Is pelvic organ support different between young nulliparous African and Caucasian women?
|
|
- Reynard Hoover
- 5 years ago
- Views:
Transcription
1 Ultrasound Obstet Gynecol 2016; 47: Published online 2 May 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI: /uog Is pelvic organ support different between young nulliparous African and Caucasian women? K. L. SHEK*, H. G. KRAUSE, V. WONG, J. GOH and H. P. DIETZ *Liverpool Clinical School, Western Sydney University, Liverpool, Australia; Nepean Clinical School, University of Sydney, Sydney, Australia; Griffith University Medical School, Nathan, Australia; Department of Gynaecology, Greenslopes Private Hospital, Greenslopes, Australia KEYWORDS: ethnicity; imaging; levator ani; levator hiatus; pelvic floor; pelvic organ prolapse; ultrasound ABSTRACT Objective There seems to be substantial variation in the prevalence of pelvic floor disorders between different ethnic groups. This may be due partially to differences in pelvic floor structure and functional anatomy. To date, data on this issue are sparse. The aim of this study was to compare hiatal dimensions, pelvic organ descent and levator biometry in young, healthy nulliparous Caucasian and African women. Methods Healthy nulliparous non-pregnant volunteers attending a local nursing school in Uganda were invited to participate in this study during two fistula camps. All volunteers underwent a simple physician-administered questionnaire and a four-dimensional translabial ultrasound examination. Offline analysis was performed to assess hiatal dimensions, pelvic organ descent, levator muscle thickness and area. To compare findings with those obtained in nulliparous non-pregnant Caucasians, we retrieved the three-dimensional/four-dimensional ultrasound volume datasets of a previously published study. Results The dataset of 76 Ugandan and 49 Caucasian women was analyzed. The two groups were not matched but they were comparable in age and body mass index. All measurements of hiatal dimensions and pelvic organ descent were significantly higher among the Ugandans (all P 0.01); however, muscle thickness and area were not significantly different between the two groups. Conclusions Substantial differences between Caucasian and Ugandan non-pregnant nulliparae were identified in this study comparing functional pelvic floor anatomy. It appears likely that these differences in functional anatomy are at least partly genetic in nature. Copyright 2015 ISUOG. Published by John Wiley & Sons Ltd. INTRODUCTION Pelvic organ prolapse (POP) is a highly prevalent condition. The lifetime risk of surgery for POP in the general female population in Western Australia was recently estimated to be 19% 1. POP can be considered a herniation of pelvic organs, i.e. bladder, uterus, small bowel and/or rectal ampulla, through the levator hiatus, the space bounded by the puborectalis component of the levator ani muscle and the os pubis. The levator hiatus is the largest potential hernia portal in the human body, the size of which has been shown to be associated with symptoms and/or signs of POP, and the latter in both asymptomatic and symptomatic populations 2,3. The etiology of POP is likely multifactorial and may be complex. Ethnicity has been proposed as a potential etiological factor. Epidemiological studies suggest that the prevalence of different forms of pelvic floor dysfunction vary among ethnic groups. Stress urinary incontinence may be more prevalent among Caucasians than African-Americans 4,5. Likewise, symptomatic POP seems to be less common among African-American compared with white women 6,7.These findings may reflect genuine differences in pelvic floor functional anatomy between populations of different ethnic backgrounds, as shown in some studies In a recent imaging study comparing South-East Asian and Caucasian pregnant nulliparous women, the former were found to have a thicker pubovisceral muscle, a smaller levator hiatus and less pelvic organ mobility 11, suggesting ethnic differences in pelvic floor functional anatomy. To date, several publications have reported findings of pelvic organ mobility and levator biometry in young nulliparous Asian and Caucasian populations ; similar data, however, are lacking for other ethnicities. The aim of this study was, first, to describe pelvic organ mobility, biometry of the levator hiatus and puborectalis muscle using translabial Correspondence to: Dr K. L. Shek, Liverpool Hospital, Locked Bag 7103, Liverpool BC NSW 1871, Australia ( shekkalai@ yahoo.com.hk) Accepted: 9 November 2015 Copyright 2015 ISUOG. Published by John Wiley & Sons Ltd. ORIGINAL PAPER
2 Pelvic floor and ethnicity 775 ultrasound in a group of young nulliparous Ugandan women and, second, to compare the findings with archived ultrasound volume data of a group of young nulliparous Caucasian women recruited for a study published previously. SUBJECTS AND METHODS Nulliparous healthy volunteers were recruited from a local nursing school in Uganda on two occasions during a fistula camp in April 2011 and July All volunteers completed a simple physician-administered questionnaire on symptoms of urinary incontinence. Four-dimensional translabial ultrasound examinations were performed with the woman in the supine position after bladder emptying, at rest, on Valsalva maneuver and on pelvic floor muscle contraction (PFMC) using a GE Voluson i ultrasound system with 8 4-MHz curved array volume transducer (GE Medical Systems, Zipf, Austria) as described previously 15. At least three ultrasound volumes on Valsalva maneuver were acquired and the volume on maximum Valsalva maneuver, i.e. the volume showing the most marked pelvic organ descent, was used for analysis of parameters on Valsalva maneuver. Hiatal dimensions, pelvic organ descent and levator muscle thickness and area were assessed offline on a desktop PC using proprietary software (4Dview v10, GE Medical Systems) as described previously 2. In brief, hiatal diameters and area were assessed in the plane of minimal hiatal dimensions as defined in the mid-sagittal plane, evident as the minimal distance between the hyperechogenic posterior aspect of the symphysis pubis and the hyperechogenic anterior border of the levator ani muscle just posterior to the anorectal muscularis. This plane is defined in the mid-sagittal orthogonal plane, which then allows representation of exactly this cross-section of the volume in the axial plane for measurement of hiatal dimensions (Figure 1). Maximum muscle thickness was determined by slowly moving the plane of minimal hiatal dimensions cranially until the plane of maximal thickness of the levator muscle was reached. In the axial view, we measured maximum diameters of the puborectalis muscle in two locations bilaterally and determined muscle area by tracing its outline at the