Levator ani trauma and pelvic organ prolapse - a comparison of three translabial ultrasound scoring systems

2016 ◽  
Vol 95 (12) ◽  
pp. 1411-1417 ◽  
Author(s):  
Gerda Trutnovsky ◽  
Ixora Kamisan Atan ◽  
Daniela Ulrich ◽  
Andrew Martin ◽  
Hans P. Dietz
Keyword(s):  
Pelvic Organ Prolapse ◽  
Scoring Systems ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Translabial Ultrasound

scholarly journals Rectal–vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheng Tan ◽  
Man Tan ◽  
Jing Geng ◽  
Jun Tang ◽  
Xin Yang
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pressure Gradient ◽  
Obstructed Defecation ◽  
Elevated Pressure ◽  
Pelvic Organ ◽  
Lower Grade ◽  
Translabial Ultrasound ◽  
Rectal Ampulla ◽  
The Relationship ◽  
Posterior Vaginal Prolapse

Abstract Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O, p < 0.001). Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.

scholarly journals Animal models for pelvic organ prolapse: systematic review

2021 ◽  
Author(s):  
Marina Gabriela M. C. Mori da Cunha ◽  
Katerina Mackova ◽  
Lucie Hajkova Hympanova ◽  
Maria Augusta T. Bortolini ◽  
Jan Deprest
Keyword(s):  
Pelvic Organ Prolapse ◽  
Animal Models ◽  
Vaginal Delivery ◽  
Structural Changes ◽  
Meta Analysis ◽  
Levator Ani ◽  
Complete Recovery ◽  
Pelvic Organ ◽  
Squirrel Monkeys ◽  
Levator Ani Muscle

Abstract Introduction and hypothesis We aimed to summarize the knowledge on the pathogenesis of pelvic organ prolapse (POP) generated in animal models. Methods We searched MEDLINE, Embase, Cochrane and the Web of Science to establish what animal models are used in the study of suggested risk factors for the development of POP, including pregnancy, labor, delivery, parity, aging and menopause. Lack of methodologic uniformity precluded meta-analysis; hence, results are presented as a narrative review. Results A total of 7426 studies were identified, of which 51 were included in the analysis. Pregnancy has a measurable and consistent effect across species. In rats, simulated vaginal delivery induces structural changes in the pelvic floor, without complete recovery of the vaginal muscular layer and its microvasculature, though it does not induce POP. In sheep, first vaginal delivery has a measurable effect on vaginal compliance; measured effects of additional deliveries are inconsistent. Squirrel monkeys can develop POP. Denervation of their levator ani muscle facilitates this process in animals that delivered vaginally. The models used do not develop spontaneous menopause, so it is induced by ovariectomy. Effects of menopause depend on the age at ovariectomy and the interval to measurement. In several species menopause is associated with an increase in collagen content in the longer term. In rodents there were no measurable effects of age apart of elastin changes. We found no usable data for other species. Conclusion In several species there are measurable effects of pregnancy, delivery and iatrogenic menopause. Squirrel monkeys can develop spontaneous prolapse.

Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse

2012 ◽  
Vol 206 (3) ◽  
pp. 244.e1-244.e9 ◽  
Author(s):  
Antonio Antunes Rodrigues ◽  
Renee Bassaly ◽  
Mona McCullough ◽  
H. Leigh Terwilliger ◽  
Stuart Hart ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle

Prevalence of levator ani muscle avulsion and effect on quality of life in women with pelvic organ prolapse

2017 ◽  
Vol 29 (5) ◽  
pp. 729-733 ◽  
Author(s):  
Chun Hung Yu ◽  
Symphorosa Shing Chee Chan ◽  
Rachel Yau Kar Cheung ◽  
Tony Kwok Hung Chung
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle ◽  
Levator Ani Muscle Avulsion

scholarly journals A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 98
Author(s):  
Gina Nam ◽  
Jae-Yen Song ◽  
Sa-Ra Lee
Keyword(s):  
Pelvic Organ Prolapse ◽  
Valsalva Maneuver ◽  
Pelvic Organ ◽  
Angle Measurement ◽  
Symphysis Pubis ◽  
Clinical Staging ◽  
Translabial Ultrasound ◽  
Inferior Margin ◽  
The Difference ◽  
Spearman’S Correlation

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

scholarly journals Correlation of levator ani muscle strength measurement between Modified Oxford Grading Scale and perineometer on pelvic organ prolapse patient

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Fernandi Moegni ◽  
Ingrid Felicia Ocsilia Wengkang
Keyword(s):  
Pelvic Organ Prolapse ◽  
Muscle Strength ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle ◽  
Moderate Pressure ◽  
Cross Sectional ◽  
Digital Palpation ◽  
Grading Scale ◽  
Spearman Test

Pelvic Organ Prolapse (POP) is a debilitating condition affecting about half of all women aged of more than 60 years globally. Reduced levator ani muscle strength in POP is associated with worse symptoms and prognosis. Measurement of levator ani muscle strength can be done with several tools such as perineometer and digital palpation. However, there is currently no study regarding conformity between tests. The aim of this study is to determine the correlation between tests in POP patients. An analytic observational study using cross sectional design was done to determine conformity between perineometer and digital examination using Modified Oxford Grading Scale (MOS) in Dr Cipto Mangunkusumo National General Hospital, Indonesia during the period of July, 2018 to June, 2020. Correlation between tests was determined using Spearman test. Cut-off of perineometer reading for each MOS score was also determined. A total of 110 subjects examined with both perineometer and digital palpation were recruited to the study. Positive correlation was observed between perineometer reading and Modified Oxford Grading Scale (r = 0.790, p < 0.001). According to the result, values between 0.01 – 9.64 cmH2O correspond to very weak pressure (MOS 1); 9.65 – 22.49 cmH2O represent weak pressure (MOS 2); 22.5 – 35.24 cmH2O represent moderate pressure (MOS 3); ≥ 35.25 cmH2O represent good pressure (MOS 4). There was a strong correlation between MOS and perineometer result for measuring levator ani strength in POP patients.

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