MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome

Introduction and hypothesis

In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls.

Methods

Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test.

Results

There were no significant differences in age, parity, or symptom duration between groups. Patients with IC/BPS exhibited shorter levator muscles (right: 5.0?±?0.7 vs. 5.6?±?0.8, left: 5.0?±?0.8 vs. 5.7?±?0.8 cm, P?<?0.002) and a wider posterior puborectalis angle (35.0?±?8.6 vs. 26.7?±?7.9°, P?<?0.01) compared with controls. The H line was shorter in patients with IC/BPS (7.8?±?0.8 vs. 8.6?±?0.9 cm, P?<?0.02), while M line did not differ. Total urethral length was similar, but vaginal cuff and bladder neck distances to the H line were longer in patients with IC/BPS (5.7?±?0.6 vs. 5.1?±?0.9 cm, P?<?0.02; 1.9?±?0.4 vs. 1.4?±?0.2 cm, P?<?0.001, respectively).

Conclusions

Patients with IC/BPS have pelvic floor hypertonicity on MRI, which manifests as shortened levator, increased posterior puborectalis angles, and decreased puborectal distances. We identified evidence of pelvic floor hypertonicity in patients with IC/BPS, which may contribute to or amplify pelvic pain. Future studies are necessary to determine the MRI utility in understanding pelvic floor hypertonicity in patients with IC/BPS.

     

Pelvic‐floor imaging using three‐dimensional ultrasonography and magnetic resonance imaging in the long term follow‐up of the bladder‐exstrophy‐epispadias complex

Study Type – Therapy (case control)
Level of Evidence 3b

OBJECTIVE

To investigate whether established pelvic floor variables can be used to predict the risk of uterine prolapse after surgery and to compare two different operative strategies, pelvic adaptation with functional reconstruction and an open pelvis with urinary diversion, as a congenital bony pelvis and pelvic floor defect predisposes females with bladder‐exstrophy‐epispadias complex (BEEC) to uterine prolapse.

PATIENTS, SUBJECTS AND METHODS

We conducted a cross‐sectional study using perineal three‐dimensional ultrasonography (3D‐US) and magnetic resonance imaging (MRI) to describe pelvic floor anatomy in 19 women with BEEC (mean age 27.3 years) and five controls, with the outcome evaluated by a semi‐structured interview. The analysis of 3D‐US and MRI was conducted by two independent investigators.

RESULTS

Of the 19 women with BEEC, 13 initially had a functional bladder reconstruction, six a urinary diversion with removal of the exstrophic bladder, and 12 women had closure of the pelvis either by traction bandage or osteotomy, and in the other seven the symphysis was not approximated. Four patients had a complete and one a mild uterine prolapse. After a mean follow‐up of 24 years, the mean symphyseal diastasis was 4.5 cm after symphyseal approximation, 9.0 cm without symphyseal approximation in BEEC and 0.49 cm in controls. The mean levator hiatus was 4.9 cm on 3D‐US and 4.1 cm on MRI after symphyseal approximation, 5.9 and 7.6 cm without symphyseal approximation and 4.2 and 3.2 cm in controls, respectively. The respective mean levator angle was 86.6° and 87.3° after symphyseal approximation, 104.1° and 101.3° without and 71.3° and 45.5 in controls. Prolapse was statistically significantly more common in patients with no symphyseal approximation.

CONCLUSION

This is the first study showing that perineal 3D‐US is useful for pelvic floor imaging in BEEC. Established pelvic floor variables might be useful for predicting the risk of pelvic organ prolapse in BEEC.     

Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse

In a study, the magnetic resonance imaging (MRI) findings of 69 women were analyzed to define the typical MRI appearance of the pelvic floor musculature in healthy subjects (n = 20) and women with urinary incontinence (UI) and/or genitourinary prolapse (GP) (n = 49). The following parameters were determined: thickness and signal intensity of the levator muscles on each side, distance between the urethra and symphysis, diameter of the proximal urethra, and thickness and configuration of the anterior vaginal wall. These parameters were correlated with the patients' age and parity, urodynamic parameters, and the clinical assessment of the pelvic floor. In contrast to healthy subjects, the frequent findings in women with UI and/or GP are higher signal intensity of the levator muscles (p < 0.05) and loss of the hammock-like configuration of the vagina (p < 0.01). On static MRI, the morphometry of the levator musculature identified no findings typical of either UI or GP. Analysis of MRI combined with patients' parity suggests that the severity of damage to the pelvic floor at delivery is determined by the traumatic event as such and not by the number of deliveries. Urethral diameter, distance of the symphysis to the urethra, and vaginal wall thickness cannot distinguish between controls and women with UI and/or GP. Urodynamic and functional clinical parameters do not correlate with the changes in the pelvic floor musculature demonstrated by static MRI. Although morphological changes in UI and/or GP can be demonstrated by MRI, they can be assigned a pathogenic role only if clinical symptoms are present. Neurourol. Urodynam. 17:579–589, 1998. © 1998 Wiley-Liss, Inc.     

腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的疗效观察

目的:探讨腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的临床应用价值及对生活质量的影响。方法:将60例盆底器官脱垂患者随机分为观察组与对照组,每组30例,观察组行腹壁自体筋膜盆底悬吊术,对照组行腹腔镜下子宫颈悬吊术,应用盆腔器官脱垂定量分度法评估手术效果。术后6个月采用盆底功能障碍问卷短表对患者生活质量进行调查,采用盆腔器官脱垂尿失禁性功能问卷对患者性生活质量进行调查。结果:观察组手术时间[(72.32±8.34)min]、术中出血量[(57.43±8.52)ml]、尿管留置时间[(3.23±0.54)d]、术后住院时间[(7.32±0.69)d]均多于对照组[(53.34±6.88)min、(45.65±7.43)ml、(2.39±0.87)d、(6.27±0.75)d],差异有统计学意义(P0.01),术后两组Aa、Ba、C、D、Ap、Bp等指示点位置术后均较术前明显上升,其中观察组上升水平明显高于对照组,更接近解剖学位置(P0.01),盆底功能障碍问卷、排便功能障碍问卷及泌尿功能障碍问卷评分观察组明显低于对照组,盆腔器官脱垂尿失禁性功能问卷中情感、生理、总分等观察组均高于对照组(P0.05)。结论:腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术在治疗盆底器官脱垂中均具有良好的临床治疗效果,其中腹壁自体筋膜盆底悬吊术治疗盆底器官脱垂恢复盆底器官解剖更理想,对患者术后生活质量影响较小。     

Interethnic variation in pelvic floor morphology in women with symptomatic pelvic organ prolapse

Introduction and hypothesis

There is a lack of epidemiological studies evaluating female pelvic organ prolapse in developing countries. Current studies have largely focused on women of white ethnicity. This study was designed to determine interethnic variation in pelvic floor functional anatomy, namely, levator hiatal distensibility and pelvic organ descent, in women with symptomatic pelvic organ prolapse in a multi-ethnic South African population.

Methods

This prospective observational study included 258 consecutive women referred for pelvic organ prolapse assessment and management at a tertiary urogynaecological clinic. After a detailed history and clinical examination, including POPQ assessment, patients underwent a 4D transperineal ultrasound. Offline analysis was performed using 4D View software. Main outcome measures included levator muscle distensibility, pelvic organ descent, and levator ani defects (avulsion).

Results

Mean age was 60.6 (range, 25–91) years, mean BMI 29.83 (range, 18–53). Points Ba and C were lower and the genital hiatus more distensible in black women (all p < 0.05). They were found to have greater hiatal area (p = 0.017 at rest, p = 0.006 on Valsalva) compared with South Asians and whites and showed greater pelvic organ mobility (all p < 0.05) than Caucasians on ultrasound. Levator defects were found in 32.2% (n = 83) of patients and most were bilateral (48.2%, n = 40), with significant interethnic differences (p = 0.014).