level of maximal muscle thickness. Pelvic organ descent was measured on maximum Valsalva maneuver with reference to the posteroinferior margin of the pubic bone in the mid-sagittal plane 16. Ethics committee approval was obtained from Greenslopes Private Hospital (EC 11/09 and QIMR HREC 2015/2100). The study was approved by the administration of the School of Nursing (Kagando Hospital, Uganda) as no formal ethics committee exists at this institution. Written consent was obtained from the volunteers. To compare findings with data obtained in healthy white Caucasians, we assessed the archived three-dimensional/four-dimensional ultrasound volume datasets of a previously published study on nulliparous non-pregnant Caucasians 17. The Caucasian women had initially been recruited in a heritability study to determine whether mobility of the bladder neck is genetically influenced. They were recruited through mailouts to secondary schools in the Brisbane region in Australia. Participants had undergone translabial ultrasound imaging for the study and their ultrasound volume data were saved and archived. Volume data had been acquired using the same method as in the current study, except that imaging on PFMC was not performed, and it was evaluated in the same manner as described above by K.L.S. Statistical analysis Statistical analysis was undertaken after normality testing using Kolmogorov Smirnov testing, with Minitab version 13 (Minitab Inc., State College, PA, USA). Student s t-test was performed for continuous variables and chi-square test analysis for categorical variables. Pearson s correlation was used to evaluate the correlation between hiatal area and pelvic organ descent. A P-value of < 0.05 was considered to be statistically significant. RESULTS In total, 76 nulliparous Ugandan women were recruited. The mean age of the participants was 21.2 (range, ) years and mean body mass index was 22.6 (range, ) kg/m 2. None of the volunteers complained of symptoms of urinary incontinence. Archived ultrasound datasets of 51 nulliparous Caucasian women seen in the context of a previously published study were identified. Two were excluded from analysis because of missing volumes, leaving 49 datasets available for review. A total of seven Caucasians reported stress urinary incontinence, one of whom also reported urge urinary incontinence. No subject in either cohort had a history of pelvic floor surgery or intervention for a pelvic floor disorder. The demographic characteristics, hiatal dimensions, measures of levator muscle bulk and pelvic organ descent in the two groups are shown in Table 1. All measures of hiatal dimensions and pelvic organ descent were significantly higher among the Ugandan volunteers (all P 0.01). This was not the case for measures of muscle bulk, as muscle thickness and area were not significantly different between the two groups. There was a significant correlation between hiatal area at rest and on Valsalva maneuver and pelvic organ descent in all three compartments (all P < 0.001; Table 2). Fourteen Caucasian participants and seven African volunteers coactivated the levator ani muscle on Valsalva maneuver despite repeated attempts to teach them to avoid this during volume acquisition (chi-square test, P = 0.005). Analysis was repeated after excluding these women and the findings were nearly identical. A subanalysis of functional pelvic floor anatomy against ethnicity after exclusion of women complaining of urinary incontinence yielded almost identical results.
3 776 Shek et al. Figure 1 (a) Translabial pelvic floor ultrasound image in the mid-sagittal plane, showing descent of bladder (cystocele, C), uterus (U) and rectal ampulla (R) relative to posteroinferior margin of pubic symphysis (S). Measurements represent maximal caudad organ position on Valsalva maneuver without reference to position at rest. Measurements below inferior symphyseal margin (reference line) are negative and those above line are positive. (b) Translabial ultrasound image in the plane of minimal hiatal dimensions, showing hiatal area (dotted outline). (c) Translabial ultrasound image in the plane of maximum muscle thickness, which is usually cm cranial to the plane of minimal dimensions, showing muscle thickness (lines) in paravaginal and pararectal locations. Table 1 Demographic data and measurements of functional pelvic floor anatomy on translabial ultrasound according to ethnicity Variable Caucasian (n = 49) Ugandan (n = 76) P Age (years) 20.5 ± ± Body mass index (kg/m 2 ) 23.6 ± ± Anteroposterior hiatal diameter At rest (cm) 4.55 ± ± 0.73 < On Valsalva maneuver (cm) 4.81 ± ± 1.15 < Lateral hiatal diameter At rest (cm) 3.55 ± ± On Valsalva maneuver (cm) 3.96 ± ± Hiatal area At rest (cm 2 ) ± ± 3.27 < On Valsalva maneuver (cm 2 ) ± ± 7.72 < Maximum muscle thickness at rest (mm) 7.86 ± ± Maximum muscle area at rest (cm 2 ) 6.50± ± Bladder-neck descent (mm) 13.2 ± ± 8.7 < Bladder descent (mm) ± ± 9.1 < Uterine descent (mm) 41.5 ± ± 20.4 < Rectal descent (mm) 15 ± ± 12.5 < Data are given as mean ± SD. Bladder-neck descent is a measure of bladder-neck mobility. Bladder/uterine/rectal descent denotes position of respective organ relative to symphysis pubis; a negative value signifies position below the symphysis. DISCUSSION In this comparative study of two cohorts of young, non-pregnant nulliparae, Ugandans were found to have a significantly larger levator hiatus and greater pelvic organ descent than Caucasians. This implies greater distensibility of the levator ani muscle and greater elasticity of fascial support structures. This difference, although not unanticipated, is of unexpected magnitude. Hiatal distensibility, as determined by average hiatal area on Valsalva maneuver in Ugandans, was found to be more than 1 SD higher than in Caucasians, and differences of a similar magnitude were found for pelvic organ mobility. Muscle thickness and area, however, were similar between the groups. Studies using magnetic resonance imaging have reported a difference in pelvic anatomy between white Americans and African-Americans 18,19. A genuine difference in pelvic anatomy is likely to be responsible for the observed differences in functional anatomy in our study. Apart from genetics, however, other causes including nutrition 20 and lifestyle factors 14 may also play a role. For example, in Uganda it is common for women to walk long distances carrying heavy loads on the shoulder or head. Racial differences in the prevalence of various forms of pelvic floor dysfunction have been reported in medical literature. Our study showing greater pelvic organ descent in Ugandans than in their Caucasian counterparts appears to be in contrast to the general opinion that POP is less prevalent in the African population, as seen in epidemiological studies in Western countries 6,7.Sucha discrepancy may be explained by a change in lifestyle and diet among Africans living in Western countries. Another explanation may concern childbirth-related trauma. It
