Levator Hiatus Research Articles

Transvaginal posterior levatorplasty and perineoplasty for female primary stress urinary incontinence: 12-month follow-up and technical presentation

ObjectiveTo investigate the feasibility of transvaginal posterior levatorplasty combined with perineoplasty (TPLP) for women with primary stress urinary incontinence and demonstrate the surgical technique with step-by-step procedures.MethodsA prospective, non-randomised study was conducted using technique of TPLP to treat female primary SUI from January 2019 to December 2021. Patient follow-up was performed at 3 and 12 months posteroperatively. A series of validated questionnaires were used to evaluate the improvement of symptom severity, sexual function and quality of life. In addition, 4-D ultrasonography was used to measure the anatomic changes of pelvic structures.ResultsA total of 47 patients were enrolled in this study with a mean age of 43.6 years. Mean operative time was 78.7 min. Median estimated intraoperative blood loss was 80.2 ml. Objective cure and subjective cure rates were 87.2% and 91.5%, respectively. Compared with baseline, scores of quality of life, symptom severity and sexual function improved after surgery. Meanwhile, mobility of the urethra and bladder neck and areas of levator hiatus were decreased after surgery. Mild coitus pain was reported in 15.4% (6/39) patients at the initial several times of intercourse after resuming sexual activity.ConclusionsThis study shows that transvaginal posterior levatorplasty combined with perineoplasty appears to be an effective surgical method for selected women with primary stress urinary incontinence.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

286 - Association of Urogenital and Levator Hiatus Length with Skeletal Muscle Size, Strength and Physical Performance in Older Women: the Study of Muscle, Mobility and Aging (SOMMA)

286 - Association of Urogenital and Levator Hiatus Length with Skeletal Muscle Size, Strength and Physical Performance in Older Women: the Study of Muscle, Mobility and Aging (SOMMA)

105 - Urogenital and Levator Hiatus Size and Lower Urinary Tract Symptoms in Older Women: the Study of Muscle, Mobility and Aging (SOMMA)

105 - Urogenital and Levator Hiatus Size and Lower Urinary Tract Symptoms in Older Women: the Study of Muscle, Mobility and Aging (SOMMA)

The "Ins and Outs" of Dynamic Magnetic Resonance Imaging for Female Pelvic Organ Prolapse.

Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders. The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation. Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings.

Magnetic resonance defecography: Post-defecation straining detects more and maximal prolapse in the anterior and middle compartments

ObjectiveTo compare pre-defecation straining without rectal gel and post-defecation straining with the defecation phase, and to investigate their roles in evaluating pelvic organ prolapse (POP). Material & methodsMagnetic Resonance Defecography (MRD) images of 65 patients with a clinical diagnosis of POP were retrospectively reviewed by two independent readers. Measurements were taken at rest, pre-defecation straining without rectal gel, defecation, and post-defecation straining. The presence, sizes, and/or grades of cystocele, uterovaginal prolapse, widened levator hiatus, perineal descent, cul-de-sac hernia, rectocele, and rectal intussusception were evaluated and compared across the four phases. ResultsCompared to pre-defecation straining, both defecation and post-defecation straining detected more cases, larger sizes, and higher grades of prolapse in all compartments. When comparing defecation and post-defecation straining, the latter diagnosed four more cases of cystocele (80 % vs 73.9 %, p = 0.2) with larger size (−34.1 vs −29.0, p < 0.01) and higher grade (p = 0.19). Post-defecation straining also identified eight more cases of uterovaginal prolapse (89.2 % vs 73.9 %, p < 0.01) with larger size (−32.9 vs −26.4, p < 0.01) and higher grade (p < 0.01) compared to defecation. Conversely, defecation detected eight more cases of rectocele (46.2 % vs 33.9 %, p < 0.01) with larger size (9.2 vs 6.2 cm, p < 0.01) and higher grade (p = 0.26). ConclusionPost-defecation straining effectively depicts the maximal extent of prolapse in the anterior and middle compartments, and should be performed whenever there is a clinical need for a comprehensive assessment of prolapse in these compartments.

