Pubic Angle Research Articles

Value of three-dimensional visualization of preoperative prostatic magnetic resonance imaging based on measurements of anatomical structures in predicting positive surgical margin after radical prostatectomy.

Positive surgical margin (PSM) or apical positive surgical margin (APSM) is an established predictive factor of biochemical recurrence or disease progression in prostate cancer (PCa) patients after radical prostatectomy. Since there are limited usable magnetic resonance imaging (MRI)-based models, we sought to explore the role of three-dimensional (3D) visualization for preoperative MRI in the prediction of PSM or APSM. From December 2016 to April 2022, 149 consecutive PCa patients who underwent radical prostatectomy were retrospectively selected from the Second Affiliated Hospital of Dalian Medical University. According to the presence of PSM or APSM, patients were divided into a PSM group (n=41) and a without PSM group (n=108) and into an APSM group (n=33) and a without APSM group (n=116). Twenty-one parameters, including prostate apical shape, PCa distance to the membranous urethra, and pubic angle, were measured on 3D visualization of MRI. The development of the nomogram models was built by the findings of multivariate logistic regression analysis for significant factors. To predict the probability of PSM, a longer PCa distance to the membranous urethra (OR=0.136, p=0.019) and the distance from the anterior peritoneum to the anterior border of the coccyx (work space AP, OR=0.240, p=0.030) were independent protective factors, while a type 3 prostate apical shape (OR=8.262, p=0.025) and larger pubic angle 2 (OR=5.303, p=0.029) were identified as independent risk factors. The nomogram model presented an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of PSM of 0.777. In evaluating the incidence of APSM, we found that the distance to the membranous urethra (OR=0.135, p=0.014) was associated with a low risk of APSM, while larger pubic angle 1 (OR=4.666, p=0.043) was connected to a higher risk of APSM. The nomogram model showed that the AUC of APSM was 0.755. As 3D visualization for preoperative MRI showed good performance in predicting PSM or APSM, the tool might be potentially valuable, which also needs to be validated by multicenter, large-scale, prospective studies.

Efficacy and safety evaluation of the scrotal skin transfer method in the treatment of pediatric concealed penis: a six-month follow-up data.

Pediatric concealed penis affects penis development and the psychological health of the children. Current surgical methods tend to retain too much of the inner foreskin plate, resulting in unsatisfactory appearance and postoperative complications. We aimed to investigate the efficacy and safety of a new surgical intervention method using a scrotal skin transfer instead of the external foreskin plate to treat pediatric concealed penis. Sixty children (aged between 3 and 9 years and 3 months) diagnosed with concealed penis admitted to our hospital between June 2020 and June 2022 were included. All patients were randomly divided into Improve group (n=30, treated with the new surgical intervention method of scrotal skin transfer) and General group (n=30, treated with traditional Shiraki procedure). The pre-operative and post-operative penis length were collected. A follow-up of 6 months was conducted in all patients. Postoperative penile appearance, penile skin color difference, and satisfaction with the penile appearance were used to evaluate the efficacy of surgery, and the postoperative complications (penile retraction, skin edema and incision infection) were collected to observe the safety of treatment. The post-operative penis length of Improve group was significantly increased compared with General group. The penile skin color was consistent, the penile scrotal angle and the penile pubic angle were formed naturally, and the penis was completely exposed in Improve group. During 6 months' follow-up, the patients in the improvement group did not have infection, penile retraction and skin color difference, and 2 patients had edema. The complication rate in the Improve group was lower than that in the General group. The scrotal skin transfer method shows remarkable efficacy and safety without apparent complications and results in a penis that is fully exposed and aesthetically pleasing.

Association Between Female Bony Pelvimetry Using Magnetic Resonance Imaging and Cesarean Delivery due to Cephalopelvic Disproportion