4 Pelvic floor and ethnicity 777 Table 2 Correlation between hiatal area at rest and on Valsalva maneuver and pelvic organ descent, as ascertained by translabial ultrasound in mid-sagittal plane Parameter Pearson s correlation Hiatal area at rest vs: Bladder-neck descent < Bladder descent < Uterine descent < Rectal descent < Hiatal area on Valsalva maneuver vs: Bladder-neck descent < Bladder descent < Uterine descent < Rectal descent < Correlations are negative for bladder/uterine/rectal descent as higher values for these parameters signify a higher organ position (less descent) on Valsalva maneuver. The larger the hiatal area, the lower the position of pelvic organs on Valsalva maneuver, i.e. the greater the descent. has been claimed that there is an association between pelvic floor biomechanics and labor outcomes 21,22. It is plausible that women with a more compliant or distensible pelvic floor may be less susceptible to trauma secondary to childbirth. Today there is growing evidence to suggest that trauma to the levator ani muscle is important in the pathogenesis of POP 3, Individuals or populations with a more compliant pelvic floor reflected by a more distensible hiatus and greater degree of pelvic organ mobility prior to the first delivery may be less likely to sustain levator trauma and hence less likely to develop symptomatic POP in the future. The relationship between pelvic floor biomechanical properties and childbirth-related fascial and muscular trauma is likely to be complex and deserves further study. Although data on levator morphobiometry of young nulliparous Caucasians 2 and East Asians 12 have shown a smaller hiatus and less pelvic organ mobility in the latter population, in both non-pregnant and pregnant populations 11, similar data were lacking for Africans until very recently. There is now a published study on a comparison of Black and White South African young nulliparae using identical methodology to ours 27. The results strongly support our data, in that Black South Africans showed significantly larger hiatal area and more pelvic organ descent than did White South Africans. Both studies are highly consistent with each other and have added baseline biometric measures for pelvic floor functional anatomy of nulliparous African women to the literature. Such data may also help us better understand the pathogenesis of POP. Strengths of our study include the identical methodology, for both acquisition of volume data and postprocessing analysis, in the two groups and the fact that both groups were closely matched for age and body mass index. A number of weaknesses, however, need to be acknowledged. The data presented in this study are based on ultrasound volume datasets acquired in two different P studies, in different locations and at widely differing timepoints. This may have introduced a degree of bias. However, all acquisitions were undertaken using the same ultrasound technology (Voluson systems), which has been shown to have good consistency in volume acquisition 28. All analyses of stored volume datasets were performed by K.L.S. using measurement techniques that have been shown to be highly repeatable by us and others Another potential source of bias is that offline analysis of ultrasound volume data was not blinded to ethnicity. However, the degree of differences noted between the two cohorts is unlikely to be explained completely by bias. Furthermore, as we did not collect data with regard to prolapse symptoms we are unable to determine whether Ugandans were more symptomatic than were their Caucasian counterparts. The lack of a clinical prolapse assessment is considered another weakness of this study; however, any internal examination is likely to impact on the recruitment of volunteers. In conclusion, substantial differences between unselected cohorts of Caucasian and Ugandan non-pregnant nulliparae were identified in this study comparing functional pelvic floor anatomy. Ugandans were found to have a significantly larger levator hiatus and greater pelvic organ descent than were Caucasians. This implies greater distensibility of the levator ani muscle and higher elasticity of fascial support structures. DISCLOSURE H.P.D. and K.L.S. have received unrestricted educational grants from GE Medical Systems. REFERENCES 1. Smith F, Holman D, Moorin R, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 2010; 116: Dietz HP, Shek KL, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 2005; 25: Dietz HP, De Leon J, Shek KL. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 2008; 31: Bump RC. Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse. Obstet Gynecol 1993; 81: Graham CA, Mallett VT. Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 2001; 185: Rortveit G, Brown JS, Thom DH, Van den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse. Prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 2007; 109: Whitcomb EL, Rortveit G, Brown JS, Creasman JM, Thom DH, Van Den Eeden SK, Subak LL. Racial difference in pelvic organ prolapse. Obstet Gynecol 2009; 114: Zacharin R. A Chinese Anatomy the pelvic supporting tissues of the Chinese and Occidental female compared and contrasted. Aust NZ J Obstet Gynaecol 1977; 17: Howard D, DeLancey JO, Tunn R, Ashton Miller JA. Racial differences in the structure and function of the stress urinary continence mechanism. 2000; 95: Dietz HP. Do Asian women have less pelvic organ mobility than Caucasians? Int Urogynecol J 2003; 14: Cheung RY, Shek KL, Chan SS, Chung TK, Dietz HP. Pelvic floor biometry and pelvic organ mobility in East Asian and Caucasian nulliparae. Ultrasound Obstet Gynecol 2015; 45: Yang J, Yang S, Huang W. Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrsound Obstet Gynecol 2006; 26: Dietz HP, Eldridge A, Grace M, Clarke B. Pelvic organ descent in young nulliparous women. Am J Obstet Gynecol 2004; 191: Kruger J, Dietz HP, Murphy B. Pelvic floor function in elite nulliparous athletes and controls. Ultrasound Obstet Gynecol 2007; 30:
5 778 Shek et al. 15. Dietz HP. Ultrasound imaging of the pelvic floor: 3D aspects. Ultrasound Obstet Gynecol 2004; 23: Dietz HP. Ultrasound imaging of the pelvic floor: Part 1: 2D aspects. Ultrasound Obstet Gynecol 2004; 23: Dietz HP, Hansell N, Grace M, Eldridge A, Clarke B, Martin N. Bladder neck mobility is a heritable trait. BJOG2005; 112: Handa V, Lockhart M, Fielding J, Bradley C, Brubaker L, Cundiff G, Ye W, Richter H. Racial differences in pelvic anatomy by magnetic resonance imaging. Obstet Gynecol 2008; 111: Baragi R, Delancey J, Caspari R, Howard D, Ashton-Miller J. Differences in pelvic floor area between African American and European American women. Am J Obstet Gynecol 2002; 187: Lukman Y. Utero-vaginal prolapse: a rural disability of the young. EastAfrMedJ 1995; 72: Lanzarone V, Dietz HP. Three-dimensional ultrasound imaging of the levator hiatus in late pregnancy and associations with delivery outcomes. Aust NZ J Obstet Gynaecol 2007; 47: Balmforth J, Toosz-Hobson P, Cardozo L. Ask not what childbirth can do to your pelvic floor but what your pelvic floor can do in childbirth. Neurourol Urodyn 2003; 22: Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005; 106: Dietz HP, Franco AV, Shek KL, Kirby A. Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand 2012; 91: Dietz HP, Simpson J. Levator trauma is associated with pelvic organ prolapse.bjog 2008; 115: Shek KL, Dietz HP. Intrapartum risk factors of levator trauma. BJOG2010; 117: Abdool A, Dietz HP, Lindeque G. Pelvic floor biometry: Are there ethnic differences? Abstract, ICS Annual Scientific Meeting, Montreal Siafarikas F, Staer-Jensen J, Braekken I, Bo K, Elistrom Engh M. Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study. Ultrasound Obstet Gynecol 2013; 41: Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Pelvic floor biometry in Chinese primiparous women 1 year after delivery: a prospective observational study. Ultrasound Obstet Gynecol 2014; 43: Dietz HP, Rojas R, Shek KL. Postprocessing of pelvic floor ultrasound data: how repeatable is it? Aust NZ J Obstet Gynaecol 2014; 54: Van Veelen GA, Schweitzer KJ, van der Vaart CH. Reliability of pelvic floor measurements on three- and four-dimensional ultrasound during and after first pregnancy: implications for training. Ultrasound Obstet Gynecol 2013;42: Li T, Guzman Rojas R, Shek KL, Dietz HP. The repeatability of sonographic measures of functional pelvic floor anatomy. Neurourol Urodyn 2014; 33:
Ballooning of the levator hiatus
Ultrasound Obstet Gynecol 2008; 31: 676 680 Published online 12 May 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5355 Ballooning of the levator hiatus H. P. DIETZ*, C. SHEK*,
More informationBiometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound
Ultrasound Obstet Gynecol 2005; 25: 580 585 Published online 10 May 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.1899 Biometry of the pubovisceral muscle and levator hiatus
More informationAssociation between ICS POP-Q coordinates and translabial ultrasound findings: implications for definition of normal pelvic organ support
Ultrasound Obstet Gynecol 216; 47: 36368 Published online 29 January 216 in Wiley Online Library (wileyonlinelibrary.com). DOI: 1.12/uog.14872 Association between ICS POP-Q coordinates and translabial
More informationMinimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound
Int Urogynecol J (2011) 22:699 704 DOI 10.1007/s00192-010-1329-4 ORIGINAL ARTICLE Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound Hans Peter Dietz &
More informationLevator trauma is associated with pelvic organ prolapse
DOI: 10.1111/j.1471-0528.2008.01751.x www.blackwellpublishing.com/bjog Urogynaecology Levator trauma is associated with pelvic organ prolapse HP Dietz, a JM Simpson b a Department of Obstetrics and Gynaecology,
More informationPelvic floor function in elite nulliparous athletes
Ultrasound Obstet Gynecol 2007; 30: 81 85 Published online 14 May 2007 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.4027 Pelvic floor function in elite nulliparous athletes J. A.
More informationLearning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study
Ultrasound Obstet Gynecol 2013; 41: 312 317 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.11192 Learning process for performing and analyzing 3D/4D transperineal ultrasound
More informationNew imaging method for assessing pelvic floor biomechanics
Ultrasound Obstet Gynecol 2008; 31: 201 205 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5219 New imaging method for assessing pelvic floor biomechanics I. THYER*,
More informationDiagnosis of cystocele type by clinical examination and pelvic floor ultrasound
Ultrasound Obstet Gynecol 2012; 39: 710 714 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.10156 Diagnosis of cystocele type by clinical examination and pelvic floor
More informationWhy are some women with pelvic floor dysfunction unable to contract their pelvic floor muscles?
Australian and New Zealand Journal of Obstetrics and Gynaecology 2013; 53: 574 579 DOI: 10.1111/ajo.12133 Original Article Why are some women with pelvic floor dysfunction unable to contract their pelvic
More informationThe prevalence of major abnormalities of the levator ani in urogynaecological patients
DOI: 10.1111/j.1471-0528.2006.00819.x www.blackwellpublishing.com/bjog Urogynaecology The prevalence of major abnormalities of the levator ani in urogynaecological patients HP Dietz, a AB Steensma b a
More informationA. FALKERT, A. WILLMANN, E. ENDRESS, P. MEINT and B. SEELBACH-GÖBEL ABSTRACT
Ultrasound Obstet Gynecol 2013; 41: 204 209 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.11214 Three-dimensional ultrasound of pelvic floor: is there a correlation
More informationDoes levator ani injury affect cystocele type?
Ultrasound Obstet Gynecol 2010; 36: 618 623 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.7712 Does levator ani injury affect cystocele type? V. H. EISENBERG*, V.
More informationIs levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement?
Ultrasound Obstet Gynecol 2013; 42: 230 234 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.12433 Is levator avulsion a predictor of cystocele recurrence following anterior
More informationUse of a visual analog scale for evaluation of bother from pelvic organ prolapse
Ultrasound Obstet Gynecol 2014; 43: 693 697 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13222 Use of a visual analog scale for evaluation of bother from pelvic organ
More informationInter- and intraobserver reliability for diagnosing levator ani changes on magnetic resonance imaging
Ultrasound Obstet Gynecol 2013; 42: 347 352 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.12462 Inter- and intraobserver reliability for diagnosing levator ani changes
More informationPelvic Floor Ultrasound Imaging. Prof HP Dietz (Sydney) A/Prof KL Shek (Sydney) Dr R Guzman Rojas (Santiago de Chile) Dr Kamil Svabik (Prague)
Pelvic Floor Ultrasound Imaging Workshop IUGA 2015 Nice Faculty: Prof HP Dietz (Sydney) A/Prof KL Shek (Sydney) Dr R Guzman Rojas (Santiago de Chile) Dr Kamil Svabik (Prague) The use of translabial ultrasound
More informationMeasuring echogenicity and area of the puborectalis muscle: method and reliability
Ultrasound Obstet Gynecol 2014; 44: 481 485 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13409 Measuring echogenicity and area of the puborectalis muscle: method
More informationHow common is pelvic floor muscle atrophy after vaginal childbirth?
