemar's test or Bowker's test of symmetry. RESULTS When unilateral LAM subdivisions were classified as "normal," "normal with minor irregularity," "grossly abnormal," and "absent," there were no significant differences between MRI and EVUS by categorization of LAM defects. Comparing "normal" versus "abnormal," there was no difference between imaging modalities. When compared by LAD score evaluation, there were no differences in the categorization of unilateral defects between MRI and EVUS. CONCLUSIONS Endovaginal 3D US is comparable to MRI in its ability to identify both normal and abnormal LAM anatomy. Neurourol. Urodynam. 36:409-413, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Pouya Javadian
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dena O'Leary
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Fairfax, Virginia
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Fairfax, Virginia
| | - Justin North
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jason Wagner
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Fairfax, Virginia
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Javadian P, Wendelken J, Quiroz LH, Shobeiri SA. Surgical Care Processing in Major Oklholma City Hosptal: The Surgeons' Perspective. J Okla State Med Assoc 2015; 108:589-591. [PMID: 27027138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aimed to assess processing of surgical care provided at major Oklahoma City hospitals based on surgeons'perception. METHODS A questionnaire was sent out to Oklahoma County Medical Society surgeons using survey monkey to assess surgeons' perception of surgical care provided by major hospitals in Oklahoma City metropolitan area. The email contained a short introduction of study and the general aim of the study. Student t test was applied to compare groups mean. P value <0.05 was considered significant. RESULTS 79 valid responses were identified. 25% of surgeons scored that their patients waited in the post-op recovery area between 31-60 minutes before they were roomed, with a 90% surgeon satisfaction rate. Compared to the longer waiting times this satisfaction rate was significantly higher (P < 0.0001). 64.6% of surgeons reported 31-60 minutes turn-over time between cases with only an 8% satisfaction rate. 10-30 minutes turnover time was reported in 13.9% of participants with 72.7% satisfaction rate which was significant when compared to the former group. The surgeons scored that their patients presented to the hospital 1-2 hours before surgery 55.7% of the times and 92.7% of the surgeons were satisfied with this process (P < 0.0001). CONCLUSION Surgeons'satisfaction increases with decreased patients processing times.
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Rostaminia G, Peck J, Quiroz L, Shobeiri SA. Levator Plate Upward Lift on Dynamic Sonography and Levator Muscle Strength. J Ultrasound Med 2015; 34:1787-1792. [PMID: 26333568 PMCID: PMC4881840 DOI: 10.7863/ultra.15.14.11075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare digital palpation with levator plate lift measured by endovaginal and transperineal dynamic sonography. METHODS Dynamic transperineal and endovaginal sonographic examinations were performed as part of multicompartmental pelvic floor functional assessment. Patients were instructed to perform Kegel contractions while a probe captured a video clip of levator plate movement at rest and during contraction in a 2-dimensional midsagittal posterior view. We measured the distance between the levator plate and the probe on endovaginal sonography as well as the distance between the levator plate and the gothic arch of the pubis on transperineal sonography. The change in diameter (lift) and levator plate lift ratio (lift/rest × 100) were calculated. Pelvic floor muscle strength was assessed by digital palpation and divided into functional and nonfunctional groups according to the Modified Oxford Scale. Mean differences in levator plate upward lift were compared by Modified Oxford Scale scores using Student t tests and analysis of variance. RESULTS Seventy-four women were available for analysis. The mean age was 55 (SD, 11.9) years. When measured by vaginal dynamic sonography, mean lift and lift/rest ratio values increased with increasing Modified Oxford Scale score (analysis of variance, P= .09 and .04, respectively). When scores were categorized to represent nonfunctional (0-1) and functional (2-5) muscle strength groups, the mean lift (3.2 versus 4.6 mm; P = .03) and lift/rest ratio (13% versus 20%; P = .01) values were significantly higher in women with functional muscle strength. All patients with lift of 30% or greater detected by vaginal sonography had functional muscle strength. CONCLUSIONS A greater levator plate lift ratio detected by dynamic endovaginal sonography was associated with higher muscle strength as determined by the Modified Oxford Scale. This novel measurement can be incorporated into sonographic evaluation of levator ani function.
