Obstructive defecation. Diagnostic methods and treatment

Obstructive defecation is observed in approximately half of all patients with functional constipation. Functional constipation has been related to alterations in intestinal motility (slow transit constipation) and to pelvic floor disorders leading to obstructive defecation associated with anatomical alterations of the pelvic floor (rectocele, posterior perineal hernia, enterocele and sigmoidocele, internal rectal intussusception, occult mucosal prolapse, solitary rectal ulcer and descending perineum syndrome), or obstructive defecation without anatomical alterations (pelvic floor dyssynergy or anismus). The diagnostic methods used (history and physical examination, colonic transit time, balloon expulsion test, proctography, anorectal manometry and electromyography) are reviewed. Conservative medical treatment and the indications for surgical treatment and its results are also discussed.     

不同体位下动态MRI排粪造影对出口梗阻型便秘病因诊断的影响（附16例报告）

目的探讨不同体位下动态MR／排粪造影对出口梗阻型便秘（OOC）病因诊断的影响。方法对16例有不同程度排便困难,并已接受x线排粪造影检查证实为OOC的患者进行动态MR／排粪造影检查。动态图像采集采用正中矢状位兀．ESTA序列连续扫描,于第1d、第3d分别取仰卧位、仰卧位＋膝髋屈曲,比较分析两种体位下MRI排粪造影诊断的结果。结果仰卧位MRI排粪造影,16例患者中,直肠前膨出6例、直肠脱垂与内套叠5例、耻骨直肠肌综合征1例、盆底疝3例、子宫后倾2例、膀胱膨出3例、子宫脱垂1例、会阴下降综合征4例;仰卧位＋膝髋屈曲位MRI排粪造影,检测出直肠前膨出7例、直肠脱垂与内套叠9例、耻骨直肠肌综合征1例、盆底疝4例、子宫后倾2例、膀胱膨出3例、直肠下降1例、会阴下降综合征7例。比较两种体位下动态MR／排粪造影OOC病因诊断的结果,仰卧＋膝髋屈位检查在直肠脱垂或套叠、会阴下降的诊断方面较单纯仰卧位具有一定的优势（P〈0．05）。结论动态MRI排粪造影能提供盆底组织器官的动静态形态影像,显示盆底结构的器质性和功能性异常;采用模拟背部垫高、膝髋屈位仰卧的模拟坐位可更真实反映出直肠脱垂或套叠、会阴下降等病理情况,提高MRI诊断成功率。     

Obstructed Defecation Caused by a Cystourethrocele and Mobile Posterior Vaginal Wall: A Case Report

Obstructed defecation may be caused by a rectocele and/or enterocele. Rectal wall procidentia may be due to an enterocele bulging into the rectum. Another cause of rectal procidentia resulting in obstructed defecation is presented. A 65-year-old woman complained of vaginal prolapse and incomplete bowel emptying. Pelvic examination revealed that a stage III anterior vaginal wall prolapse caused a mobile posterior vaginal wall to prolapse into the anal canal, resulting in rectal procidentia and subsequently in obstructed defecation. Careful assessment of all pelvic floor compartments is important to identify the cause of obstructed defecation, particularly in the absence of a rectocele.     

出口梗阻性便秘病人的盆腔、阴道、膀胱及排粪同步造影

目的：研究出口梗阻性便秘（Outlet Obstructive Constipation,OOC)病人盆腔器官及盆底形态结构变化。方法：对38例出口梗阻性便秘病人及12例正常对照者行盆腔、阴道、膀胱及排粪同步造影（以下简称“四重造影”）,包括盆腔造影,阴道涂以钡剂,结合排尿膀胱造影和排粪造影。测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果：四重造影诊断直肠内脱垂37例,直肠前突5例,盆底痉挛综合征5例,而物理检查拟诊断分别为12例,4例,1例,均100％得到造影检查证实。四重造影检查还发现盆底及腹膜疝9例,膀胱脱出6例,会阴下降综合征3例,子宫后倒或脱垂10例。与对照组相比,OOC组和排相肛直角增大,静息相及力排相会阴异常下降,力排相Douglas陷凹加深;OOC组中有泌尿系症状者,静息相及力排相膀胱异常下降。结论：四重造影诊断直肠内脱垂和直肠前突的阳性率明显高于临床物理诊断;而且对临床隐匿、物理检查难以诊断的盆底及腹膜疝、膀胱及子宫、阴道脱出等提供了形象客观的诊断依据,提高了诊断的准确性,有助于选择正确合理的手术方式。     

