Ghazaleh Rostaminia

Levator ani deficiency and pelvic organ prolapse severity.

OBJECTIVE: To estimate whether levator ani deficiency severity is a predictor of clinically significant pelvic organ prolapse (POP) and to determine whether there is a levator ani deficiency threshold above which POP occurs. METHODS: Two-hundred twenty three-dimensional ultrasound scans performed on urogynecologic clinic patients were reviewed, and each levator ani muscle subdivision was individually scored (0=no defect, 1=50% or less defect, 2=more than 50% defect, 3=total absence of the muscle) on each side. A levator ani deficiency score was calculated and categorized as mild (score 0–6), moderate (score 7–12), and severe (score more than 13). Clinically significant prolapse was defined as stage 2 or higher. RESULTS: The mean age was 56.50 (standard deviation ±15.58) and median parity was 2 (range 0–6). A mild positive correlation was demonstrated between levator ani deficiency category and prolapse stage (rs=0.44; P<.001). Score distribution significantly differed by prolapse stage (P<.001). No patients with stage 3 prolapse had a levator ani score less than 6, and no patients with stage 4 prolapse had a levator ani score less than 9. In patients with prolapse, those with moderate levator ani deficiency had 3.2 times the odds of POP compared with patients with a minimal defect; those with severe levator ani deficiency had 6.4 times the odds of prolapse than those with minimal deficiency. CONCLUSIONS: Levator ani deficiency severity is associated with clinically significant prolapse. LEVEL OF EVIDENCE: II

The determinants of minimal levator hiatus and their relationship to the puborectalis muscle and the levator plate

To determine the muscles comprising the minimal levator hiatus.

Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications

The objective of this study was to investigate the clinical and ultrasonographic findings of women who had three‐dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications.

Levator plate descent correlates with levator ani muscle deficiency

Measurements such as the minimal levator hiatus dimension, levator plate angle, iliococcygeal angle, and anorectal angle have been used for assessing the impact of levator damage on static and dynamic imaging features. The primary aim of this study was to investigate the association between levator ani muscle deficiency (LAD) and the position of the levator plate.

Evaluation of Vaginal Cysts and Masses by 3-Dimensional Endovaginal and Endoanal Sonography

The purpose of this pictorial essay is to describe the utility of 3‐dimensional endovaginal and endoanal sonography in the assessment of vulvovaginal cysts and masses. It is accepted that compared with transabdominal pelvic sonography, transvaginal end‐fire sonography provides improved resolution for visualization of female reproductive organs with fewer artifacts. To visualize the structures that are located in or lateral to the vaginal canal, side‐fire 3‐dimensional endovaginal or endoanal sonography can be used. This special technique has the advantage of maintaining the spatial anatomic relationship of any abnormality in the vagina.

Levator Plate Upward Lift on Dynamic Sonography and Levator Muscle Strength

To compare digital palpation with levator plate lift measured by endovaginal and transperineal dynamic sonography.

Development of an in-house endoanal ultrasound teaching phantom.

The aim of this study was to construct an anatomically correct phantom for visualization of anal sphincter complex structures.

Endovaginal Imaging of Pelvic Floor Cysts and Masses

The purpose of this chapter is to describe the 3D endovaginal ultrasonography utility in the assessment of pelvic floor cysts and masses. In order to visualize the structures that are located in or lateral to the vaginal canal, 3D endovaginal ultrasound technique is described. This special technique has the advantage of evaluating the anatomical relationship of any pathology in the vagina.

Vaginal Mesh and Pain Complications

In pelvic reconstructive surgery, the school of thought that fascial defects are a primary etiology for development of pelvic organ prolapse has led to increased graft utilization to augment fascial strength in an attempt to promote repair longevity and permanence. Grafts serve to strengthen attenuated tissue and enhance healing in areas with compromised tissue integrity. However, the use of synthetic mesh or biologic grafts in pelvic organ prolapse surgery is associated with unique complications not seen in repair with native tissue including pain that can be debilitating for patient. Pain can be a result of direct nerve injury during mesh placement or delayed neuropathy due to fibrosis, or mesh shrinkage. There is also a human factor involved in reactivity to mesh in vivo. Some individuals are “high responders,” and others are “low responders” in the formation of fibrous tissue as stimulated by the presence of the mesh. Treating pain complication after mesh placement requires complete work up and can be challenging in presence of neuropathy.

Patient-Specific Studies of Pelvic Floor Biomechanics Using Imaging

Biomechanical modeling and simulation of the pelvic floor structures have caught much attention in the past decade. Many computational approaches were developed with the goal of advancing our understanding the mechanism of the pelvic floor pathologies and improving treatment clinically. In this chapter, we review some of the existing work on building three dimensional (3D) models of the pelvic floor and modeling its mechanics.