Ultrasound Obstet Gynecol 2014; 43: 3 Published online 2 December 2013 in Wiley Online Library wileyonlinelibrary.com. DOI: 10.1002/uog.12543 How common is pelvic floor muscle atrophy after vaginal childbirth?
More informationLaparoscopic sacrocolpopexy: how low does the mesh go?
Ultrasound Obstet Gynecol 2017; 49: 404 408 Published online 7 February 2017 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.15882 Laparoscopic sacrocolpopexy: how low does the mesh
More informationBirth Trauma. H. P. Dietz. University of Sydney, Nepean Campus. Penrith, Australia
Birth Trauma H. P. Dietz University of Sydney, Nepean Campus Penrith, Australia Procedures in US (2010): 1.6 Prolapse Urinary Incontinence Fecal Incontinence Prolapse 200.000 Urinary Incontinence 120.000
More informationOriginal Article Efficacy of 3D ultrasound on diagnosis of women pelvic flour dysfunction
Int J Clin Exp Med 2016;9(8):16523-16528 www.ijcem.com /ISSN:1940-5901/IJCEM0028796 Original Article Efficacy of 3D ultrasound on diagnosis of women pelvic flour dysfunction Aifang Chen 1*, Yingzi Zhang
More informationDoes delayed child-bearing increase the risk of levator injury in labour?
Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 491 495 Blackwell Publishing Asia Original Article Delayed child-bearing and levator injury Does delayed child-bearing increase
More informationBiometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women
Ultrasound Obstet Gynecol 2006; 28: 710 716 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.3825 Biometry of the pubovisceral muscle and levator hiatus in nulliparous
More informationAbstract. Introduction
Original article doi:10.1111/codi.12740 Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity
More informationOriginal paper Med Ultrason 2016, Vol. 18, no. 3,
Original paper Med Ultrason 2016, Vol. 18, no. 3, 345-350 DOI: 10.11152/mu.2013.2066.183.zsu Reproducibility in pelvic floor biometric parameters of nulliparous women assessed by translabial three-dimensional
More informationGuide to Pelvic Floor Multicompartment Scanning
Guide to Pelvic Floor Multicompartment Scanning These guidelines have been prepared by Giulio A. Santoro, MD, PhD, Head Pelvic Floor Unit, Section of Anal Physiology and Ultrasound, Coloproctology Service,
More informationLevator Plate Upward Lift on Dynamic Sonography and Levator Muscle Strength
ORIGINAL RESEARCH Levator Plate Upward Lift on Dynamic Sonography and Levator Muscle Strength Ghazaleh Rostaminia, MD, Jennifer Peck, PhD, Lieschen Quiroz, MD, S. Abbas Shobeiri, MD Received December 4,
More informationNIH Public Access Author Manuscript Int Urogynecol J. Author manuscript; available in PMC 2012 December 06.
NIH Public Access Author Manuscript Published in final edited form as: Int Urogynecol J. 2011 December ; 22(12): 1491 1495. doi:10.1007/s00192-011-1458-4. URETHRAL CLOSURE PRESSURES AMONG PRIMIPAROUS WOMEN
More informationDoes childbirth alter the reflex pelvic floor response to coughing?
Ultrasound Obstet Gynecol (2012) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.10083 Does childbirth alter the reflex pelvic floor response to coughing? H. P. DIETZ,
More informationTEST-RETEST RELIABILITY OF PELVIC FLOOR MUSCLE CONTRACTION. Ingeborg Hoff BRÆKKEN, PhD student, Msci, PT, Manual therapist 1
TEST-RETEST RELIABILITY OF PELVIC FLOOR MUSCLE CONTRACTION MEASURED BY 4D ULTRASOUND Ingeborg Hoff BRÆKKEN, PhD student, Msci, PT, Manual therapist 1 Memona MAJIDA, Consultant gynaecologist 2 Marie Ellström
More informationLong-term follow-up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound
Ultrasound Obstet Gynecol 2017; 49: 398 403 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.15891 Long-term follow-up of sacrocolpopexy mesh implants at two time intervals
More informationAxial Plane Imaging. Hans Peter Dietz. Levator Ani Complex
6 Axial Plane Imaging Hans Peter Dietz Levator Ani Complex It is only very recently that imaging of the levator ani has become feasible using translabial ultrasound. The inferior aspects of the levator
More informationEditorial. Assessment of pelvic organ prolapse: a review. K. L. SHEK* and H. P. DIETZ
Ultrasound Obstet Gynecol 2016; 48: 681 692 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.15881 Editorial Assessment of pelvic organ prolapse: a review K. L. SHEK*
More informationM. OTCENASEK*, L. KROFTA*, V. BACA, R. GRILL, E. KUCERA*, H. HERMAN*, I. VASICKA*, J. DRAHONOVSKY* and J. FEYEREISL*
Ultrasound Obstet Gynecol 2007; 29: 692 696 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.4030 Bilateral avulsion of the puborectal muscle: magnetic resonance imaging-based
More informationThe relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction
DOI: 10.1111/1471-0528.12666 www.bjog.org Urogynaecology The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction K van Delft, a AH Sultan, a R
More informationAetiology 1998 Bump & Norton Theoretical model
Kate Lough MSc MCSP Handout IUGA Nice 2015 Physiotherapy and the Provision of Pelvic Floor Muscle Training and Lifestyle Intervention in the Conservative Management of Pelvic Organ Prolapse an evidence
More informationSpecial Thank You NO DISCLOSURES. Objectives. Pelvic Floor Dysfunction Role of Ultrasound Text
Special Thank You Pelvic Floor Dysfunction Role of Ultrasound Phyllis Glanc Sunnybrook Health Sciences Center Department Medical Imaging Associate Professor, University of Toronto phyllis.glanc@sunnybrook.ca
More informationPELVIC FLOOR ASSESSMENT
Fetal and Maternal Medicine Review 2009; 20:1 49 66 C 2009 Cambridge University Press doi:10.1017/s096553950900237x First published online 17 March 2009 PELVIC FLOOR ASSESSMENT HANS PETER DIETZ Nepean
More informationPelvic floor trauma in childbirth
Australian and New Zealand Journal of Obstetrics and Gynaecology 2013; 53: 220 230 DOI: 10.1111/ajo.12059 Review Article Pelvic floor trauma in childbirth Hans Peter DIETZ Sydney Medical School Nepean,
More informationORIGINAL ARTICLE. Judith A. Thompson & Peter B. O Sullivan & N. Kathryn Briffa & Patricia Neumann
Int Urogynecol J (2007) 18:779 786 DOI 10.1007/s00192-006-0225-4 ORIGINAL ARTICLE Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions
More informationThe Urethral Motion Profile Before and After Suburethral Sling Placement
The Urethral Motion Profile Before and After Suburethral Sling Placement Ka Lai Shek,* Varisara Chantarasorn and Hans Peter Dietz From the Nepean Clinical School, University of Sydney, Sydney, Australia
More informationCan the rectovaginal septum be visualized by transvaginal three-dimensional ultrasound?