Conclusion

There was significant variation in clinical prolapse stage, levator distensibility, and pelvic organ descent in this racially diverse population presenting with pelvic organ prolapse, with South Asians having a lower avulsion rate than the other two ethnic groups (p = 0.014).

     

Focal levator ani eventrations: detection and characterization by magnetic resonance in patients with pelvic floor dysfunction

The aim of this study was to assess the frequency and imaging characteristics of focal levator eventrations in patients with pelvic floor dysfunction on magnetic resonance (MRI). A review of 81 dynamic MR pelvic examinations in patients with pelvic floor dysfunction was carried out to detect and characterize focal eventrations in the levator ani muscle. These were defined as muscle outpouchings which made an angle of >180 degrees with the remainder of the muscle and had a depth of >or=1 cm. Of 81 patients 11(13.5%) had focal eventrations in the levator muscle on MRI: bilateral in 2 cases, right in 5 and left in 4. There was protrusion of pelvic viscera into the eventration in 5 cases, fat in 7 and fluid in 1. Focal levator ani muscle abnormalities are not uncommon on MRI in patients with pelvic floor dysfunction. Characterization of levator muscle morphology can be useful as a research tool in this population.     

Characteristics associated with pelvic organ prolapse in women with significant levator ani muscle deficiency

Introduction and hypothesis

Age is a factor associated with symptomatic pelvic organ prolapse (POP) among women with significant levator ani deficiency.

Methods

This cross-sectional study included patients who were referred for varied pelvic floor disorders, had 3D endovaginal ultrasound as part of their evaluation, and were diagnosed with significant levator ani muscle deficiency defined as a score of 12 or more on 3D endovaginal ultrasound. Patients were categorized as having no pelvic organ prolapse (stages 0 and 1), or symptomatic prolapse (stages 2–4).

Results

Seventy-six women were available for analysis and found to have significant levator ani muscle deficiency, including 51 with symptomatic POP and 25 without POP. Patients with symptomatic POP were older, (mean age 66 (SD?±?11.8) vs 48 (SD?±?17.3) years; p <0.0001), had greater mean minimal levator hiatus (MLH) area (19.7 cm² (SD?±?4.6) vs 17.5 cm² (SD?±?3.5); p?=?0.048), and were more likely to be menopausal (91.3 % vs 54.5 %; p <0.001) compared with those with no POP. In a modified Poisson regression analysis excluding nulliparous women, increasing age (RR?=?2.39, 95 % CI 1.03–5.55) and smoking (RR?=?1.34, 95 % CI 1.08–1.67) remained associated with symptomatic POP after controlling for one another and the MLH area.

Conclusions

Among women with significant levator ani deficiency, older women and smokers had an increased prevalence of symptomatic POP. On average, women without POP, but with significant levator ani deficiency were 18 years younger than women with POP and significant muscle deficiency.

     

Dynamic magnetic resonance imaging of the pelvic floor in patients with idiopathic combined fecal and urinary incontinence

The etiologies of combined fecal and urinary incontinence may be interrelated but remain poorly understood. A potential variable in this process is global pelvic floor dysfunction. The aim of this study was to prospectively assess the use of phased-array, body coil dynamic MRI in identifying pelvic floor abnormalities in patients with combined incontinence symptoms. Symptomatic patients were compared to asymptomatic control subjects and were selected from those referred to the pelvic physiology laboratory with complaints of combined urinary and fecal incontinence. All patients underwent standard urodynamic studies and anorectal physiologic assessment. Colonoscopy and endoanal ultrasonography were also performed. A standardized protocol was used for dynamic MRI, and the parameters were measured using workstation software (callipers, compass, and densitometer). In the incontinent group there was a significant difference, when compared to control subjects, in the angle of the levator ani muscle arch of the levator plate complex (3.0 ± 5 degrees vs. 14 ± 10 degrees; P = 0.004), the width of the levator hiatus (58.3 ± 8 mm vs. 46.5 ± 8 mm; P = 0.001), the area and tissue density of the levator ani muscle (19.5 ±1 mm² vs. 26.9 ±1 mm²; P = 0.001, and 157.3 ± 47 pixels vs. 126.1 ± 23 pixels; P ± 0.025, respectively), and in the length of the external anal sphincter (20.0 ± 5 mm vs. 26.6 ± 13 mm; P = 0.03). Body coil dynamic MRI is a noninvasive and well-tolerated imaging modality. Our data show that it can identify changes in pelvic muscle morphology in patients with disorders of incontinence, and this may help in planning better management strategies. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (oral presentation), and the Eighteenth Annual SSAT Residents and Fellows Research Conference, Orlando, Florida, May 17, 2003.     