Chronic pelvic pain syndrome in women of reproductive age: An observational cohort clinical ultrasound study

Background. The annual number of new cases of chronic pelvic pain syndrome in women of reproductive age is increasing worldwide. The high prevalence of this condition among the able-bodied female population leads to higher state expenditures on the treatment of this category of patients. New methods of diagnosis and early prophylaxis contribute to reducing economic burden associated with chronic pelvic pain syndrome in women and improving health of the female population as a fundamental demographic factor.Objectives. To determine somatic, obstetric-gynecological, anatomical, and psycho-emotional predictors of chronic pelvic pain syndrome.Methods. An observational cohort clinical and ultrasound study involved 60 patients of reproductive age. The study was conducted on the basis of the clinic for women, Voronezh City Outpatient Clinic No. 1 — clinical base of the Department of Obstetrics and Gynecology No. 2, Voronezh State Medical University named after N. N. Burdenko, Russia. According to clinical and laboratory data, the participants were divided into 2 groups. Group 1 (n = 30) included women of reproductive age without clinical manifestations of chronic pelvic pain syndrome; Group 2 (n = 30) enrolled women of reproductive age clinically diagnosed with chronic pelvic pain.Results. The mean age of the study participants in the main group comprised 27.4 ± 6.30 and 26.3 ± 7.25 years in the control group, p &gt; 0.05. Diseases of gastrointestinal tract, endocrine, cardiovascular, musculoskeletal and urinary systems, as well as neurocirculatory and vegetative disorders prevailed in the structure of somatic pathology in the main group, p &lt; 0.001. Analysis of obstetric and gynecologic anamnesis revealed no statistically significant differences in the incidence of gynecologic pathology in the study groups. However, according to the detailed analysis of the delivery history of the participants, 23 patients of the main group (76 %) and 3 patients (6.6 %) of the control group underwent episiotomy during labor, p &lt; 0.001. The evaluation of the comparison groups in terms of pain component in myofascial syndrome involved the pain rating index, number of selected descriptors, sensory index of the selected descriptors, emotional index of the selected descriptors, and pain intensity. Statistically significant differences were revealed for all of the above indicators, thereby confirming a reliable picture of pathopsychological changes in the compared groups of women. The analysis of the ultrasound parameters of topographic and anatomical relationships demonstrated the relevant change in the following parameters: urethral length, diameter of the external urethral sphincter, angle between the external urethra and the body of the bladder, direct and transverse dimensions of the levator hiatus in the studied groups under the muscle tension.Conclusion. An issue of early diagnosis and prophylaxis of chronic pelvic pain syndrome in women of reproductive age remains urgent and requires interdisciplinary participation of medical specialists. The development of new approaches to ultrasound evaluation of pelvic floor will increase the effectiveness of therapeutic and prophylactic measures and reduce the economic burden of this nosology in the morbidity structure of the able-bodied female population.

Mechanisms for pelvic floor muscle training: Morphological changes and associations between changes in pelvic floor muscle variables and symptoms of female stress urinary incontinence and pelvic organ prolapse-A narrative review.

Today there is Level 1, recommendation A for pelvic floor muscle training (PFMT) to be effective in treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, the mechanisms of action are discussed. The aim of the present overview was to give an update of studies evaluating the effect of PFMT on pelvic floor morphology and associations between changes in PFM strength and symptoms of female SUI and POP. MATERIALS ANDMETHODS: This was a narrative review retrieving studies from systematic reviews of PFMT for SUI and POP. In addition, an open search on PubMed with the search terms PFMT and morphology was conducted. Both randomized controlled trials (RCTs) and pre-posttest design studies were included. PEDro rating scale (0-10) was used to assess risk of bias. Ten studies were found reporting on morphological changes after PFMT. The four RCTs had PEDro score between 5 and 8/10. The studies found significant higher bladder neck position and narrower levator hiatus dimensions, thicker external urethral sphincter, increased cross-sectional area of PFM, improvement in PFM tears and blood flow. Twenty studies analyzed associations between changes in different PFMT variables and SUI and POP. Eleven studies found a positive weak to moderate association and six studies reported no association. Studies comparing responders and nonresponders to PFMT found statistically significant better PFM variables in responders. PFMT can change pelvic floor muscle and external urethral sphincter anatomy. This contributes to the understanding on how PFMT can be effective in prevention and treatment of SUI and POP.