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Affiliation(s)
- Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia USA (G.R.); and Departments of Obstetrics and Gynecology and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA (J.P., L.Q., S.A.S.)
| | - Jennifer Peck
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia USA (G.R.); and Departments of Obstetrics and Gynecology and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA (J.P., L.Q., S.A.S.)
| | - Lieschen Quiroz
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia USA (G.R.); and Departments of Obstetrics and Gynecology and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA (J.P., L.Q., S.A.S.)
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia USA (G.R.); and Departments of Obstetrics and Gynecology and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA (J.P., L.Q., S.A.S.).
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Rostaminia G, White D, Quiroz L, Shobeiri SA. Is a new high-resolution probe better than the standard probe for 3D anal sphincter and levator ani imaging? Ultrason Imaging 2015; 37:168-175. [PMID: 24831299 DOI: 10.1177/0161734614534831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of our study was to determine the accuracy of a new three-dimensional (3D) endoluminal ultrasound probe in assessing the levator ani muscle and anal sphincter complex. A total of 85 patients who had undergone concurrent 3D endovaginal (EVUS) and 3D endoanal (EAUS) ultrasound with both the standard BK 2052 probe and the new high-definition BK 8838 probes were included. For EVUS volumes, the levator ani deficiency (LAD) scores were calculated for each probe. For the EAUS volumes, any defects in the external anal sphincter (EAS) and the internal anal sphincter (IAS) visualized with each probe were recorded. The 3D volumes were evaluated in a blinded fashion. Appropriate statistics were utilized to assess absolute agreements between each pair of imaging modalities. The mean age of the patient population was 59 years (SD ± 10.76), the mean body mass index (BMI) was 28.36 (SD ± 5.99), and the median parity was 2 (range 1, 7). In all, 93% of the patients were Caucasian, 31% had stage 0 or 1 prolapse, while 59% had stage 2 prolapse. The mean total LAD score obtained on EVUS with the standard and the new probes were 11.49 (SD ± 4.94) and 11.53 (SD ± 5.01), respectively, p = 0.3778. Among the 53 patients who had EAUS with both probes, exact agreement for visualization of EAS and IAS for the standard and the new probes was 83% and 98%, respectively. Both transducers can be used for endovaginal imaging of the levator ani muscles interchangeably. Both transducers can be used for endoanal imaging of anal sphincter complex interchangeably.
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Affiliation(s)
- Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Dena White
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Lieschen Quiroz
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
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Rostaminia G, Peck JD, Quiroz LH, Shobeiri SA. How well can levator ani muscle morphology on 3D pelvic floor ultrasound predict the levator ani muscle function? Int Urogynecol J 2015; 26:257-62. [PMID: 25246297 PMCID: PMC4874572 DOI: 10.1007/s00192-014-2503-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/30/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of our study was to assess the performance of levator ani muscle deficiency (LAD) evaluated by 3D endovaginal ultrasound (EVUS) to detect pelvic floor muscle function as assessed by digital examination. METHODS This cross-sectional study was conducted among 77 patients referred to our urogynecology clinic for pelvic floor dysfunction symptoms. Patients underwent physical examinations including digital pelvic muscle strength assessment using the Modified Oxford scale (MOS). EVUS volumes were evaluated and levator ani muscles were scored according to a validated LAD scoring system. MOS scores were categorized as nonfunctional (scores 0-1) and functional (scores 2-5). RESULTS Mean age of participants was 56 (SD ± 12.5) and 71% were menopausal. Overall, 32.5% had nonfunctional muscle strength and 44.2% were classified as having significant LAD. LAD identified by ultrasound had a sensitivity of 60% (95% CI 41 -79%) for detecting nonfunctional muscle and a specificity of 63% (95% CI 50 -77%) for detecting functional muscle. Overall, LAD demonstrated fair ability to discriminate between patients with and those without poor muscle function (area under the ROC curve = 0.70 [95% CI 0.58-0.83]). Among patients with an LAD score of 16-18, representing almost total muscle avulsion, 70% had nonfunctional MOS scores, whereas in patients with normal/minimal LAD (scores of 0-4), 89.5% had functional MOS scores. CONCLUSIONS Levator ani deficiency and MOS scales were moderately negatively correlated. Among patients with normal morphology or the most severe muscle deficiency, LAD scores can identify the majority of patients with functional or nonfunctional MOS scores respectively.