Failures and complications in pelvic floor surgery

Objectives

To review current literature on the failures of different surgical approaches in pelvic floor surgery, in particular the use of alloplastic materials, and to analyze complications related to them.

Methods

A Medline search was performed to retrieve English language literature (from the year 1995 to 2011) on the success rates, failures, and complications profiles of pelvic floor surgery. Search terms used are “pelvic organ prolapse,” “stress urinary incontinence,” “complications,” “vaginal mesh,” “mid-urethral slings,” and “colposuspension.” The review includes surgical techniques for the correction of pelvic organ prolapse and stress urinary incontinence. Failure rates and complications in different studies are compiled and analyzed.

Results

Use of synthetic materials in pelvic organ prolapse surgery has reduced surgical failures but it is associated with an increased risk of complications compared to traditional surgical repairs. Synthetic mid-urethral slings for stress urinary incontinence seem to have good success rates over long term, but they have unique complication profile including denovo development of overactive bladder, voiding dysfunction, sling exposures, dyspareunia, and long-term pain. However, some of these complications seem to be related to wrong surgical indications and improper surgical techniques, although some complications may be directly related to the use of synthetic material itself.

Conclusion

Use of synthetic materials in pelvic floor surgery has definitely reduced surgical failures, but at the same time, it is associated with an increased risk of complications (some of which are unique to synthetic materials) compared to traditional surgical repairs.     

Imaging of pelvic floor contractions using MRI

Magnetic resonance was used to visualize the effect of voluntary pelvic floor contractions on the abdominal structures with particular emphasis in determining the dynamic relationship between the bladder and surrounding organs. The pelvic floor was imaged in 6 asymptomatic female volunteers using MRI viewed in seven coronal and seven sagittal planes. The relative displacement of the bladder resulting from voluntary pelvic floor contraction was measured and the changes from the relaxed to the contracted stage were identified. Measurements from sagittal images show superior bladder wall movement of 3.8 ± 1.3 mm, posterior of 7.0 ± 2.8 mm, while maximum movement in the gluteal region was 3.5–4.0 mm. The results show that voluntary contractions of the pelvic floor measured and visualized using this technique can be identified and displayed using image processing techniques. Anatomical displacement of the bladder in the superior direction is illustrated, demonstrating that pelvic floor contraction provides increased levator muscle support. There is no significant displacement of the anterior aspect of the bladder, while the posterior wall demonstrates maximum movement. © 1995 Wiley-Liss, Inc.     

动态磁共振成像与盆腔器官造影术诊断女性盆底功能失调的对比研究

目的采用盆底动态MRI与同步联合盆腔器官造影术对比研究女性盆底功能失调,寻找女性盆底功能失调的最佳影像学检查模式。方法对30例盆底功能失调患者分别行同步联合盆腔器官造影术(膀胱尿道造影加腹膜腔造影加阴道造影加排粪造影)和盆底动态MRI检查,比较两种影像检查结果之间的相关性。结果盆底动态MRI与同步联合盆腔器官造影术对评价膀胱颈膨出的诊断符合率为100%,其次依次是肛直肠连接异常下降(95.2%),盆底陷窝疝(86.7%)和子宫颈脱垂(85.7%)。但同步联合盆腔器官造影术检出12例直肠膨出和直肠黏膜脱垂或套叠28例(93.3%),而盆底动态MRI仅检出6例(50.0%)直肠膨出。盆底动态MRI的平均检查时间是(16±3)min。同步联合盆腔器官造影术为(34±9)min(P<0.01)。结论盆底动态MRI结合排粪造影术是全面评价女性盆底功能失调的最佳影像学检查模式。     

Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh

In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.     