Surgical treatment of rectocele with the use of mesh implants by the obstructive defecation syndrome

The aim of current study was to evaluate in complex the effectiveness of transvaginal mesh implants in women with obstructed defecation (OD) syndrome based on the comparison of preoperative and postoperative results of objective diagnostic tools and quality of life parameters. Methods: from prospectively collected database of patients treated in our department those who were treated for OD by means of transvaginally placed mesh implants were chosen. The comparison of pre- and postoperative results of objective evaluation (prolapse stage according to POP-Q system, X-ray defecography - XR-DG and MRI defecography - MRI-DG) as well quality of life parameters (Wexner constipation score and validated Russian version of King's Health Questionnaire) was undertaken. Treatment effectiveness was evaluated using Сlinical Global Impression - Improvement (CGI-I) и Patient Global Impression - Improvement (PGI-I) scales. Results: In 2007-2011 40 women (mean age 51.8±10.7 years) underwent transvaginal pelvic floor reconstruction with mesh implants. All of them had ≤3 stage pelvic prolapse (POP-Q) and rectocele. Preoperative XR-DG and MRI-DG helped reveal rectocele >4 cm in 85 and 43% of women respectively, 68% of patients had cystocele and 18% - genital prolapse. In 21 case mesh implants for posterior pelvic floor reinforcement were used, in other cases mesh implants for total pelvic floor repair were placed. At a mean of 19 months after the operation manual examination revealed that 90% of women had 1 stage posterior pelvic proplapse, at XR-DG and MRI-DG significant reduction of rectocele size and depth of pelvic floor descent was noted. Besides that significant decrease in mean values of Wexner constipation score and King's health questionnaire was demonstrated. Though mean values of global treatment effectiveness assessment on CGI-I and PGI-I scales didn't significantly differ (2.13±0.85 и 2.68±1.42, р=0.06), the rate of agreement between these scales measured at each single case was very low (κ-0.154), this reflects that clinician has more positive perception of disease dynamics due to treatment than the patient. When mean values of dynamics in different indexes of King's health questionnaire were compared it was demonstrated that the index of quality of life influence (3.53±0.96) was significantly higher than the indexes of OD influense (2.63±1.08) and mechanical symptoms (2.58±1.04), this suggests that while the manifestations of OD syndrome are significantly improved patient quality of life doesn't change substantially. Conclusions: XR-DG is more specific than MRI-DG in evaluating the size of rectocele and the depth of pelvic floor descent; the use of mesh implants in surgical treatment of OD syndrome results in significant reduction of rectocele and prolapse stage in 90% of patients; clinical evaluation of treatment effectiveness based on objective examination is more optimistic than subjective perception of treatment results by the patient, this indicates that anatomic correction does not always lead to quality of life improvement.     

盆腔四重造影在出口梗阻性便秘诊断中的作用和意义

目的研究出口梗阻性便秘(OOC)患者盆底形态变化和盆腔脏器间的相互关系。方法对59例经物理检查初步诊断为OOC的患者和12例正常自愿者行排粪造影,结合盆底、膀胱造影,女性阴道放置浸钡标记物(四重造影)检查,测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果在59例OCC患者中,经盆腔四重造影诊断直肠内脱垂46例,盆底腹膜疝29例,直肠前突7例,盆底肌痉挛综合征7例,会阴下降综合征5例;还发现膀胱脱垂6例,子宫后倾或脱垂10例。与正常自愿者相比,OOC组力排相肛直角明显增大(P<0.05),静息相和力排相会阴异常下降(P<0.05,P<0.01),力排相盆底腹膜位置下降非常显著(P<0.01)。OOC组中伴泌尿系症状者静息相和力排相膀胱位置均显著低于正常自愿者(P<0.05,P<0.01)。结论盆腔四重造影可有效诊断直肠内脱垂和直肠前突;对临床症状隐匿、物理检查难以诊断的盆底腹膜疝以及膀胱、子宫脱垂提供了诊断依据;有助于选择正确合理的治疗方法。     