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Affiliation(s)
- G Rostaminia
- Section of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP2410, P.O. Box 26901, Oklahoma City, OK, 73190, USA
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Manonai J, Rostaminia G, Denson L, Shobeiri SA. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications. Neurourol Urodyn 2015; 35:407-11. [PMID: 25620321 DOI: 10.1002/nau.22725] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/24/2014] [Indexed: 01/26/2023]
Abstract
AIM The objective of this study was to investigate the clinical and ultrasonographic findings of women who had three-dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications. METHODS This was a retrospective study of patients that had EVUS due to mesh complications at a tertiary care center. The clinical charts were reviewed. The stored 3D volumes were reviewed regarding mesh information by two examiners independently. The predictive value of physical examination for detection of vaginal mesh was calculated. Patient outcomes were reviewed. RESULTS Seventy-nine patients presented to our center because of their, or their physicians' concern regarding mesh complications. Forty-one (51.9%) had vaginal/pelvic pain, and 51/62 (82.2%) of sexually active women experienced dyspareunia. According to ultrasonographic findings, mesh or sling was not demonstrated in six patients who believed they have had mesh/sling implantation. The positive predictive value for vaginal examination was 94.5% (95% CI: 84.9%-98.8%), negative predictive value was 12.5% (95% CI: 2.8%-32.4%), sensitivity was 72.2% (95% CI: 59.4%-81.2%), and specificity was 50.0% (95% CI: 12.4%-87.6%). Fifty-four patients were indicated for surgical treatment. Median postoperative review was 12 (range, 3-18) months and 38/53 (71.7%) patients were satisfied. CONCLUSIONS The most common complaints of vaginal mesh complications were pain and dyspareunia. EVUS appeared to be helpful for assessing mesh presence, location, and extent including planning for surgical intervention.
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Affiliation(s)
- Jittima Manonai
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lindsay Denson
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Santiago AC, O'Leary DE, Quiroz LH, Shobeiri SA. Is there a correlation between levator ani and urethral sphincter complex status on 3D ultrasonography? Int Urogynecol J 2014; 26:699-705. [PMID: 25448493 DOI: 10.1007/s00192-014-2577-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/10/2014] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To determine the correlation between levator ani deficiency (LAD) and urethral sphincter complex measurements as visualized on 3D endovaginal ultrasonography, and to compare the LAD score with continence status. METHODS This was a retrospective analysis of patients seen at our institution between January 2011 and August 2013. Patients were dichotomized into those with urodynamic stress urinary incontinence (SUI) and those with no SUI. Levator ani status was evaluated using a validated scoring system yielding scores of 0 - 6 (normal levator ani/mild LAD), 7 - 12 (moderate LAD), and 13 - 18 (severe LAD). The length, horizontal diameter, and cross-sectional area of the urethra, and the length, width, and the area of the rhabdomyosphincter and smooth muscle sphincter were likewise measured using 3D ultrasound volumes. RESULTS Of the 80 patients included, 54 (67.5%) had SUI and 26 (32.5%) were continent. 18 (22.5%) had evidence of mild LAD, 54 (67.5%) had moderate LAD, and 8 (10.0%) had severe LAD. Among patients with SUI, those with normal levator ani muscles or mild LAD had greater urethral smooth muscle width than those with moderate and severe LAD (p = 0.0238). A greater proportion of patients with SUI also had moderate to severe LAD than continent patients (p = 0.0177, OR 3.59, 95% CI 1.21 - 10.65). There was no difference in LAD distribution by type of stress incontinence (presence or absence of intrinsic sphincter deficiency; p = .2377). CONCLUSIONS LAD and urethral sphincter complex status, as visualized on 3D ultrasonography, are independent factors. Moderate to severe LAD is more prevalent in patients with SUI.