超声检查评估产后早期女性腹直肌及盆底结构与功能

目的探讨超声检查评估产后早期女性腹直肌及盆底结构与功能的价值。方法对产后6～8周的102名初产妇均行经会阴盆底超声检查和腹部超声检查,检测最大瓦氏动作状态下肛提肌裂孔面积,分别测量脐、脐上3 cm及脐下3 cm水平腹直肌间距(IRD),采用Spearman相关性分析观察最大瓦氏动作状态下肛提肌裂孔面积与IRD之间的相关性。结果经会阴盆底超声检查示,102名产妇中47名盆底未见明显异常(无PFD组),55例诊断为PFD(PFD组)。无PFD组最大瓦氏动作下肛提肌裂孔面积为(14.52±2.72)cm~2,PFD组(22.78±5.51)cm~2,组间差异有统计学意义(t=9.81,P0.05)。无PFD组脐水平IRD小于PFD组(P0.05),2组脐上3 cm及脐下3 cm水平IRD差异均无统计学意义(P均0.05)。产妇最大瓦氏动作状态下肛提肌裂孔面积与脐水平IRD呈正相关(r_s=0.42,P0.01)。结论超声检查可有效评估产后早期女性腹直肌及盆底结构与功能;腹直肌间距增加可能对女性盆底结构与功能造成不良影响。     

Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh

AIMS: The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair. MATERIALS AND METHODS: We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging. RESULTS: Mean age was 67 years. Mean follow-up was 6 months (range 3-12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0-6 scale was 0.74 (0 = delighted, 1 = pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy. CONCLUSIONS: We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent.     

Does fibromyalgia influence symptom bother from pelvic organ prolapse?

Introduction and hypothesis

Determine if women with fibromyalgia report increased bother from pelvic organ prolapse compared with women without fibromyalgia.

Methods

We performed a cross-sectional study of women with symptomatic prolapse on consultation with a private urogynecology practice within a 46-month period. After matching for age, women with a diagnosis of fibromyalgia were compared with a reference group of women without fibromyalgia. Demographic, POPQ examination, medical history, and pelvic floor symptom data (PFDI, PFIQ, and PISQ-12) were collected. Our primary outcome was to compare the mean Pelvic Floor Distress Inventory (PFDI) scores of women with and without fibromyalgia.

Results

The prevalence of fibromyalgia in women evaluated for initial urogynecology consultation during the study period was 114 out of 1,113 (7 %). Women with fibromyalgia reported significantly higher symptom bother scores related to pelvic organ prolapse, defecatory dysfunction, urinary symptoms, and sexual function: PFDI (p?=?0.005), PFIQ (p=0.010), and PISQ (p=0.018). Women with fibromyalgia were found to have a higher BMI (p=0.008) and were more likely to report a history of sexual abuse, OR 3.1 (95 % CI 1.3, 7.9), and have levator myalgia on examination, OR 3.8 (95 % CI 1.5, 9.1). In a linear regression analysis, levator myalgia was found to be the significant factor associated with pelvic floor symptom bother.

Conclusions

In women with symptomatic prolapse, fibromyalgia is associated with an increased risk of levator myalgia and 50 % more symptom bother from pelvic floor disorders.     

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.     