Ultrasound Obstet Gynecol 2011; 37: 348 352 Published online 10 January 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.8896 Can the rectovaginal septum be visualized by transvaginal
More informationUrogynaecology. Introduction. G Hilde, a,b J Stær-Jensen, b F Siafarikas, b,c K Gjestland, b M Ellstr om Engh, b,c KBø a,b
DOI: 10.1111/1471-0528.12321 www.bjog.org Urogynaecology How well can pelvic floor muscles with major defects contract? A cross-sectional comparative study 6 weeks after delivery using transperineal 3D/4D
More informationPELVIC FLOOR ULTRASOUND
PELVIC FLOOR ULTRASOUND How, When, Why Part 1: Phyllis Glanc MD Sunnybrook Health Science Center University of Toronto Phyllis.Glanc@sunnybrook.ca www.phyllisglanc.com (current exact handout) Disclosures
More informationLevator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study
DOI: 10.1111/1471-0528.13340 www.bjog.org Urogynaecology Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study TFM Vergeldt, a KJB Notten, b M Weemhoff, c SMJ
More informationVaginal Parity and Pelvic Organ Prolapse
The Journal of Reproductive Medicine Vaginal Parity and Pelvic Organ Prolapse Lieschen H. Quiroz, M.D., Alvaro Muñoz, Ph.D., Stuart H. Shippey, M.D., Robert E. Gutman, M.D., and Victoria L. Handa, M.D.
More informationModern methods of imaging in urogynecology when do we really need them?
Archives of Perinatal Medicine 23(2), 77 81, 2017 ORIGINAL PAPER Modern methods of imaging in urogynecology when do we really need them? GRZEGORZ SURKONT, EDYTA WLAŹLAK Abstract Imaging is more often used
More informationPelvic organ prolapse a review
FOCUS Pelvic organ prolapse a review Hans Peter Dietz Background Female pelvic floor dysfunction encompasses a number of prevalent clinical conditions including urinary and faecal incontinence, obstructed
More informationThree-dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy
Ultrasound Obstet Gynecol 2014; 43: 459 465 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13303 Three-dimensional transperineal ultrasound for imaging mesh implants
More informationAn Introduction to 4D View TM (Version 5.0)
9 An Introduction to 4D View TM (Version 5.0) Hans Peter Dietz This book includes a DVD that contains a version of the software 4D View (version 5.0), courtesy of GE Medical, Kretz Ultrasound, Zipf, Austria.
More informationThe diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth
Int Urogynecol J (8) 19:525 53 DOI.7/s192-7-472-z ORIGINAL ARTICLE The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth Jacobus
More informationK. SVABIK, A. MARTAN, J. MASATA, R. EL-HADDAD and P. HUBKA ABSTRACT
Ultrasound Obstet Gynecol 2014; 43: 365 371 Published online 11 March 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.13305 Comparison of vaginal mesh repair with sacrospinous vaginal
More informationHow can we measure bladder volumes in women with advanced pelvic organ prolapse?
Ultrasound Obstet Gynecol 215; 46: 233 238 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 1.12/uog.14678 How can we measure bladder volumes in women with advanced pelvic organ
More informationThe Role of Two- and Three-Dimensional Dynamic Ultrasonography in Pelvic Organ Prolapse
Review Article The Role of Two- and Three-Dimensional Dynamic Ultrasonography in Pelvic Organ Prolapse Hans Peter Dietz, MD, PhD* From the Sydney Medical School Nepean, Penrith, Australia. ABSTRACT Keywords:
More informationAssociation between Magnetic Resonance Imaging Findings of the Pelvic Floor and de novo Stress Urinary Incontinence after Vaginal Delivery
Original Article Genitourinary Imaging https://doi.org/10.3348/kjr.2018.19.4.715 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2018;19(4):715-723 Association between Magnetic Resonance Imaging Findings
More informationNEWER DIMENSIONS IN THE EVALUATION OF PELVIC PATHOLOGY BY TRANSPERINEAL ULTRASONOGRAPHY S. C. Sanjay 1, N. Krishnappa 2, Anil Kumar Shukla 3
NEWER DIMENSIONS IN THE EVALUATION OF PELVIC PATHOLOGY BY TRANSPERINEAL ULTRASONOGRAPHY S. C. Sanjay 1, N. Krishnappa 2, Anil Kumar Shukla 3 HOW TO CITE THIS ARTICLE: S. C. Sanjay, N. Krishnappa, Anil
More informationEFFECT OF SPINAL MANIPULATION ON PELVIC FLOOR FUNCTIONAL CHANGES IN PREGNANT AND NONPREGNANT WOMEN: A PRELIMINARY STUDY
EFFECT OF SPINAL MANIPULATION ON PELVIC FLOOR FUNCTIONAL CHANGES IN PREGNANT AND NONPREGNANT WOMEN: A PRELIMINARY STUDY Heidi Haavik, BSc (Chiro), PhDip (Science), PhD, a Bernadette A. Murphy, DC, MSc,
More informationThe Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (3), Page
The Egyptian Journal of Hospital Medicine (April 2018) Vol. 71 (3), Page 2742-2750 Role of dynamic MRI in assessment of Pelvic Floor Dysfunction in Females Nada Ahmed Hussein, Naglaa Hussein Shebrya, Nermeen
More informationOriginal article J Bas Res Med Sci 2015; 2(2): The incidence of recurrent pelvic organ prolapse: A cross sectional study
The incidence of recurrent pelvic organ prolapse: A cross sectional study Ashraf Direkvand-Moghadam 1, Ali Delpisheh 2, Azadeh Direkvand-Moghadam 3* 1. Psychosocial Injuries Research Center, Faculty of
More informationPelvic floor trauma following vaginal delivery Hans Peter Dietz
Pelvic floor trauma following vaginal delivery Hans Peter Dietz Purpose of review Recent years have seen a steady increase in the information available regarding pelvic floor trauma in childbirth. A review
More informationIraqi JMS. Perineal Ultrasound for Evaluating Bladder Neck and Urethra in Stress Urinary Incontinence
Iraqi JMS Published by Al-Nahrain College of Medicine ISSN 1681-6579 Email: iraqi_jms_alnahrain @yahoo.com http://www.colmed-nahrain.edu.iq/ Perineal Ultrasound for Evaluating Bladder Neck and Urethra
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/160830
More informationDynamic rehabilitative ultrasound for pelvic floor disorders Introduction in techniques and hands-on-workshop
Dynamic rehabilitative ultrasound for pelvic floor disorders Introduction in techniques and hands-on-workshop Bärbel Junginger, B.Sc. /physiotherapist, manualtherapist (IFOMPT) Kaven Baessler, MD, PhD
More informationThe effect of physical activity on pelvic organ prolapse
DOI: 10.1111/j.1471-0528.2009.02112.x www.blackwellpublishing.com/bjog Urogynaecology The effect of physical activity on pelvic organ prolapse NS Ali-Ross, ARB Smith, G Hosker The Warrell Unit, St Mary
More informationDevelopment of the pelvic floor : implications for clinical anatomy Wallner, C.