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Affiliation(s)
- A C Santiago
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard WP 2410, P.O. Box 26901, Oklahoma City, OK, 73190, USA
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Shobeiri SA, Santiago AC. Individualised pelvic floor muscle training is an effective conservative treatment in women with pelvic organ prolapse. Evid Based Med 2014; 19:213. [PMID: 25038067 DOI: 10.1136/ebmed-2014-110020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrea C Santiago
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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O'Leary DE, Pickett SD, Shobeiri SA. Description of the methodology in the study of the association between vaginal parity and minimal levator hiatus. BJOG 2014; 122:872. [PMID: 24990183 DOI: 10.1111/1471-0528.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D E O'Leary
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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van Delft KWM, Sultan AH, Thakar R, Shobeiri SA, Kluivers KB. Agreement between palpation and transperineal and endovaginal ultrasound in the diagnosis of levator ani avulsion. Int Urogynecol J 2014; 26:33-9. [DOI: 10.1007/s00192-014-2426-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/29/2014] [Indexed: 02/05/2023]
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Van Delft K, Shobeiri SA, Thakar R, Schwertner-Tiepelmann N, Sultan AH. Reply: To PMID 23939804. Ultrasound Obstet Gynecol 2014; 43:480. [PMID: 24692223 DOI: 10.1002/uog.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- K Van Delft
- Croydon University Hospital, Department of Obstetrics and Gynaecology, Urogynaecology and Pelvic Floor Reconstruction Unit, 530 London Road, Croydon, CR7 7YE, UK
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Rostaminia G, Machiorlatti M, Omoumi F, Shobeiri SA. Statistical justifications for interrater reliability of levator ani deficiency (LAD) assessment by 3D endovaginal ultrasonography: response to critique. Int Urogynecol J 2014; 25:709-10. [PMID: 24595413 DOI: 10.1007/s00192-014-2351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Rostaminia
- Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, The University of Oklahoma Health Sciences Center, WP 2410, 920 Stanton L. Young Blvd., Oklahoma City, OK, 73104, USA
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Allen AM, Shobeiri SA, Quiroz LH, Fong DN, Nihira MA. Obstetric laceration repair in the United States: is there a common practice? J Reprod Med 2014; 59:127-133. [PMID: 24724220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess practice preferences in the repair of severe obstetric lacerations among obstetrician/gynecologists in the United States. STUDY DESIGN A survey detailing third and fourth degree laceration repair techniques was distributed to 634 obstetrician/gynecologists from demographically diverse areas of the United States. Categorical outcomes were compared among respondents using chi2 or Fisher's exact test where appropriate. RESULTS Of the 266 respondents, there were 124 self-reported "experts" (47%) and 106 physicians-in-training (40%). Repair techniques were compared between experts versus nonexperts and trainees versus practicing physicians. There were no significant differences found between either comparison group on the type and size of suture utilized or preferred method of closure for repair. CONCLUSION There is little variation in the practice pattern of complex laceration repairs among obstetrician-gynecologists in the United States. This commonality should encourage the design of standard teaching models and techniques for physicians in training.
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Abstract
The objective of this pictorial essay is to emphasize the ability of 3-dimensional endovaginal sonography to image synthetic implanted materials in the female pelvic floor. Implanted materials discussed in this pictorial essay include polypropylene vaginal mesh, polypropylene suburethral slings, and urethral bulking agents. Three-dimensional endovaginal sonography allows for more detailed imaging compared to computed tomography and magnetic resonance imaging of the female pelvic floor, in that each plane can be manipulated to show unique images of synthetic implanted materials.
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Affiliation(s)
- Lindsay Denson
- Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, PO Box 26901, WP2410, Oklahoma City, OK 73190 USA.