Purpose: To analyze the difference in bony pelvimetry using magnetic resonance imaging (MRI) in women who delivered vaginally and those who underwent cesarean section (CS) due to cephalopelvic disproportion (CPD).Methods: This retrospective case-control study enrolled Korean women who gave birth to their first child between 37 and 42 weeks of pregnancy and underwent pelvic MRI between January 2014 and June 2020. These women were classified into 3 groups: vaginal delivery (VD), CS due to CPD (CPD-CS), and CS due to reasons other than CPD (Other-CS). In MRI images, true conjugate (TC), obstetric conjugate (OC), mid anterior-posterior (AP) distance (MAD), outlet AP distance (OAD), ischial spine distance (ISD), ischial tuberosity distance (ITD), and pubic angle (PA) were measured.Results: In total, 392 women were enrolled. There were no significant differences in maternal height and body mass index at birth among the 3 groups. The ISD was statistically different between the VD group (106.2±6.4 mm) and the Other-CS group (110.4±8.8 mm) (p=0.014). After multiple regression analysis, short ISD (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.87-0.97; p=0.002), short MAD (aOR, 0.95; 95% CI, 0.89-0.99; p=0.047), and short ITD (aOR, 0.95; 95% CI, 0.91-0.99; p=0.019) were significantly associated with CS due to CPD.Conclusion: Short ISD, MAD, and ITD, measured using MRI, are important parameters that can predict CS due to CPD. The accumulation of related research could promote the development of an excellent imaging method in terms of cost-effectiveness. Thus, it may be possible to establish a method to reduce obstetric and perinatal complications due to dystonia.

Anthropometric study using three-dimensional pelvic CT scan in sex determination among adult Indonesian population

This study aims to determine pelvic anthropometry characteristics and logistic regression formula for adult sex identification obtained from adult three-dimensional pelvic computed tomography images. This study was an observational analytical study with retrospective regression and cross-sectional approach. The population was all patients at Radiology Installation of Dr. Soetomo General Academic Hospital as referral hospital in East Indonesian region, from September to December 2019 who underwent 3D pelvic CT examination. Then, age distribution and pelvic measurements data were obtained. In this case, statistical analysis was conducted for all the data obtained. A number of 204 samples were included in this study. All radiologic components were also significantly different between sexes (p < 0.05) except for transverse diameter of sacral segment (p = 0.180). Moreover, the conjugate pelvic inlet diameter (CPID), the left innominate height (LIH), and sub pubic angle (SPA) showed significant values for regression formula to determine an adult’s sex using 3D pelvic CT. The calculation result > 0 is a prediction for female while < 0 is a prediction for male. From logistic regression model calculation, a high validity value (91.05%) was found with 100% sensitivity to identify male sex and 81.1% specificity to identify female sex. There were differences on radiometric variable characteristics in pelvic anthropometric study among adult Indonesians at Dr. Soetomo General Academic Hospital, Surabaya. The estimated values of pelvic measurements using 3D CT images could develop a pelvic model with a regression formula with high accuracy value using CPID, LIH, and SPA values.

Prediction of mode of delivery by an ultrasound score similar to Bishop score and performance of independent predictors.

There is evolving literature on the superiority of transperineal ultrasound (TPU) in predicting the mode of delivery either before induction or during the course of labour. An ultrasound score (USG score) similar to a Bishop score or an ultrasound scoring method based on independent predictors before the onset of labour at term gestation would serve as a baseline objective record over which further progress of labour could be evaluated. 1. To sonographically examine the clinical parameters evaluated during a digital examination. 2. To derive an USG score using TPU parameters, similar to a Bishop score, and determine its performance in predicting pregnancy outcomes. 3. To identify which are the independent predictors of caesarean section among all the studied ultrasound (USG) parameters. In this prospective study, all the eligible women who came for routine antenatal care at term gestation and who were due for pelvic assessment were recruited. They underwent transabdominal ultrasound (TAS) for evaluating head position and head circumference, and TPU for evaluating head station with and without applying fundal pressure, various cervical parameters, sub pubic angle. Equivalent five USG parameters were scored along similar lines as the Bishop score. These women underwent vaginal examination for Bishop score and pelvic adequacy by an obstetrician who was blinded about USG parameters. While spontaneous onset of labour (SOL) was awaited in some of these women, some were induced as and when indicated. After delivery, the Bishop scores, pregnancy outcome in terms of SOL or induction of labour (IOL), mode of delivery and duration of labour were noted retrospectively from case records. Independent predictors of caesarean were obtained by univariate and multivariate analysis. All the parameters were assessed for predictive ability of caesarean section by univariate analysis. The cervical length, angle of progression (AOP) at rest, head perineal distance (HPD) at rest and with pressure, Bishop score and USG score were found significant. On multivariate analysis, cervix length and USG score were found to be statistically significant. At a USG score of ≤ 5, the sensitivity and specificity to predict caesarean section were 84% and 68%, respectively. The relative risk (RR) was 4.9 (95% CI 2.3-12). The USG score could predict SOL. The p value was 0.001. The area under the curve (AUC) for the ultrasound score was 0.74. USG examination by USG score at term gestation before the onset of labour can predict mode of delivery by caesarean section. It can predict spontaneous onset of labour. However, among all the individual parameters, cervix length has best predictive ability for caesarean section.