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目的 研究出口梗阻性便秘（OCC）病人盆腔器官及盆底形态结构变化及其临床意义。方法 对38例OOC病人及12位健康自愿者（对照组）行空，阴道，膀胱及排粪同步造影（以下简称“四重造影”），测量肛直角，会阴位置，盆底腹膜位置，膀胱位置。结果 四重造影诊断直肠内脱垂直37例，直肠前突5例，盆底痉挛综合征5例。四重造影检查还发现盆底及腹膜疝9例，膀胱脱出6例，会阴下降综合征3例，子宫后倾或脱垂10例。与对照组相比，OOC组力排相肛直角增大，静息相及力排相会阴异常下降，力排相Douglas陷凹加深；OOC组中有泌尿系统症状者，静息相及力排相膀胱异常下降。结论 四重造影诊断直肠内脱垂和直肠前突的阳性率较高，而且对临床隐匿，物理检查难以诊断的盆底及腹膜疝，膀胱及子宫异常，阴道脱出等疾病提供了形象客观的诊断依据，提高了诊断的性，有助于选择正确合理的治疗方式。     

盆腔脏器多重造影在出口梗阻性便秘诊断中的应用

目的：研究出口梗阻性便秘(outlet obstructive constipation，OOC)病人盆腔器官及盆底形态结构变化。方法：对38例OOC病人及12例正常自愿受试者行排粪造影检查，结合盆腔、膀胱造影，及在女性阴道内放置浸钡标志物(以下简称“多重造影”)测量肛直角、会阴位置、盆底腹膜位置、膀胱位置情况。结果：经多重造影诊断直肠内脱垂37例，直肠前突5例，盆底痉挛综合征5例。经物理检查上述诊断分别为12例、4例、1例，所有病例均得到造影证实。多重造影检查还发现盆底及腹膜疝9例，膀胱脱出6例，会阴下降综合征3例，子宫后倒或脱垂10例。与对照组相比，OOC组力排相肛直角增大，静息相及力排相会阴异常下降，力排相Douglas陷凹加深；OOC组中有泌尿系症状者静息相及力排相膀胱异常下降。结论：多重造影诊断直肠内脱垂和直肠前突的阳性率明显高于物理诊断；对临床症状隐匿、物理检查难以诊断的盆底腹膜疝，以及膀胱、子宫和阴道脱出提供了诊断依据，有助于选择正确合理的治疗方式。     

超声评估盆腔器官脱垂的进展

超声可清晰显示盆底解剖结构、盆底重建术后网片位置及长度,且诊断重度盆腔器官脱垂与盆腔器官脱垂定量分度标准的一致性较好,可为评价盆底重建术的安全性及有效性提供影像学基础。本文对超声在盆腔器官脱垂诊断及盆底重建术术后疗效评价中的应用进展进行综述。     

Laparoscopic sacral suture hysteropexy for uterine prolapse

This study aims to describe and review a new method of uterine conservation in pelvic reconstruction for women with uterine prolapse. This is a prospective study of women who have undergone laparoscopic sacral suture hysteropexy. Structured questions, visual analogue patient satisfaction score (VAS), and vaginal examination were undertaken. Follow-up was performed by non-surgical reviewers. From July 2001 until August 2003, a total of 81 women underwent laparoscopic sacral suture hysteropexy for uterine prolapse. At a mean of 20.3 months follow-up, 76 women (93.8%) were available for questioning and 57 (70.3%) attended for examination. Sixty-five women (87.8%) had no symptoms of pelvic floor prolapse, 54 women (94.7%) had no objective evidence of uterine prolapse, and 61 women (82.4%) were satisfied with their surgery (VAS≥80%). Laparoscopic sacral suture hysteropexy attaches the posterior cervix to the sacral promontory via the right uterosacral ligament. Follow-up data of laparoscopic sacral suture hysteropexy indicate it to be an effective method in the management of uterine prolapse.     