Improving radiological quantification of levator hiatus features with measures informed by statistical shape modeling.

The measures that traditionally describe the levator hiatus (LH) are straightforward and reliable; however, they were not specifically designed to capture significant differences. Statistical shape modeling (SSM) was used to quantify LH shape variation across reproductive-age women and identify novel variables associated with LH size and shape. A retrospective study of pelvic MRIs from 19 nulliparous, 32 parous, and 12 pregnant women was performed. The LH was segmented in the plane of minimal LH dimensions. SSM was implemented. LH size was defined by the cross-sectional area, maximal transverse diameter, and anterior-posterior (A-P) diameter. Novel SSM-guided variables were defined by regions of greatest variation. Multivariate analysis of variance (MANOVA) evaluated group differences, and correlations determined relationships between size and shape variables. Overall shape ( ), SSM mode 2 (oval to -shape, ), mode 3 (rounder to broader anterior shape, ), and maximal transverse diameter ( ) significantly differed between groups. Novel anterior and posterior transverse diameters were identified at 14% and 79% of the A-P length. Anterior transverse diameter and maximal transverse diameter were strongly correlated ( , ), while posterior transverse diameter and maximal transverse diameter were weakly correlated ( , ). The traditional maximal transverse diameter generally corresponded with SSM findings but cannot describe anterior and posterior variation independently. The novel anterior and posterior transverse diameters represent both size and shape variation, can be easily calculated alongside traditional measures, and are more sensitive to subtle and local LH variation. Thus, they have a greater ability to serve as predictive and diagnostic parameters.

Role of Preoperative and Postoperative Endovaginal Ultrasound and 24 h Pad Test in Evaluation of Efficacy of Various Treatment Modalities for Stress Urinary Incontinence

ABSTRACT Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Materials and Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and 6 months postoperatively for levator hiatus (LH), pubovisceral thickness, urethral length, and bladder neck (BN) position. A 24 h pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: The mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with a mean duration of symptoms being 4.04 years. On 24 h pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%) with mean preoperative 24 h pad test being 36.69 g which significantly reduced to 9.79 g postoperatively (P = 0.001). There was significant change in LH and pubovisceral thickness with treatment of SUI. Overall urethral length increased but there was significant decrease in urethral length on Valsalva after the treatment (0.40 cm vs. 0.28 cm, P = 0.04) and significant reduction in BN descent after Valsalva after treatment (0.41 cm vs. 0.27 cm, P = 0.001). Conclusion: Endovaginal ultrasound and 24 h pad test are the useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Fully Automated Localization and Measurement of Levator Hiatus Dimensions Using 3-D Pelvic Floor Ultrasound