女性盆底松弛综合征患者肛提肌裂隙的动态三维超声研究

目的探讨动态三维超声对盆底松弛综合征患者治疗前后肛提肌裂隙形态结构改变方面的评估价值。方法2011年10月到2012年9月间于南京市中医院便秘专病门诊筛选出盆底松弛综合征所致便秘的40例女性患者,填写克里夫兰便秘评分（CCS评分）量表,并在Valsalva动作时进行动态三维超声检查,测量患者肛提肌裂隙的前后径和左右径。经1个疗程（2周）的生物反馈和针灸治疗后,再次填写治疗后CCS评分量表并复查Valsalva动作时的动态三维超声。结果最终有25例盆底松弛综合征女性患者接受治疗前、后的动态三维超声检查并完成CCS评分量表。与治疗前相比,治疗后Valsalva动作时动态三维超声所测得的肛提肌裂隙纵轴[（5．13±0．82）cm比（4．89±0．89）cm,P〈O．01]、横轴[（4．86±0．74）cm比（4．62±0．75）cm,P〈0．01]和面积[（19．92±6．33）cm。比（18．16±6．42）cm2．P〈0．01]均明显减小,CCS评分亦明显下降[（15．80±3．42）比（9．52±2．50）,P〈0．01）。结论使用动态三维超声可以为女性盆底松弛综合征肛提肌裂隙的测定提供一种简单、无创并有效的影像学检测方法。     

Are bony pelvis dimensions associated with levator ani defects? A case–control study

Introduction and hypothesis

Bony pelvis dimensions have been shown to differ in women with and without pelvic floor dysfunction. The goal of this study was to determine whether bony pelvis dimensions are different when comparing women with severe bilateral levator ani defects (LAD) with those with normal muscles.

Methods

This is a secondary analysis of a case–control study comparing women with and those without pelvic organ prolapse. Subjects underwent pelvic organ prolapse quantification (POP-Q) examination and were classified as either having prolapse or being normal. All underwent pelvic magnetic resonance imaging (MRI). Levator defects were assessed based on the muscles’ appearance on imaging and subjects were stratified into two groups—women with normal muscles (n?=?99) and women with severe bilateral LAD (n?=?50). Bony pelvis dimensions were measured via MRI pelvimetry. The subpubic angle, interspinous and intertuberous diameters, and the sacrococcygeal joint-to-infrapubic point (SCIPP) lengths were compared.

Results

Both groups had similar demographics. The SCIPP length was 2.5 % (3 mm) shorter in women with severe LAD than in those without defects (P?=?0.02). The SCIPP measured 4 % (5 mm) less in women with prolapse and severe LAD than in subjects with prolapse but normal muscles (P?=?0.01). Logistic regression identified SCIPP length and history of forceps delivery as being independent predictors of severe bilateral LAD.

Conclusions

Severe bilateral LAD are associated with shorter SCIPP length and forceps-assisted vaginal delivery.     

女性盆底肌磁共振弥散张量成像价值分析

目的探讨磁共振弥散张量成像(DTI)在女性盆底肌成像应用中的可行性。方法筛选35名无孕育史、无盆底疾病的年轻志愿者(对照组)和35名初产妇(研究组),分别行盆底肌常规磁共振成像(MRI)扫描和DTI扫描,测量肛提肌和肛门括约肌复合体的部分各向异性分数(FA)值,计算其平均值。并使用计算机软件描绘肛提肌和肛门括约肌复合体的三维纤维示踪图。结果对照组35名志愿者肛提肌平均FA值是(0.41±0.02),研究组35名初产妇肛提肌平均FA值是(0.34±0.03),差异有统计学意义(P0.05);对照组肛门括约肌复合体平均FA值为(0.70±0.03),研究组为(0.65±0.03),差异有统计学意义(P0.05)。DTI三维失踪成像可清晰显示初产妇肛提肌、肛门括约肌的肌肉形态改变。结论 DTI可以对女性盆底肌进行量化分析和三维形态学观察,有利于女性盆底肌肉损伤的早期诊断,值得临床推广。     

Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction

Introduction and hypothesis  

Major levator ani abnormalities (LAA) may lead to abnormal pelvic floor muscle contraction (pfmC) and secondarily to stress urinary incontinence (SUI), prolapse, or fecal incontinence (FI).