动态MRI联合排粪造影在出口梗阻型便秘诊治中的应用

目的 采用盆底动态MRI联合排粪造影技术研究出口梗阻型便秘患者盆底功能失调情况,评价其对诊断出口梗阻型便秘的敏感性、可行性.方法 选取2007年7月至2009年3月收治的109例临床表现有排便频率改变和排便困难、盆部坠胀痛等的盆底功能失调的女性患者.对患者进行盆底MRI和排粪造影检查,评价盆底解剖结构.结果 盆底动态MRI共诊断膀胱膨出54例(49.6%)、直肠子宫陷窝疝11例(10.1%),会阴脱垂29例(26.6%)、直肠前膨出71例(65.2%),外括约肌萎缩19例(18.2%)、耻骨直肠肌痉挛综合征32例(29.4%).排粪造影检查结果发现直肠前膨出和耻骨直肠肌痉挛综合征的诊断符合率为100%.但排粪造影检出骶直分离征33例(30.3%)、直肠黏膜脱垂和(或)套叠41例(37.7%),盆底动态MRI未能显示直肠黏膜的脱垂和套叠.结论 盆底动态MRI能够较全面的评价盆底功能性疾病,具有较好的灵敏度,其不足可通过排粪造影来弥补.     

Place du traitement chirurgical par « voie haute »

Indications for surgical repair of rectocele are symptomatic large rectocele, patient with obstructive defecation syndrome (i.e. incomplete evacuation and digital support during defecation), patient with a rectocele of a depth of > 3 cm, or barium paste remaining trapped in the cavity after evacuation. Rectocele often coexists with other pelvic organ prolapses, such as cystocele, vaginal vault prolapse and enterocele. For these reasons, surgical rectocele treatment is designed to reduce specific symptoms and requires a multidisciplinary approach. What constitutes the optimal surgical approach has been debated for some considerable time. Various surgical techniques with a transanal, transperineal, transvaginal or abdominal approach have been used for rectocele. No randomized trial has clearly established the best approach. A laparoscopic sacral colpopexy approach is effective for genito-urinary prolapse associated with rectocele. Furthermore, laparoscopic ventral recto(colpo)pexy is a innovative technique that avoids any posterolateral rectal mobilization, thus minimizing the risk of autonomic neural damage. The unique anterior placement of the mesh with reinforcement of the rectovaginal septum restores normal rectal evacuation. The abdominal approach seems the most suitable for rectocele in sexually active women because it is not associated with dyspareunia. Two surgical techniques may be proposed, either laparoscopic double sacral colpopexy using prosthetic materials, or laparoscopic ventral recto(colpo)pexy.     

Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction

Objective Whilst trans‐abdominal fixation +/? resection offers better functional results and lower recurrence than perineal procedures, mesh rectopexy is complicated by constipation. Laparoscopic autonomic nerve‐sparing, ventral rectopexy allows correction of the underlying abnormalities of the rectum, vagina, bladder and pelvic floor. Method A prospective database was used to audit our 7‐year experience of this technique. The recto‐vaginal septum was mobilized anteriorly to the pelvic floor avoiding nerve damage. A prolene mesh was sutured to the ventral rectum, posterior vagina and vaginal fornix and secured to the sacral promontory. Patients were assessed with questionnaires and Cleveland Clinic scores. Results Eighty patients, six males, median age 59 years (range 31–90) underwent laparoscopic prolapse surgery between Jan 1997 and Dec 2005; 55% had full thickness prolapse and 46% rectal anal intussusception. Five had a solitary rectal ulcer. A total of 58% had undergone previous surgery; hysterectomy 33%, posterior colporrhaphy 15%, posterior rectopexy 6%, Delorme's rectal mucosectomy 5% and Birch colposuspension 3%. Half (54%) were incontinent (mean Wexner score 11, range 2–17) and 31% reported symptoms of obstructed defecation; seven had slow transit constipation and underwent resection. The median operative time was 125 min (range 50–210) with one conversion. Median time to diet was 12 h and median length of stay 3 days (1–12). No patient has developed recurrent full thickness prolapse at a median follow‐up of 54 months (30–96). Incontinence improved in 39 of 43 patients (91%); median post‐operative Wexner score 1 (0–9). Obstructed defecation resolved in 20 of 25 patients (80%). Pelvic pain resolved in all but one. Complications occurred in 21%; faecal impaction 4%, wound infection 2%, bleeding 2%, leak 1%, chest infection 1%, retention 1%. Three developed minor evacuatory difficulties and two, urinary stress incontinence. Conclusion Laparoscopic ventral rectopexy is safe with relatively low morbidity. In the medium‐term, it provides good results for prolapse and associated symptoms of incontinence and obstructed defecation.     