ObjectiveTo develop an algorithm for the automated localization and measurement of levator hiatus (LH) dimensions (AI-LH) using 3-D pelvic floor ultrasound. MethodsThe AI-LH included a 3-D plane regression model and a 2-D segmentation model, which first achieved automated localization of the minimal LH dimension plane (C-plane) and measurement of the hiatal area (HA) on maximum Valsalva on the rendered LH images, but not on the C-plane. The dataset included 600 volumetric data. We compared AI-LH with sonographer difference (ASD) as well as the inter-sonographer differences (IESD) in the testing dataset (n = 240). The assessment encompassed the mean absolute error (MAE) for the angle and center point distance of the C-plane, along with the Dice coefficient, MAE, and intra-class correlation coefficient (ICC) for HA, and included the time consumption. ResultsThe MAE of the C-plane of ASD was 4.81 ± 2.47° with 1.92 ± 1.54 mm. AI-LH achieved a mean Dice coefficient of 0.93 for LH segmentation. The MAE on HA of ASD (1.44 ± 1.12 mm²) was lower than that of IESD (1.63 ± 1.58 mm²). The ICC on HA of ASD (0.964) was higher than that of IESD (0.949). The average time costs of AI-LH and manual measurement were 2.00 ± 0.22 s and 59.60 ± 2.63 s (t = 18.87, p < 0.01), respectively. ConclusionAI-LH is accurate, reliable, and robust in the localization and measurement of LH dimensions, which can shorten the time cost, simplify the operation process, and have good value in clinical applications.

Postpartum Changes in Levator Plate Shape and Genital Hiatus Size After Vaginal Delivery.

Vaginal delivery is a risk factor for pelvic organ prolapse. We sought to quantify changes in level III pelvic support measurements at 7weeks and 8months following vaginal delivery. This secondary analysis included primiparous women who underwent pelvic MRI and clinical examinations at 7weeks and 8months after vaginal delivery. Demographics and obstetrical data were abstracted. Mid-sagittal resting MRIs were used to perform level III measurements including urogenital hiatus (UGH), levator hiatus (LH), and mid-sagittal levator area (LA), and to trace the levator plate (LP). Using principal component analysis, 7-week and 8-month principal component scores (PC1s) and MRI measurements were compared using paired t test. If the PC1 score change from 7weeks to 8months was > 0, women were considered to have a more dorsally oriented LP shape. Of 76 participants, POP-Q values did not significantly differ between 7weeks and 8months, but MRI measurements improved (UGH: 3.9 ± 0.8 vs 3.5 ± 0.8, p < 0.001; LH: 5.4 ± 0.8 vs 5.2 ± 0.8, p = 0.01; LA: 18.0 ± 6.0 vs 15.2 ± 6.5, p < 0.001). Approximately 30% (22 out of 76) had a more dorsally oriented LP shape and larger level III measurements at 8months than women with a more ventrally oriented LP shape (LA: 86.4% vs 1.9%, p < 0.001; LH: 16% vs 12%, p < 0.001; UGH: 59.1% vs 3.7%, p < 0.001). After vaginal delivery, most women had "recovery" of level III support-defined by smaller UGH, LH, and LA measurements-and a more ventrally oriented LP shape. However, nearly 30% had larger level III measurements and a more dorsally oriented LP shape, indicating "impaired recovery" of support.

Clinical application of three-dimensional pelvic floor ultrasound in patients with pelvic organ prolapse and the application value of levator hiatus and levator ani indicators

Clinical application of three-dimensional pelvic floor ultrasound in patients with pelvic organ prolapse and the application value of levator hiatus and levator ani indicators

