Clara Shek

Ballooning of the levator hiatus.

The levator hiatus defines the ‘hernial portal’ through which female pelvic organ prolapse develops. Hiatal area may therefore be an independent etiological factor for this condition. In this retrospective study we defined ‘normality’ for hiatal area by assessing its relationship with symptoms and clinical signs of prolapse.

Levator avulsion and grading of pelvic floor muscle strength

In a retrospective study investigating the relationship between levator avulsion and clinical grading of levator ani muscle strength, we analyzed the 3D/4D translabial ultrasound and digital assessment data of 1,112 women seen in a tertiary Urogynecological clinic. Levator avulsion was diagnosed whenever the examiner was unable to palpate the insertion of the pubovisceral muscle on the inferior pubic ramus and/or whenever a discontinuity between bone and muscle was detected on ultrasound. For clinical grading of levator muscle strength, we used the modified Oxford grading. Avulsion defects were found in 252 women (23%), and this was associated with a highly significant reduction in the overall Oxford grading (2.07 vs 2.81, P < 0.001). The prevalence of avulsion increased depending on the side differences in the modified Oxford grading: from 16% when there was no difference to 76% when the side difference was 1.5 or higher (P < 0.001). Avulsion of the puborectalis muscle seems to have a marked effect on pelvic floor muscle strength, which may help in diagnosing trauma.

Defecation proctography and translabial ultrasound in the investigation of defecatory disorders.

Defecation proctography is the standard method used in the investigation of obstructed defecation. Translabial ultrasound has recently been shown to demonstrate rectocele, enterocele and rectal intussusception. We performed a comparative clinical study to determine agreement between the two methods.

New imaging method for assessing pelvic floor biomechanics

The investigation of female pelvic floor biomechanics is attracting attention due to its importance in pelvic floor dysfunction and childbirth. To date, there are no established means of assessing pelvic floor elasticity. We propose the use of translabial ultrasound to estimate strain, one element of pubovisceral muscle elasticity.

Pelvic organ prolapse symptoms in relation to POPQ, ordinal stages and ultrasound prolapse assessment.

Adequate staging of pelvic organ prolapse is important in clinical practice and research. The ability of the POPQ, ordinal stages and ultrasound prolapse assessment were evaluated for their ability to discriminate between women with and without prolapse symptoms. The leading edge of the predominant compartment in the three assessment systems was used for the calculation of receiver operating characteristics curves. Two hundred and sixty five (265) consecutive women were evaluated. The area under the receiver operating characteristics curve for the three staging systems ranged from 0.715 to 0.783. POPQ staging and ordinal staging performed equally well in the prediction of prolapse symptoms (p = 0.780), and both performed better as compared with ultrasound prolapse assessment (p = 0.048 and p = 0.015, respectively). Prolapse staging can equally be performed by the POPQ and ordinal stages systems as far as the discrimination between women with and without prolapse symptoms is concerned. The ultrasound prolapse assessment does not perform better as compared with these two systems.

OP16.04: Translabial 3D/4D ultrasound of transobturator mesh implants

Methods: 17 nulligravid females (19–54 yrs) were studied prospectively with 3D-US (Voluson 730, GE Medical Systems, Milwaukee, WI or Phillips HD11, Phillips Medical Systems, Bothell, WA) using an endovaginal transducer probe placed on the perineum. Images were obtained during rest and squeeze of the anal sphincter. Images were analyzed and displayed in a standard, symmetrical orientation in three perpendicular planes: axial, coronal and sagittal. The sagittal image was rotated to the anorectal angle to bring the PRM into full view in the coronal plane. Measurements of the PRM length, the PRM perimeter, the inner area, outer area and PRM area (subtracting inner from outer) were made. All measurements were performed by two blinded observers to determine the inter-rater reliability. The Wilcoxon rank sum test was used to determine if the rest and squeeze measures were different and the Spearman correlation coefficient was used to measure the inter-rater reliability between the two observers. Results: Table 1 displays the PRM measurements obtained by one observer with the subject at rest and with squeeze. Table 1: PRM measurements