改良全盆底重建手术治疗女性盆腔器官脱垂35例疗效观察

目的评价改良盆底重建术治疗盆腔脏器脱垂的临床效果。方法盆腔脏器脱垂定量(POP-Q)分度为Ⅲ～Ⅳ度35例患者行改良盆底重建术,观察手术时间、术中出血量、住院时间等围手术期指标,以POP-Q分度为客观疗效评价指标,以临床症状消失为主观治愈指标。术后定期随访,观察疗效。结果手术平均时间(55士20.2)min、术中平均出血(100±40.2)ml,术后住院平均(4.5±1.5)d,术后随访3～18个月、中位随访时间6个月,客观治愈率94%(33/35),主观有效率91%(32/35)。术后仅1例发生网片侵蚀,3例发生排尿困难,2例发生性交痛,2例发生急迫性尿失禁。结论改良盆底重建术是治疗盆腔脏器脱垂的有效术式,保留子宫同时加强盆底组织,手术简单、安全、微创、经济,远期疗效有待进一步观察。     

52例会阴下降综合征的诊治

报道52例会阴下降综合征(DPS),均行排粪造影结合盆腔造影及肛管测压,并设对照组。结果表明排便中DPS会阴下降达3.58cm,以耻骨直肠肌压迹中点测量会阴位置变化与盆底腹膜一致,是可取的。DPS的肛管压力显著降低。81%的DPS伴直肠或肛管内脱垂,积极处理内脱垂,避免用力排便,打断其与DPS间恶性循环,是DPS防治的关键,治疗有效率为80.8%。     

Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse.

BACKGROUND: Full thickness rectal prolapse in young adults with normal pelvic floor is a disease in which the rectum is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, which is expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. METHODS: Thirty-five patients (30 women) of median age 44 years (range 18 to 74) were operated on for full thickness rectal prolapse with normal pelvic floor. The rectum was mobilized posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired with a nonabsorbable mesh. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in 1 patient. Mean hospital stay was 8 days (range 6 to 14). Mean follow-up was 34 months (range 10 to 93). No recurrence was seen. Preoperatively, 33 patients (94%) complained of constipation mainly with emptying problems (21 patients) and 25 patients (71.5%) were incontinent. Postoperatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 17 patients (81%). Eighteen incontinent patients (72%) regained full continence. On the other hand, 2 patients with normal bowel function worsened and 1 patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal pelvic floor undergoing prosthetic rectopexy and sigmoid resection (a) morbidity was low, (b) anatomical control was obtained in all cases, (c) emptying problems were corrected, and (d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.     

Symptomatic vaginal enterocele associated with malfunctioning ventriculoperitoneal shunt and cerebrospinal ascites

Abdominal pseudocyst formation is a rare adult complication associated with ventriculoperitoneal (VP) shunts. Presenting symptoms are primarily abdominal and include distention, pain and anorexia, and secondarily neurological with signs and symptoms of shunt malfunction. We describe a case of VP shunt-related pseudocyst formation presenting as symptomatic pelvic organ prolapse with stage 4 enterocele 4 years after VP shunt placement. The patient's vaginal enterocele enlarged and became more symptomatic as intra-abdominal cyst formation expanded. Symptomatic relief of pelvic floor symptomatology including resolution of exteriorized prolapse was established by conservative measures and eventual VP shunt revision and removal. VP shunt malfunction may present as symptomatic pelvic organ prolapse and may require shunt removal or revision for resolution of symptoms.     