The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum

ObjectiveThis study investigated the predicting value of the ratio of levator hiatus diameter (LHS) to fetal head circumference (HC) in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum. MethodsA total of 120 first-time women who gave vaginal delivery at 37 weeks of pregnancy were selected as the subjects in our hospital during March 2021 to March 2022. The subjects were divided into the second stage of labor > 1 h group and the second stage of labor ≤ 1 h group, according to the delivery time of the second stage of labor. According to the 6-week postpartum follow-up ultrasound examination with or without levator ani injury, they were divided into levator ani injury group and no injury group. All primipara women underwent three-dimensional ultrasonography at 37 weeks of gestation, and the resting LHS, Valsalva LHS, fetal HC and the ratio of resting LHS and fetal HC were compared. The correlation between these factors and the length of the second labor stage was analyzed using Pearson correlation analysis. The value of these factors in predicting labor progression and postpartum levator ani injury was assessed by receiver operating characteristic (ROC) curves. ResultsThe resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the levator ani injury group were lower than these in the no injury group, while fetal HC in the levator ani injury group was higher than that in the no injury group (P < 0.05). The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the second stage of labor > 1 h group were lower than these in the second stage of labor ≤ 1 h group, while fetal HC in the second stage of labor > 1 h group was higher than that in the second stage of labor ≤ 1 h group (P < 0.05). A significant negative correlation was observed between resting LHS/HC and total labor process (=-0.333, P < 0.01). ROC curve analysis showed that the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting prolongation of the second stage of labor were 0.741, 0.740, 0.702, and 0.843 respectively. Besides, the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting the total labor process were 0.657, 0.684, 0.768, and 0.836 respectively. The AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting postpartum levator ani muscle injury were 0.769, 0.773, 0.747, and 0.885 respectively.These results suggested that the ratio of resting LHS and fetal HC may have certain clinical value in predicting levator ani injury in pregnant women. ConclusionLHS, fetal HC and the ratio of resting LHS and fetal HC are significantly correlated with labor progression and postpartum levator ani injury, which have certain value in predicting labor progress and postpartum levator ani injury. Therein, the ratio of resting LHS and fetal HC has the highest predictive value, and early detection of the ratio of resting LHS and fetal HC is helpful to guide the selection of appropriate delivery mode.

Pubococcygeal Line Versus H-line as MR Defecography Reference for Bladder Descent.

Magnetic resonance defecography imaging techniques have been used widely to study pelvic floor function and diagnose pelvic organ prolapse (POP). The aim of this study was to investigate the diagnostic accuracy of the H-line to detect bladder descent compared with the current landmark, the pubococcygeal line (PCL). In this retrospective cohort study, patients who underwent MR defecography in our medical center and were diagnosed with moderate to severe cystocele by radiological measurements were recruited. One rest image and one maximum evacuation image for each subject were used for the following measurements: bladder base perpendicular distance from the genital hiatus (GH), indicative of clinically significant bladder descent, PCL as the current radiological reference line, and the H-line, or minimal levator hiatus line, indicative of pelvic floor muscle and connective tissue support.Subjects were categorized as having clinically significant cystocele if the "bladder base" reached within 1 cm or lower of the GH (stage II or higher cystocele). A comparison was performed to assess differences and predictive capabilities of the reference lines relative to the GH measure. Seventy subjects were included, 30 with clinically significant bladder descent based on distance to GH. Women with bladder descent were older (64.0 ± 11.8 vs 51.2 ± 15.6, p < 0.001), had increased parity (3 [1-7] vs 2 [0-5], p = 0.009), and had a bladder that descended lower than the H-line at rest (1.9 ± 0.5 vs 2.2 ± 0.4, p = 0.003) and evacuation (-2.4 ± 1.6 vs -0.7 ± 1.1, p < 0.001). Multivariate regression analysis confirmed that age, length of the H-line at evacuation, the perpendicular distances between the H-line and the lowest bladder point at rest, and the PCL to the lowest bladder point at evacuation significantly correlated with bladder descent.Receiver operating characteristic analysis was used to identify a measurement threshold to diagnose clinically significant cystocele for both measurements, bladder base to the H-line: -1.2 (80.0, 72.5) area under the curve (AUC) 0.82, and bladder base PCL: -3.3 (77.8, 79.5) AUC 0.86. Our data support the application of using the minimal levator hiatus plane and specifically the H-line as a reliable landmark to diagnose bladder descent using MR defecography imaging.

Advancements in artificial intelligence for pelvic floor ultrasound analysis.

Pelvic floor ultrasound provides a clear depiction of pelvic floor structures and their spatial anatomical relationships, enabling enhanced observation of pelvic organ function and position. The integration of artificial intelligence (AI) into medical imaging has revolutionized the automatic analysis of imaging data, offering efficient and accurate preprocessing and analysis. This technological advance addresses challenges associated with traditional pelvic floor ultrasound, such as reliance on operator's experience, time-intensive manual measurements, and significant potential for human error. Current AI applications in pelvic floor ultrasound encompass automatic measurement of the angle of progress (AOP), automatic segmentation of the levator hiatus (LH), and automatic identification of the levator ani muscle (LAM). AI excels in mimicking human analysis, distilling patterns from reorganized data. This paper, grounded in a comprehensive literature review, outlines the principal aspects of pelvic floor ultrasound and its augmentation through AI, highlighting the application value and progress of AI in this field.