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van Delft K, Shobeiri SA, Thakar R, Schwertner-Tiepelmann N, Sultan AH. Intra- and interobserver reliability of levator ani muscle biometry and avulsion using three-dimensional endovaginal ultrasonography. Ultrasound Obstet Gynecol 2014; 43:202-209. [PMID: 23939804 DOI: 10.1002/uog.13193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To test intra- and interobserver reliability of assessment of levator ani muscle (LAM) biometry and avulsion using antenatal and postnatal three-dimensional (3D) endovaginal ultrasonography (EVUS), and to determine levator-urethra gap (LUG) values on EVUS. METHODS Primigravid women were scanned prior to delivery, early postpartum and 3 months postpartum, with EVUS performed at rest using a standardized protocol. During post-processing, measurements were taken in the plane of minimal hiatal dimensions by two independent investigators blinded to the clinical information and each other's results. LAM attachment to the pubic bone was assessed at the pubococcygeus and puborectalis levels using a score system: (1) intact; (2) partial avulsion (< 50%); (3) partial avulsion (≥ 50%); and (4) complete avulsion. Intraclass correlation coefficients (ICCs) and limits of agreement (LOAs) were calculated for each time point, with intraobserver analysis conducted in a random sample of 20 women scanned 3 months following delivery. RESULTS One hundred and sixty-nine antenatal scans, 83 early postpartum scans and 75 scans at 3 months postpartum were performed. The intra- and interobserver ICCs, respectively, were 0.95 and 0.86-0.88 for hiatal area, 0.90 and 0.16-0.74 for hiatal transverse diameter, 0.91 and 0.73-0.80 for hiatal anteroposterior diameter, 0.50 and 0.32-0.52 for LAM thickness at the '9 o'clock position' and 0.55 and 0.33-0.45 for LAM thickness at the '3 o'clock position'. Both intra- and interobserver analysis revealed acceptable LOAs for hiatal measurements, but the LOAs were wide for thickness measurements. The correlation of LAM avulsion score was excellent on intra- and interobserver analysis. Antenatal mean ± SD LUGs were 18.8 ± 2.4 mm and 19.2 ± 2.3 mm on right and left sides, respectively; the intraobserver ICC was 0.82-0.91 but LOAs were wide, while interobserver ICC was 0.13-0.68 and also had wide LOAs. CONCLUSIONS 3D-EVUS is a reliable tool for the assessment of hiatal measurements and LAM avulsion in women during pregnancy and after delivery, but performs less well for measurements of LAM thickness and LUG. EVUS can therefore be used in research studies involving childbirth and recurrent prolapse.
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Affiliation(s)
- K van Delft
- Croydon University Hospital, Department of Obstetrics and Gynaecology, Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon, UK
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van Delft K, Thakar R, Shobeiri SA, Sultan AH. Levator hematoma at the attachment zone as an early marker for levator ani muscle avulsion. Ultrasound Obstet Gynecol 2014; 43:210-217. [PMID: 23893754 DOI: 10.1002/uog.12571] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/08/2013] [Accepted: 07/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Childbirth causes overstretching of the levator ani muscle (LAM), predisposing to avulsion. LAM avulsion has not been evaluated early postpartum using endovaginal ultrasound (EVUS). The aim of this study was to evaluate the relationship between hematomas and LAM avulsion using EVUS and palpation early and late postpartum. METHODS Nulliparous women were studied prospectively at 36 weeks' gestation and within 4 days and 3 months postpartum. Palpation and high-frequency three-dimensional EVUS were performed. Two independent investigators reviewed the scans. RESULTS No antenatal LAM avulsions were found (n = 269). 114/199 (57.3%) women seen early postpartum agreed to examination. 27/114 (23.7%) had well delineated, hypoechoic areas consistent with hematomas (100% agreement), 26 following vaginal delivery, one following emergency Cesarean section. In total, 38 hematomas were found (11 bilateral, 16 unilateral). Hematomas away from the attachment zone of the LAM to the pubic bone (n = 22) resolved. Hematomas at the attachment zone (n = 16) manifested as pubococcygeus avulsions 3 months postpartum. In addition to these 16 avulsions, we found another 20 at 3 months postpartum. 13/20 were not scanned early postpartum and in seven no hematomas were seen, but avulsion was seen early postpartum. Overall, LAM avulsion was found in 23/191 (12.0%) women (13 bilateral, 10 unilateral) 3 months postpartum. Hematomas were significantly associated with episiotomy, instrumental delivery and increased hiatal measurements. Palpation was unreliable early postpartum as only seven avulsions were diagnosed. CONCLUSION Hematomas at the site of LAM attachment to the pubic bone always result in avulsion diagnosed 3 months postpartum. However, one third of avulsions are not preceded by a hematoma at the site of LAM attachment to the pubic bone.
