Sung-Ae Jung

Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles

OBJECTIVE We used a novel technique, high-definition manometry (HDM) that utilizes 256 tactile sensitive microtransducers to define the characteristics of vaginal high-pressure zone. STUDY DESIGN Sixteen nullipara asymptomatic women were studied using HDM, transperineal 2-dimensional dynamic ultrasound and dynamic magnetic resonance (MR) imaging. RESULTS Vaginal high-pressure zone revealed higher contact pressures in anterior and posterior directions compared with lateral directions, both at rest and squeeze. At rest, anterior pressure cluster is located 10 mm cephalad to posterior pressure cluster; with squeeze the latter moves in the cranial direction by 7 mm. Ultrasound and MR images revealed that the anorectal angle moves cephalad and ventrally during squeeze. Cephalad movement of posterior pressure cluster during squeeze is similar to the cranial movement of anorectal angle. CONCLUSION We propose that the vaginal high-pressure zone represents the constrictor function and cranial movement of the posterior pressure cluster represents the elevator function of pelvic floor. HDM may be used to measure the constrictor and elevator functions of pelvic floor muscles.

Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women.

Introduction and hypothesisWe aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women.Methods3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups.ResultsForty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon.ConclusionsIn asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.

OC42: Visualization of the vaginal high‐pressure zone by three‐dimensional ultrasound images in the pelvic floor

Objective: The measurement of detrusor wall thickness (DWT) has been used as a screening test for detrusor overactivity in men and women. The aim of this study was to define receiver operator characteristics for DWT as a test for DO and urge incontinence in women. Methods: The notes of 792 women with lower urinary tract symptoms who had undergone a urodynamic study and transperineal ultrasound were reviewed. The urodynamic study included free uroflowmetry and filling and voiding phase cystometry using a fluidfilled system. Transperineal ultrasound was performed after catheter removal and bladder emptying, at a maximum bladder volume of 50 ml. Detrusor wall measurements were taken at the bladder dome as previously described. Results: After exclusion of missing data (largely due to residuals of over 50 ml), 686 datasets remained. The most commonly reported irritable bladder symptom was urge incontinence (503, 73.3%). 36.6% of women had symptoms of frequency, and 46.6% had nocturia. One hundred and eighty-four women (27%) had detrusor overactivity (DO) detected on multichannel urodynamics. The average DWT in the DO group was 4.7 ± 1.9 mm. compared to 4.1 ± 1.6 mm in the non-DO group (p < 0.001). Receiver operator characteristics for DWT as a test for DO were calculated and shown to be very poor, with an area under the curve of 0.606. The published cutoff of 5 mm gave a sensitivity and specificity of 37.0% and 79.3%, respectively. No other potential cutoff performed substantially better. Conclusions: Increased DWT seems to be associated with DO. However, receiver operator characteristics demonstrate that DWT is of little use as a diagnostic test for detrusor overactivity, giving an area under the curve of only 0.606. The sensitivity and specificity of a measurement of > 5 mm for DO was 37.0% and 79.3% respectively. Measurement of Detrusor wall thickness should not be used as a diagnostic parameter for detrusor overactivity in women.