The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

Lone, Farah; Sultan, Abdul H.; Stankiewicz, Aleksandra; Thakar, Ranee

doi:10.1259/bjr.20140145

Cited by 11 publications

(13 citation statements)

References 30 publications

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“…5,6 A recent publication demonstrated that the coexisting abnormalities identified on ultrasound do not change the initial surgical management or the management at 1-year follow-up. 14 Clinicians and researchers are increasingly using PFUS as part of the work-up of PFD; 1,5-7,17 therefore, it is important to assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment PFUS. In order to determine the relevant clinical application of PFUS, long-term studies are needed.…”

Section: Discussionmentioning

confidence: 99%

“…This study population also formed a part of another study evaluating the value of pre-operative multicompartment PFUS. 14 Prior to the examination, patients were asked to empty their bladder if it was felt full or uncomfortable. POPQ assessment was conducted by an independent examiner (either RT or AHS) in the left lateral and standing position as per unit protocol and examination was completed using bimanual pelvic palpation.…”

Section: Ethics Approvalmentioning

confidence: 99%

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Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using twodimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-toexcellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

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Section: Discussionmentioning

confidence: 99%

Section: Ethics Approvalmentioning

confidence: 99%

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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show abstract

“…All patients underwent vaginal examination performed by experienced clinicians (AHS, RT). This study population also forms part of another study from our group evaluating the value of pre-operative multicompartment pelvic floor ultrasonography [9].…”

Section: Methodsmentioning

confidence: 99%

“…High-frequency endovaginal ultrasound eliminates the limitations of TPUS and has been reported to be a reliable tool in the assessment of vascularity of nulliparous female urethra [6,7] owing to the small array of the transducer, high-frequency (9)(10)(11)(12) and direct contact of the transducer and the organs examined, providing high resolution and resulting in more precise visualisation of the urethra. These features make EVUS highly efficient in the assessment of the urethral vascularity pattern, even including the smallest vessels.…”

Section: Introductionmentioning

confidence: 99%

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

et al. 2015

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“…Integrated total pelvic floor ultrasound is becoming the standard of care, along with the multidisciplinary team approach to the evaluation and treatment of pelvic floor dysfunction [20][21][22].…”

mentioning

confidence: 99%

Imaging the pelvic floor

Santoro

2017

Tech Coloproctol

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Urinary and fecal incontinence, obstructed defecation, pelvic pain and pelvic organ prolapse are common in older multiparous women, affecting approximately 16% of females aged 40-56 years [1]. As we evaluate a patient with a clinically evident anatomic defect (rectocele, rectal prolapse, perineal descent), it is essential to establish whether this defect is really associated with the patient's symptoms (obstructed defecation). Moreover, a pelvic floor disorder in one compartment frequently coexists with disorders involving other compartments. Indeed, rather than considering the pelvic floor as divided into three vertical compartments, the current concept is to approach the pelvic floor as a horizontal structure [1]. The pelvic floor is a three-dimensional mechanical apparatus that acts as a unit, with a close interrelationship between organ systems, fascia and ligaments, muscles, vessels and nerves. Because the levator ani muscle provides support to all three organ systems, its weakness will result in impaired function of any, or all, of the structures that the muscle supports. In addition, damage to the endopelvic, pubocervical or rectovaginal fascias will lead to herniation of one organ system into another. This is demonstrated by the common coexistence of prolapse of the anterior and posterior vaginal walls requiring repair of both. Understanding pelvic floor anatomy is therefore crucial for an effective management of these dysfunctions.A careful preoperative evaluation is key to determining the pathophysiology of pelvic floor dysfunction [2]. Clinical examination, however, is not accurate in diagnosing anatomical defects of the posterior vaginal wall, overestimating the presence of rectocele (large false-positive rate) but missing enterocele or intussusception in patients with primary pelvic organ prolapse (large false-negative rate) [3,4]. Imaging allows the clinician to better evaluate the patients in order to determine what anatomical alterations are present, and this leads to appropriate surgical interventions and increased success rates [5]. Traditional evacuation proctography or colpocystoproctography, modern dynamic magnetic resonance imaging and ultrasound can be used for visualization of the pelvic floor [5]. Advantages of ultrasound over the other imaging modalities are that it is more widely available, more cost-effective, less time-consuming, and associated with better patient compliance. It is performed by the clinician during office consultation and can be considered as an extension of the physical examination. The development of new technological innovations such as three-/four-dimensional (3D/4D) tools, video-recording, post-processing analysis and the standardization of methodology and terminology [6] have made ultrasound imaging more reproducible and less operator dependent.Several ultrasound techniques can be used to assess the pelvic floor [6]. Translabial ultrasound (TLUS) is performed with the patient placed in the dorsal lithotomy position, with hips flexed and abducted, by using a con...

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The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

Cited by 11 publications

References 30 publications

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

Imaging the pelvic floor

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