UvA-DARE (Digital Academic Repository) Development of the pelvic floor : implications for clinical anatomy Wallner, C. Link to publication Citation for published version (APA): Wallner, C. (2008). Development
More informationUSING AN INVERSE METHOD TO OBTAIN THE MATERIAL PARAMETERS OF THE MOONEY-RIVLIN CONSTITUTIVE MODEL FOR PELVIC FLOOR MUSCLES
Congresso de Métodos Numéricos em Engenharia 2015 Lisboa, 29 de Junho a 2 de Julho, 2015 APMTAC, Portugal, 2015 USING AN INVERSE METHOD TO OBTAIN THE MATERIAL PARAMETERS OF THE MOONEY-RIVLIN CONSTITUTIVE
More informationConstriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study
DOI 10.1007/s00192-008-0719-3 ORIGINAL ARTICLE Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study Kari Bø & Ingeborg H. Brækken
More informationHigh-field (3T) magnetic resonance defecography with functional assessment of the evacuation phase: A pictorial essay
High-field (3T) magnetic resonance defecography with functional assessment of the evacuation phase: A pictorial essay Poster No.: C-430 Congress: ECR 2009 Type: Educational Exhibit Topic: Abdominal and
More informationOperative Vaginal Delivery and Pelvic Floor Trauma. Anna Padoa, MD Urogynecology Service Dept of Ob & Gyn Assaf Harofe Medical Center
+ Operative Vaginal Delivery and Pelvic Floor Trauma Anna Padoa, MD Urogynecology Service Dept of Ob & Gyn Assaf Harofe Medical Center + Vaginal birth and the pelvic floor Mechanisms of injury Damage to
More informationThe urethral support system during pregnancy and after childbirth Wijma, Jacobus
University of Groningen The urethral support system during pregnancy and after childbirth Wijma, Jacobus IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish
More informationFunctional anatomy of the female pelvic floor and lower urinary tract Stefano Floris, MD, PhD Department of Obstetrics and Gynaecology
Functional anatomy of the female pelvic floor and lower urinary tract Stefano Floris, MD, PhD Department of Obstetrics and Gynaecology Ospedale San Giovanni di Dio, Gorizia, Italy ANATOMY URINARY CONTINENCE
More information2. Pelvic Floor Anatomy: The primary supportive structures of the pelvis consist of the pelvic fascia and pelvic floor musculature.
MR Imaging of the Female Pelvic Floor Katarzyna J. Macura, MD, PhD The Russell H. Morgan Department of Radiology and Radiological Sciences Johns Hopkins University Baltimore, MD 21287 kmacura@jhmi.edu
More informationDefecation proctography and translabial ultrasound in the investigation of defecatory disorders
Ultrasound Obstet Gynecol 2008; 31: 567 571 Published online 11 April 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5337 Defecation proctography and translabial ultrasound in
More informationState of the art: an integrated approach to pelvic floor ultrasonography
Ultrasound Obstet Gynecol 2011; 37: 381 396 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.8816 State of the art: an integrated approach to pelvic floor ultrasonography
More informationDoctor s assessment and evaluation of the pelvic floor in antenatal and postpartum women: routine or???