Prospective study of the Iliac Bicrest Pubic Angle through the 3D reconstruction of the bone pelvis and the correlation with giant incisional hernia.

to describe and measure the Bicrista Iliaca Pubo Angle (APBCI) as a new anthropometric parameter. Correlate the measurement with patients with giant incisional hernia (HIG), in the midline of the anterior abdominal wall (AAW). measurement of APBCI, through 3D reconstruction from computed tomography (CT). Measurements performed by two observers, R and C, in 246 women and 60 men, normal adults, in order to obtain the APBCI measurement and its correlation in patients with HIG of the AAW. after sample calculations, the measurement of APBCI in men: 92.5+6.3º to 93.8+6.7º; in women: 90+6.7° to 94.3+6.8° [p-value 0.337(R)/0.628(C)]. The mean age was 57.9+15.9 years (22 to 91 years). Female gender 57+15.7 years (22 to 91 years) and male 61.7+16.5 years (23 to 89 years) p=0.067. As for the distribution of the ranges from 5 to 5 degrees, there is no difference in the distribution of the angle [p-value 0.455(R)/0.672(C)]. The correlation between age and angle showed that the higher the age, the higher the APBCI. There was no variability between angle measurements: 0.97 (95% CI 0.97; 0.98). In men with HIG, the average is between 108.3+5.37º (102.92º to 113.67º), and in women, 107.8+6.64 (101.16º to 114.44º). the study allowed us to conclude that HIG is not just an isolated AAW defect. Determines skeletal changes, as the APBCI is influenced by the distance of the iliac crests.

Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women.

Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term “pregnancy-related sacroiliac joint pain.” All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.

Three-dimensional modeling of female urinary system based on MRI and CT data

To reconstruct a three-dimensional model of female urinary system based on magnetic resonance imaging (MRI) and tomography angiography (CTA) data. MRI and CTA datasets were collected from 20 patients in our department in 2018 for reconstructing 3D models of the bladder urethra in resting state using Mimics19.0 software combined with engineering software. The metric parameters of the bladder urethra were analyzed in the reconstructed 3D model. The bladder and urethra were successfully reconstructed using 10 MRI datasets, and the kidney, ureter and bladder were reconstructed using 10 CTA datasets. Using engineering software, we measured a number of cysto-urethral geometric parameters, including the cysto-urethral posterior angle (151.1±17.9°), beta angle (137.3±14.0°), urethral pubic angle (47.8± 12.1°), urethral tilt angle (21.5±7.3°), alpha angle (83.8±13.8°), the posterior pubic space (15.3±3.0 mm), and the urethral striated muscle thickness (2.6±0.6 mm). Three-dimensional reconstruction of the anatomical model of the human urinary system provides a platform for studying the fine anatomy of the female urinary system and allows measurement of multiple parameters to better understand the functional differences of the bladder and urethra in different populations.

Effects of menopausal factor on fine anatomy of bladder urethra and vagina in women undergoing vaginal delivery

Objective: To explore the effects of menopausal factor on fine anatomy of bladder, urethra and vagina in women undergoing vaginal delivery. Methods: Gynecological patients in Nanfang hospital from January 2013 to October 2016 were collected, and then the patients whose MRI images quality meet the require of reconstruction, with the history of vaginal delivery experience, without any cesarean section experience, and the first labor time was ≤30 years old were enrolled. The patients who had pelvic floor dysfunction when done MRI examinations were excluded. Finally, 238 cases were randomly selected out, and 238 models of data were reconstructed and measured by Mimics and UG software. The independent t test was used to do the comparison between menopausal group and those not yet menopause. Results: First, we built 238 3D models totally. Second, the parameters related with bladder and urethra: the angle of bladder and urethra, β angle, urethra pubic angle, α angle, retropubic space, the length between bladder neck and edge of pubic midpoint, and urethral striated muscle thickness of menopausal group were bigger than those of pre-menopausal group. While for the urethra tilt angle, the former group was smaller than that of the latter group. But there was no significant statistical differences between two groups. Third, the parameters related with vagina: the proximal urethral vaginal gap of the post-menopause group was smaller than that of pre-menopausal group, while for the middle and distal urethral vaginal gap, the former group was bigger than that of the latter group. The length and width of vaginal anterior wall of the post-menopausal group were smaller than those of pre-menopausal group. Beside the middle urethral vaginal gap, all the difference between two groups had no statistical meaning. The 2D shape of axial vaginal, H type occupation of the former group was obviously lower than that of the latter group. Conclusions: Menopause has an effect on fine anatomy of pelvic organ. Especially on the shape of vagina, the middle urethral vaginal gap become much wider after menopause, the occupation of shallow concave type become much higher post-menopausal. It means the lateral and backward support function of the urethra and vagina is relatively weakened after menopausal, and the shape of vagina become smaller.

MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt Breech at term cohort (FRABAT)

ObjectivesThe purpose of this study was to investigate the role of the maternal pelvis, assessed by MRI pelvimetry in nulliparous women expecting a term fetus in breech presentation, to predict a successful and safe vaginal birth. Study designIn this monocentric and anonymized cohort study, we enrolled 367 nulliparous women with breech presentation at 39+0 to 41+0 weeks of gestation during a period of 8 years at the University Women's Hospital in Frankfurt/Main. Pelvic measurements were obtained by standard MRI imaging. We correlated the obstetric conjugate, the pubic angle and the distance between the ischial tuberosities (intertuberous distance) with the maternal and fetal outcomes of vaginally intended breech births. The data was evaluated using logistic regression analysis. Results241 of 367 participants (65.7%) experienced a successful vaginal delivery whereas 126 patients (34.3%) were subjected to secondary cesarean section. An increasing obstetric conjugate was significantly associated with an increasing rate of successful vaginal deliveries. No significant correlation of the intertuberous distance and the pubic angle with the mode of delivery could be shown. Although statistically not significant, we were able to define cut-off values of 10.9 cm in the intertuberous distance and 70° in the pubic angle; below these values, no successful vaginal delivery was recorded. No significant differences in the short-term outcomes were seen between the neonates of the vaginal delivery and the cesarean section groups. Inter- and intraobserver variability showed excellent reproducibility for all MRI parameters. ConclusionThe obstetric conjugate correlates with the rate of vaginal deliveries in nulliparous women at term and can be used as a useful criterion for pre-selection and counseling of women with breech presentation and the desire for a vaginal delivery.

Gender determination from diagnostic factors on anteroposterior pelvic radiographs

BackgroundGender determination from skeletal remains is one of the primary factors in forensic medicine. This study aimed to identify the gender of patients referred to the radiology ward of the Rasoul Akram Hospital of Tehran using anteroposterior pelvic radiography. MethodsA total of 200 patients (100 male and 100 female) referred to the radiology ward of the Rasoul Akram Hospital for anteroposterior pelvic radiography during 2013–2014 were included in this study. After taking a standard radiographic image of all patients in the supine position and an anteroposterior view of the pelvis, factors including subpubic angles, pubic angle, X angle, ischiopubic index, ratio of the length of the symphysis pubis to the mid and minimum width of the pubis body, and ratio of the length of the symphysis pubis to the minimum width of the pubic superior ramus were measured on radiographs. The Student t test and receiver operating characteristic curve were used to compare the data of male and female patients. Values were significant at p<0.05. ResultsAll the evaluated variables were significantly different in male and female patients (p=0.000), with the highest level of measurement accuracy noted in the subpubic angle, Pubic Angle 1, X angle, Pubic Angle 2, minimum width of the pubic superior ramus, and ischiopubic index. Length of the symphysis pubis, length of the pubis, and ratio of the length of the pubis to the minimum width of the pubic superior ramus showed the lowest accuracy. ConclusionThe results of this study revealed that the evaluation of the radiographic images of pelvic bones by assessing the mentioned factors can be useful for sex determination from skeletal remains. However, ethical considerations should also be taken into account while using these factors.

Prospective study of the neurotopographic adequacy of transverse incision in Lichtenstein inguinal hernioplasty.

Lichtenstein technique requires identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.The aim of the study was to verify if the transverse incision is suitable for identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.This study included 29 patients who underwent hernioplasty, and also 10 dissections of the inguinal regions from 5 cadavers. The anthropometric measurements included: incision size (IS) and topography, pubic angle (PA), body mass index (BMI), and the distance from the pubis to the incision and bi-iliac crest plane. The correlations between variables of interest and the ability to identify the nerves were assessed.Measures of height (P = 0.108), BMI (P = 0.343), and abdominal circumference (AbC) (P = 1.000); the correlations between incision IS and PA (r = −0.17, P = 0.406), IS and BMI (r = 0.56, P = 0.002), IS and AbC (r = 0.56, P = 0.002); incision and pubic heights (r = −0.26, P = 0.174); patient height and PA (r = −0.33, P = 0.092). The associations between these measures were: BMI (P = 0.136), AbC (P = 0.104), PA (P = 0.641), and IS (P = 0.399). The rates of successful nerve identification in patients and corpse were: iliohypogastric—29 (29)/9 (10), 100% (P = 0.147); ilioinguinal—29 (29)/10 (10), 100%; and genital branch of the genitofemoral nerve—26 (29)/9 (10), 89.7/80% (P = 0.488).The transverse incision permitted identification of the nerves for Lichtenstein hernioplasty.