65例便秘腹腔手术发现其与盆底脱垂关系分析

报告６５例经腹手术治疗便秘的患者，其中出口梗阻型（ＯＯＣ）５０例，结肠慢通过型（ＳＴＣ）１５例。女性为男性之６倍。ＣＣＯ排粪造影发现：ＩＲＰ５０；ＲＣ１３；肠疝３；ＤＰＳ２４。ＳＴＣ排粪造影发现：ＩＲＰ１２；ＤＰＳ１０；巨乙状结肠１。术中ＯＯＣ发现：ＩＲＰ（直肠松驰与可套迭）５０：３３例前子宫者均脱垂及后倒；盆底下降５０例；盆底疝１３。ＳＴＣ手术发现；ＩＲＰ１２；１２例有子宫者均脱垂及后倒；盆底下     

Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis

PURPOSE: We assessed the merit of dynamic half Fourier acquisition, single shot turbo spin-echo sequence T2-weighted magnetic resonance imaging (MRI) for evaluating pelvic organ prolapse and all other female pelvic pathology by prospectively correlating clinical with imaging findings. MATERIALS AND METHODS: From September 1997 to April 1998, 100 consecutive women 23 to 88 years old with (65) and without (35) pelvic organ prolapse underwent half Fourier acquisition, single shot turbo spin-echo sequence dynamic pelvic T2-weighted MRI at our institution using a 1.5 Tesla magnet with phased array coils. Mid sagittal and parasagittal views with the patient supine, relaxed and straining were obtained using no pre-examination preparation or instrumentation. We evaluated the anterior vaginal wall, bladder, urethra, posterior vaginal wall, rectum, pelvic floor musculature, perineum, uterus, vaginal cuff, ovaries, ureters and intraperitoneal organs for all pathological conditions, including pelvic prolapse. Patients underwent a prospective physical examination performed by a female urologist, and an experienced radiologist blinded to pre-imaging clinical findings interpreted all studies. Physical examination, MRI and intraoperative findings were statistically correlated. RESULTS: Total image acquisition time was 2.5 minutes, room time 10 minutes and cost American $540. Half Fourier acquisition, single shot turbo spin-echo T2-weighted MRI revealed pathological entities other than pelvic prolapse in 55 cases, including uterine fibroids in 11, ovarian cysts in 9, bilateral ureteronephrosis in 3, nabothian cyst in 7, Bartholin's gland cyst in 4, urethral diverticulum in 3, polytetrafluoroethylene graft abscess in 3, bladder diverticulum in 2, sacral spinal abnormalities in 2, bladder tumor in 1, sigmoid diverticulosis in 1 and other in 9. Intraoperative findings were considered the gold standard against which physical examination and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 100%, 83% and 97% for cystocele; 100%, 75% and 94% for urethrocele; 100%, 54% and 33% for vaginal vault prolapse; 83%, 100% and 100% for uterine prolapse; 87%, 80% and 91% for enterocele; and 76%, 50% and 96% for rectocele. CONCLUSIONS: Dynamic half Fourier acquisition, single shot turbo spin-echo MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for rectocele, pelvic floor prolapse is accurately staged and pelvic organ pathology reliably detected. The technique is rapid, noninvasive and cost-effective, and it allows the clinician to visualize the whole pelvis using a single dynamic study that provides superb anatomical detail.     

A new method for the evaluation of pelvic organ prolapse in women using a three-dimensional optic scanner

Introduction and hypothesis

Modern classifications of pelvic floor movements are based on pelvic floor assessment in a static midsagittal plane. This study presents a new and potentially useful 3D noninvasive tool for studying pelvic floor mobility in women with pelvic organ prolapse (POP).

Materials and methods

Thirty-four patients with POP [grade ≥3 using the Pelvic Organ Prolapse Quantification (POP-Q) system] and 30 healthy volunteers (controls) at rest and during Valsalva maneuver were scanned using an Artec? 3D optic portable scanner and 3D pelvic floor models were generated. We calculated the volume of the prolapsed vaginal wall using dynamic prolapse increment (DPI), which is defined as an increase in prolapse volume from rest to its maximal Valsalva probe [DPI?=?(Vval – Vrest) / Vrest %)].

Results

In the control group, the average DPI was 28 % (16–51 %). As the DPI in patients with POP varied widely, two subgroups were identified. In the first subgroup, the average DPI was 290 % (125–437 %), whereas it was only 48.8 % (41–55 %) in the second subgroup. Prolapse volume in subgroup 1 was not due to the most prominent component of POP but was induced by enlargement of the prolapsed vaginal wall from other components, such as a cystocele or enterocele, which was evident only during the 3D procedure and could not be validated by the POP-Q system.

Conclusions

In addition to existing methods, 3D modelling is a useful tool for evaluating pelvic floor mobility. Further investigation of the pelvic floor dynamic features in women is necessary.