Ultrasound Imaging of the Pelvic Floor: linking anatomical findings with clinical symtoms

For evaluation of pelvic floor and lower urinary tract dysfunction the use of transabdominal ultrasound was first documented in the early eighties, with the translabial [1], transrectal [2] and transvaginal [3, 4] techniques developing somewhat later. To obtain a translabial or transperineal image of the pelvic floor, the transducer (ideally a 3.5-6 MHZ curved array abdominal probe) is placed on the perineum, after covering the transducer with an unpowered glove or thin plastic wrap for hygienic reasons. The terms translabial, transperineal and perineal are considered synonymous and are used interchangeably in the following text

Postpartum sexual function; the importance of the levator ani muscle

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant as

Agreement and reliability of pelvic floor measurements during rest and on maximum Valsalva maneuver using three-dimensional translabial ultrasound and virtual reality imaging

Objectives Imaging of the levator ani hiatus provides valuable information for the diagnosis and follow-up of patients with pelvic organ prolapse (POP). This study compared measurements of levator ani hiatal volume during rest and on maximum Valsalva, obtained using conventional three-dimensional (3D) translabial ultrasound and virtual reality imaging. Our objectives were to establish their agreement and reliability, and their relationship with prolapse symptoms and POP quantification (POP-Q) stage.Methods One hundred women with an intact levator ani were selected from our tertiary clinic database. Information on clinical symptoms were obtained using standardized questionnaires. Ultrasound datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm, at the level of minimal hiatal dimensions, during rest and on maximum Valsalva. The levator area (in cm(2)) was measured and multiplied by 1.5 to obtain the levator ani hiatal volume (in cm(3)) on conventional 3D ultrasound. Levator ani hiatal volume (in cm(3)) was measured semi-automatically by virtual reality imaging using a segmentation algorithm. Twenty patients were chosen randomly to analyze intra-and interobserver agreement.Results The mean difference between levator hiatal volume measurements on 3D ultrasound and by virtual reality was 1.52 cm(3) (95% CI, 1.00-2.04 cm(3)) at rest and 1.16 cm(3) (95% CI, 0.56-1.76 cm(3)) during maximum Valsalva (P= 0.96 for conventional 3D ultrasound and >0.99 for virtual reality. Patients with prolapse symptoms or POP-Q Stage >= 2 had significantly larger hiatal measurements than those without symptoms or POP-Q Stage<2.Conclusions Levator ani hiatal volume at rest and on maximum Valsalva is significantly smaller when using virtual reality compared with conventional 3D ultrasound; however, this difference does not seem clinically important. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.FWN – Publicaties zonder aanstelling Universiteit Leide