Validation of a built-in software in automatically reconstructing the tomographic images of the levator ani muscle.

Transperineal ultrasound (TPUS) is an effective tool for evaluating the integrity of the levator ani muscle (LAM). Several operating steps are required to obtain the standard multi-slice image of the LAM, which is experience dependent and time consuming. This study was aimed at evaluating the feasibility and reproducibility of the built-in software, Smart-pelvic™, in reconstructing standard tomographic images of LAM from 3D/4D TPUS volumes. This study was conducted at a tertiary teaching hospital, enrolling women who underwent TPUS. Tomographic images of the LAM were automatically reconstructed by Smart-pelvicTM and rated by two experienced observers as standard or nonstandard. The anteroposterior diameter (APD) of the levator hiatus was also measured on the mid-sagittal plane of the automatically and manually reconstructed images. The APD measurements of each approach were compared using Bland-Altman plots, and interclass correlation coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility. Meanwhile, the time taken for the reconstruction process of both methods was also recorded. The ultrasound volume of a total of 104 patients were included in this study. Using Smart-pelvicTM, the overall success rate of the tomographic image reconstruction was 98%. Regarding measurements of APD, the ICC between the automatic and manual reconstruction methods was 0.99 (0.98, 0.99). The average time taken for reconstruction per case was 2.65 ± 0.52 s and 22.08 ± 3.45 s, respectively. Using Smart-pelvicTM to reconstruct tomographic images of LAM is feasible, and it can promote TPUS by reducing operator dependence and improving examination efficiency in a clinical setting.

The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence

Introduction and hypothesisThe aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI).MethodsThis cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI (n = 19) and runners who did not (n = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated.ResultsNo changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run (p ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run (p ≤ 0.05). No between-group differences were observed for any outcomes.ConclusionsRunning appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function.

Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation.

The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades. Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression. Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age ( P = 0.017), vaginal delivery ( P = 0.008), and prior pelvic surgery ( P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion ( P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades. Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.

Parto vaginal: evaluación ecográfica del músculo elevador del ano y del ángulo de progresión como predictor de éxito

Objective: To evaluate the levator ani and the angle of progression by transperineal ultrasound as a prediction of delivery in fullterm primigestas who are not in labor, at the “Santa Ana” Maternity Clinic of the Venezuelan Institute of Social Security, between October 2021-March 2022. Methods: Prospective, descriptive, cross-sectional study. It included 50 full-term primigestas, not in labour. The anteroposterior diameter of the levator hiatus of the anus, the coactivation of the muscle and the angle of progression were evaluated by transperineal ultrasound. The usefulness of the determinations described in predicting successful vaginal delivery was established. Results: The mean anterosposterior diameter of the hiatus of the levator ani, at rest, was 48.9 ± 10.2 mm and, in Valsalva maxima, was 58.1 ± 11.0 mm (p=0.001). Coactivation of the levator ani was observed in one patient (2.0 %). The mean angle of progression of the fetal head was 88.9 ± 11.6 degrees. The duration of labour and the route of resolution were independent of both measures. The critical points of the anteroposterior diameter of the hiatus of the levator of the anus were: at rest, 31 mm; in Valsalva maximum, 61.5 mm and in Valsalva-rest, 9.5 mm. For the angle of progression it was 79.0 degrees. The best performance was obtained for the maximum-resting Valsalva measurement (sensitivity 78.1% and specificity 100%). Conclusion: No significant association was established between the levator ani and the angle of progression measured before labour, and the route of labour.