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Affiliation(s)
- K van Delft
- Croydon University Hospital, Department of Obstetrics and Gynaecology, Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon, UK
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Rostaminia G, White DE, Quiroz LH, Shobeiri SA. Levator plate descent correlates with levator ani muscle deficiency. Neurourol Urodyn 2013; 34:55-9. [DOI: 10.1002/nau.22509] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/04/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology; The University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Dena E. White
- Department of Obstetrics and Gynecology; The University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Lieschen H. Quiroz
- Department of Obstetrics and Gynecology; The University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - S. Abbas Shobeiri
- Department of Obstetrics and Gynecology; The University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
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Abstract
Urethral bulking is an office procedure for treatment of stress urinary incontinence that has increased in popularity in recent years. Numerous types of urethral bulking agents have been used since its introduction in the 1930s. Typically, these agents are imaged using specialty 3D 360° field-of-view transducers; however, a sonographer, during a pelvic or renal examination, may inadvertently find and image an echogenic structure near the urethrovesical junction in patients with a history of urethral bulking. Familiarizing oneself with the sonographic appearance of urethral bulking agents and optimizing techniques to obtain improved images of these agents may eliminate the need for additional imaging for the patient. Urethral bulking can be readily imaged with transducers commonly found in most ultrasound departments. This review will focus on the sonographic characteristics of urethral bulking agents and knowing when and how to use appropriate transducers to image the urethra.
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Affiliation(s)
- Lindsay Denson
- Division of Female Pelvic Medicine Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - S. Abbas Shobeiri
- Division of Female Pelvic Medicine Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Shobeiri SA, Rostaminia G, White D, Quiroz LH, Nihira MA. Evaluation of vaginal cysts and masses by 3-dimensional endovaginal and endoanal sonography. J Ultrasound Med 2013; 32:1499-1507. [PMID: 23887963 DOI: 10.7863/ultra.32.8.1499] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this pictorial essay is to describe the utility of 3-dimensional endovaginal and endoanal sonography in the assessment of vulvovaginal cysts and masses. It is accepted that compared with transabdominal pelvic sonography, transvaginal end-fire sonography provides improved resolution for visualization of female reproductive organs with fewer artifacts. To visualize the structures that are located in or lateral to the vaginal canal, side-fire 3-dimensional endovaginal or endoanal sonography can be used. This special technique has the advantage of maintaining the spatial anatomic relationship of any abnormality in the vagina.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190 USA.
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Abstract
OBJECTIVES The aim of this study was to construct an anatomically correct phantom for visualization of anal sphincter complex structures. METHODS To ake an endoanal ultrasound phantom, we experimented with a variety of commercially available materials to simulate hyperechoic, hypoechoic, and isoechoic tissue consistency. We created external anal sphincter muscle and the levator plate using stand-alone density gel and microbubbles to simulate the echogenicity of the muscles. A mold was created in a container, the muscles were inserted, and the mold was filled with high-density clear gel and allowed to fill. Once finished, the container was sealed tightly and stored for later use. To evaluate the accuracy of the model, 6 ultrasound imaging raters from different disciplines were included. The raters were administered a 6-item Internet-based interactive test using 2-dimensional images obtained from scanning the phantom. Rater agreement was determined. The Fleiss κstatistic was calculated to determine inter-rater reliability. RESULTS The raters identified the structures in 32 (89%) of 36 test questions. There was good to excellent agreement among the readers. Agreement rates for visualization of the external anal sphincter, perineal body, and internal anal sphincter were 67%, 83%, and 100%, respectively. CONCLUSIONS An endoanal phantom can be constructed as a simulator for endoanal sonography.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA.
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Quiroz LH, Shobeiri SA, White D, Wild RA. Does age affect visualization of the levator ani in nulliparous women? Int Urogynecol J 2013; 24:1507-13. [PMID: 23411510 DOI: 10.1007/s00192-013-2053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to assess whether differences in the ages of nulliparous women affect: (1) interobserver reliability, and (2) visualization of the levator ani (LA) muscle subdivisions in nulliparous women using 3D endovaginal ultrasound (3D-EVUS). METHODS This was a cross-sectional study. Community-dwelling nulliparous women ages 21-70 years were recruited. Participants underwent a standard examination and a 3D-EVUS. LA subdivisions of interest included the puboperinealis, puboanalis, pubococcygeus, puborectalis, and ileococcygeus muscles. Each ultrasound (US) volume was scored using a validated scale and assessed by two observers. Defect severity was scored for each muscle from 0 (no defect) to 6 (complete muscle loss). A summed score of the two sides was grouped as normal (0), minor (1-3), or major (4-6). Bias was examined using Bland-Altman plots. Intraclass coefficients were calculated to report agreement of total scores. Spearman's rank correlation was used to evaluate the association between age and LA scores. RESULTS Eighty nulliparous women were evaluated. Exact agreement for bilateral scoring of each LA subdivision ranged from 82 % to 84 %. Bilateral scoring of the puboperinealis, puborectalis, and ileococcygeus showed moderate to substantial agreement. Bilateral scores of the puboperinealis demonstrated substantial agreement between observers, with an ICC of 0.8 and a mean difference of -0.2 using the Bland-Altman analysis. When women were analyzed by age decade, reader agreement was overall good to excellent. There was no significant correlation between increasing age and total LA muscle scores (r = 0.179, p = 0.113). CONCLUSIONS Interobserver reliability or visualization of the LA muscle in nulliparous women was not affected by a woman's age.