Relationship between Sacral Pelvic Incidence and Acetabular Orientation

The importance of the sacral pelvic incidence (SPI) in relation to individual variations of sagittal spinal curvature has become well-recognised. We attempted to determine the relationship between SPI and acetabular orientation. The three-dimensional coordinates of 47 homologous points were observed on 51 adult anatomical pelvises (26 female and 25 male). The reference vertical plane was Lewinnek's anterior pelvic plane. 10 angular parameters and 11 linear parameters were defined and calculated. These were expressed both in absolute value (in millimetres) and in "acetabular unit" (relative to the mean value of the right and left acetabular rays). Mean values of the parameters were calculated for all pelvises and according to gender. There were two dominant parameters: the "sacral slope" and the "V pubic angle". "Acetabular tilting" was primarily dependent on the "sacral slope" and its intermediary on the "SPI", while "acetabular anteversion" dependent on the "V pubic angle" via the "angle of prow". It is recommended that positioning of the acetabular cup in total hip arthroplasty relates to anatomical parameters, and to the global sagittal balance of the pelvi-spinal unit.

Pelvic roentgenometry of the third kind: age- and sex-related measurement results in adulthood

Normal values in adults for the hip joint (3.5-6 mm), the sacro-iliac joint (1-3.5 mm) and the symphysis (up to 7.5 mm) were obtained by measurements of a.p. views of the pelvis. Contrary to the literature there was no sex difference as regards the CCD. The roentgenometric features of the female and male pelvis depend on the pubic angle, the transverse diameter of the pelvic inlet and the sulcus paraglenoidalis. In females there are age-related changes consisting of a reduction of the pubic angle, increasing height of the symphysis components of the pubis and an increase in the transverse diameter of the pelvis. In the male, age changes consist of an increase of the symphysis component of the pubis and the transverse diameter of the pelvis.

Anatomical Variations in the Female Pelvis: The Caldwell-Moloy Classification

Since 1933, when Caldwell and Moloy (1) first came out with their classification of the female pelvis, several articles have been written by the same authors and their co-workers on the general use of x-ray in the study of the mechanics of obstetrics, particularly as it relates to pelvic form and fetal-pelvic relationships. Other writers have added to the literature follow-up reports to evaluate further the application of these studies by careful clinical-roentgenologic correlation. It has been rather definitely shown that measurements are not the entire story and that the x-ray can be of aid in determining the course of labor over and above the procedures which deal primarily with the mensuration of the fetal head and maternal pelvis. The problem is not entirely one of size, but includes pelvic form and fetal-pelvic relationships. If one disregards the clinical correlation, particularly with border-line disproportions, one will easily mislead the clinician and discredit an otherwise valuable roentgen procedure, however important fetal cephalometry and maternal pelvimetry may seem to be in a specific case. A recent article by Nicholson and Allen (2) we believe deserves some comment. These authors criticize the Caldwell-Moloy classification of the female pelvis because of its lack of precision. They feel that there are so many subclassifications under the four parent types that the method of classification becomes unwieldy. To quote these authors: “Classification may be a fine weapon in the armament of science, but classification without precise definition is simply the negation of science and can only lead to the multiplication of types. until every example has a type of its own.” They seek to disprove (1) the fact that the android pelvis is a male pelvis and that it is associated with other male stigmata in the female, (2) that the android pelvis and to some extent the anthropoid pelvis are associated with narrow outlets, and (3) that the android pelvis is associated with difficult labor, propositions which they say Caldwell and Moloy have propounded. They attempt to produce proof that the android pelvis is associated with neither contraction of the pubic angle nor with difficult labor. They also point out that any deformities in the pelvis which lead to difficult labor are due to deficient nutrition in childhood. Some of these ideas cannot go unchallenged. In the first place, Caldwell and Moloy never “argued” that the android pelvis was necessarily associated with difficult labor. They did say that a relatively small android pelvis is more apt to cause trouble than a relatively small gynecoid pelvis because of the difficult mechanism that may be associated with the android type. In those pelves which are borderline or normal as to size, the pelvic form may play a major role. In this regard Nicholson and Allen have missed a very important point.