Doctor s assessment and evaluation of the pelvic floor in antenatal and postpartum women: routine or??? Dr Barry O Reilly Head of department of Urogynaecology Cork University Maternity Hospital Ireland
More informationijer.skums.ac.ir Risk factors of pelvic organ prolapse in Iranian women: a cross-sectional study
International Journal of Epidemiologic Research, 2014; 1 (1): 29-34. ijer.skums.ac.ir Risk factors of pelvic organ prolapse in Iranian women: a cross-sectional study Ashraf Direkvand-Moghadam 1 ; Zeinab
More informationAnatomical and Functional Results of Pelvic Organ Prolapse Mesh Repair: A Prospective Study of 105 Cases
International Journal of Clinical Urology 2018; 2(1): 20-24 http://www.sciencepublishinggroup.com/j/ijcu doi: 10.11648/j.ijcu.20180201.14 Anatomical and Functional Results of Pelvic Organ Prolapse Mesh
More informationTwo-dimensional and three-dimensional ultrasound imaging of suburethral slings
Ultrasound Obstet Gynecol 0; : 000 000 Published online in Wiley InterScience (www.interscience.wiley.com). DOI:.0/uog. UOG Two-dimensional and three-dimensional ultrasound imaging of suburethral slings
More informationKaranvir Virk M.D. Minimally Invasive & Pelvic Reconstructive Surgery 01/28/2015
Karanvir Virk M.D. Minimally Invasive & Pelvic Reconstructive Surgery 01/28/2015 Disclosures I have none Objectives Identify the basic Anatomy and causes of Pelvic Organ Prolapse Examine office diagnosis
More information3D Dynamic Ultrasound In Obstructed Defecation
3D Dynamic Ultrasound In Obstructed Defecation By Ramy Salahudin Abdelkader Assist. Lecturer of General Surgery Cairo University Introduction Pelvic floor is complex system, with passive and active components
More informationClinical Study Perineal Ultrasound as a Complement to POP-Q in the Assessment of Cystoceles
BioMed Research International, Article ID 740925, 7 pages http://dx.doi.org/10.1155/2014/740925 Clinical Study Perineal Ultrasound as a Complement to POP-Q in the Assessment of Cystoceles Laila Najjari,
More informationThis file was dowloaded from the institutional repository Brage NIH - brage.bibsys.no/nih
This file was dowloaded from the institutional repository Brage NIH - brage.bibsys.no/nih Bø, K., Hilde, G., Stær-Jensen, J., Brækken, I. H. (2011). Can the Paula method facilitate co-contraction of the
More informationPelvic static MR vs MR-defecography in the study of woman's pelvic floor disorders
Pelvic static MR vs MR-defecography in the study of woman's pelvic floor disorders Poster No.: B-0043 Congress: ECR 2015 Type: Scientific Paper Authors: A. ambrosi, G. De Franco, F. Lorusso, M. Cascarano,
More informationStudy of correlation between symptoms and signs in women with anterior vaginal wall prolapse
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Bijwe SA et al. Int J Reprod Contracept Obstet Gynecol. 2017 Jul;6(7):3155-3159 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172953
More informationPELVIC FLOOR REHABILITATION IN WOMEN UNDERGOING PELVIC FLOOR RECONSTRUCTIVE SURGERY: a double-blind randomized controlled clinical trial
PELVIC FLOOR REHABILITATION IN WOMEN UNDERGOING PELVIC FLOOR RECONSTRUCTIVE SURGERY: a double-blind randomized controlled clinical trial DR CORLIA BRANDT OUTLINE Introduction and motivation Aim QOL DISEASE
More informationLAPAROSCOPIC REPAIR OF PELVIC FLOOR
LAPAROSCOPIC REPAIR OF PELVIC FLOOR Dr. R. K. Mishra Elements comprising the Pelvis Bones Ilium, ischium and pubis fusion Ligaments Muscles Obturator internis muscle Arcus tendineus levator ani or white
More informationLook Beyond the Surface and Get the Complete Pelvic Floor Picture
Pelvic Floor Look Beyond the Surface and Get the Complete Pelvic Floor Picture Endovaginal ultrasound. Levator ani defect seen on the right side (arrows). A=anus, B=bladder, LA=levator ani, U=urethra.
More informationPelvic floor trauma in childbirth Myth or reality?
Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 3 11 Blackwell Publishing, Ltd. Systematic Review Pelvic floor trauma in childbirth Pelvic floor trauma in childbirth Myth or
More informationBen Herbert Alex Wojtowicz
Ben Herbert Alex Wojtowicz 54 year old female presenting with: Dragging sensation Urinary incontinence Some faecal incontinence HPC Since May 14 had noticed a mass protruding from the vagina when going
More informationVincent Letouzey, MD, PhD
How to protect the perineum and prevent obstetric perineal trauma Standards of OASIS diagnosis: Primary (clinical) and Secondary (ultrasound) Vincent Letouzey, MD, PhD Obst/Gyne Dept Nîmes University Hospital
More informationComprehensive 3D Pelvic Floor Ultrasonography with emphasis on endovaginal (EVUS) and endoanal imaging (EAUS) W44, 30 August :00-18:00
Comprehensive 3D Pelvic Floor Ultrasonography with emphasis on endovaginal (EVUS) and endoanal imaging (EAUS) W44, 30 August 2011 14:00-18:00 Start End Topic Speakers 14:00 14:10 Introduction: Pre-test,
More informationProlapse and Urogynae Incontinence. Lucy Tiffin and Hannah Wheldon-Holmes
Prolapse and Urogynae Incontinence Lucy Tiffin and Hannah Wheldon-Holmes 66 year old woman with incontinence PC: 7 year Hx of urgency, frequency, nocturia (incl. incontinence at night), and stress incontinence
More informationMoneli Golara Consultant Obstetrician and Gynaecologist Royal Free NHS Trust Barnet Hospital
Moneli Golara Consultant Obstetrician and Gynaecologist Royal Free NHS Trust Barnet Hospital Pelvic Organ Prolapse (POP)- herniation of pelvic organs into vaginal walls Common Huge impact on daily activities
More informationPelvic organ prolapse (POP) affects approximately
Original Research Vaginal Pessary in Women With Symptomatic Pelvic Organ Prolapse A Randomized Controlled Trial Rachel Y. K. Cheung, MBChB, Jacqueline H. S. Lee, MBChB, L. L. Lee, MSc, Tony K. H. Chung,
More informationTransperineal ultrasound to assess the effect of tension-free vaginal tape position on flow rates
Ultrasound Obstet Gynecol 2010; 36: 379 383 Published online 3 August 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.7640 Transperineal ultrasound to assess the effect of tension-free
More informationImaging of Pelvic Floor Weakness. Dr Susan Kouloyan-Ilic Radiologist Epworth Medical Imaging The Women s, Melbourne
Imaging of Pelvic Floor Weakness Dr Susan Kouloyan-Ilic Radiologist Epworth Medical Imaging The Women s, Melbourne Outline Overview and Epidemiology Risk Factors, Causes and Results Review of Relevant
More informationChildbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England,
DOI: 10.1111/1471-0528.12076 www.bjog.org Urogynaecology Childbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England, 2002 2008 A Pradhan, a DG Tincello, b R Kearney a a Department
More informationThe pelvic floor muscles (PFM) form
Correlation of Digital Palpation and Transabdominal Ultrasound for Assessment of Pelvic Floor Muscle Contraction Amir Massoud Arab, PT, PhD 1 ; Roxana Bazaz Behbahani, PT, BSc 2 ; Leila Lorestani, PT,
More informationOriginal Article Evaluation of levator ani with no defect on elastography in women with POP
Int J Clin Exp Med 2015;8(6):10204-10212 www.ijcem.com /ISSN:1940-5901/IJCEM0008463 Original Article Evaluation of levator ani with no defect on elastography in women with POP Meng Xie 1,4*, Xuyin Zhang
More information