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Affiliation(s)
- Lieschen H Quiroz
- Division Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Shobeiri SA, Rostaminia G, White D, Quiroz LH. The determinants of minimal levator hiatus and their relationship to the puborectalis muscle and the levator plate. BJOG 2012; 120:205-211. [PMID: 23157458 DOI: 10.1111/1471-0528.12055] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the muscles comprising the minimal levator hiatus. DESIGN Cross-sectional study. SETTING The University of Oklahoma Health Sciences Center, USA. POPULATION Eight female fresh frozen pelves and 80 nulliparouswomen. METHODS Three-dimensional endovaginal ultrasound was performed in eight fresh frozen female pelves. The structures of the levator hiatus were tagged with needles and the cadavers were dissected to identify the tagged structures. A group of 80 nullipara underwent 3D endovaginal ultrasound, and the minimal levator hiatus area, puborectalis area, and anorectal angle were assessed, and normal values were obtained. MAIN OUTCOME MEASURES Anatomic borders of minimal levator hiatus and normality in pelvic floor measurements. RESULTS The pubococcygeus forms the inner lateral border and anterior attachment of the minimal levator hiatus to the pubic bone. The puboanalis fibres are immediately lateral to pubococcygeus attachments. There are variable contributions of the puborectalis fibres lateral to the puboanalis attachment. The posterior border of the minimal levator hiatus is formed by the levator plate. Eighty community-dwelling nulliparous women underwent 3D endovaginal ultrasound. The median age was 47 years (range 22-70 years). The mean of minimal levator hiatus and puborectalis hiatus areas were 13.4 cm(2) (±1.89 cm(2) SD) and 14.8 cm(2) (±2.16 cm(2) SD). The mean anorectal and levator plate descent angles were 156° (±10.04° SD) and 15.9° (±8.28° SD). CONCLUSION Anterior and lateral borders of the minimal levator hiatus are formed mostly by pubococcygeus. The puborectalis, pubococcygeus, and iliococcygeus form the bulk of the levator plate.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - G Rostaminia
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - D White
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L H Quiroz
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Foust-Wright CE, Shobeiri SA, Curry CL, Quiroz LH, Nihira MA. Medical student knowledge of global health problems: obstetric fistulas in developing countries. J Reprod Med 2012; 57:427-430. [PMID: 23091991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. STUDY DESIGN A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. RESULTS Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). CONCLUSION U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.
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Rostaminia G, Shobeiri SA, Quiroz LH. Surgical repair of bilateral levator ani muscles with ultrasound guidance. Int Urogynecol J 2012; 24:1237-9. [PMID: 22885726 DOI: 10.1007/s00192-012-1912-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/22/2012] [Indexed: 12/22/2022]
Abstract
Separation of the levator ani muscles from pubic bone is a common major levator trauma that may occur in vaginal delivery and is associated with pelvic floor dysfunctions. We describe a novel ultrasound-guided technique to repair these muscles. A 33-year-old woman presented with a history of difficult vaginal delivery and complaint of numbness and weakness of the vagina. In evaluation, bilateral levator defects were diagnosed by physical examination, three-dimensional endovaginal ultrasound, and magnetic resonance imaging. With ultrasound guidance the detached ends of muscles were tagged and sutured to their insertion points at the pubic bone. The patient's normal anatomy was restored with the return to normal pelvic floor tone. A follow-up ultrasound showed restored levator anatomy at 3 months.
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Affiliation(s)
- Ghazaleh Rostaminia
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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