Levator trauma is associated with pelvic organ prolapse
|
|
- Avis York
- 6 years ago
- Views:
Transcription
1 DOI: /j x Urogynaecology Levator trauma is associated with pelvic organ prolapse HP Dietz, a JM Simpson b a Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia b School of Public Health, University of Sydney, Sydney, New South Wales, Australia Correspondence: Assoc. Prof. HP Dietz, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith NSW 2750 Australia. hpdietz@bigpond.com Accepted 17 March Published OnlineEarly 23 May Objective To estimate the risk of prolapse associated with levator avulsion injury among a urogynaecological clinic population. Design Retrospective observational study. Setting Tertiary urogynaecological unit. Sample A total of 934 women seen for interview, examination using the pelvic organ prolapse quantification (POP-Q) staging system and imaging of the levator ani muscle by four-dimensional translabial ultrasound. Methods Retrospective review of charts and stored imaging data. Main outcome measures Pelvic organ prolapse stage II and higher and presence of defects of the levator ani muscle. Results After exclusion of 137 women with a history of antiincontinence or prolapse surgery, and a further exclusion of 16 women in whom either examination or imaging was impossible, we compared prolapse and imaging data in 781 women. Mean age was 53 years (range years), and median parity was 2 (range 0 12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (stage II or higher) was diagnosed in 415 (53%) women, and 181 (23%) women were found to have levator avulsion defects. Prolapse was seen in 150/181 (83%) women with avulsion and in 265/600 (44%) women without avulsion, giving a relative risk (RR) of 1.9 (95% CI ). The association was strongest for cystocele (RR 2.3, 95% CI ) and uterine prolapse (RR 4.0, 95% CI ). Conclusions Women with levator avulsion defects were about twice as likely to show pelvic organ prolapse of stage II or higher than those without. This effect is mainly due to an increased risk of cystocele and uterine prolapse. Keywords 3D ultrasound, avulsion, birth trauma, levator ani, pelvic floor ultrasound, pelvic organ prolapse. Please cite this paper as: Dietz H, Simpson J. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115: Introduction Trauma to the levator ani muscle is a common consequence of vaginal childbirth 1 and generally seems to manifest as a partial or complete detachment or avulsion of the puborectalis muscle from its insertion on the pelvic sidewall. 2 Such trauma is almost certainly the direct result of childbirth, 1 because perinatal comparison of imaging data direct observation immediately postpartum, 3 biomechanical studies 4 and large imaging case series 5,6 make a convincing case for the assumption that levator avulsion occurs during crowning of the fetal head. As a result of such trauma, the levator hiatus is enlarged, in particular in its anterior part, 7 which is clearly associated with pelvic organ prolapse, 8 especially of the anterior and central compartment, 9 and may be a risk factor for recurrence after pelvic reconstructive surgery. 10,11 This form of birth trauma is associated with vaginal operative delivery and higher maternal age at first delivery, as shown in studies using both magnetic resonance and ultrasound imaging. 5,6 However, there also are women who show congenitally high pelvic organ mobility, 12 and in others, prolapse may be due to fascial trauma or overdistension of the levator hiatus rather than due to avulsion injury. To date, there have been no attempts at developing preventive strategies, aimed at reducing the prevalence of female pelvic organ prolapse. Such strategies should be a high research priority, given the fact that in the USA alone over surgical procedures are carried out each year for prolapse. 13 In this study, we set out to determine the risk of complete avulsion injury of the levator ani muscle in women with prolapse, and the risk of significant prolapse in women with ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology 979
2 Dietz, Simpson complete levator avulsion, in an attempt to quantify the aetiological link between such trauma and pelvic organ prolapse and to allow estimates of the potential effect of preventative intervention. We used translabial four-dimensional (4D) ultrasound to confirm findings because, while such trauma is palpable and was in fact first diagnosed by palpation in the 1940s, 14 the repeatability of palpation and its agreement with imaging data is limited, even for trained operators Study design, materials and methods A total of 934 women were seen in a tertiary urogynaecological unit. They were assessed by the first author or under his immediate supervision, with a standardised interview that included questions about symptoms of prolapse (sensation of a vaginal lump and/or a dragging sensation), an examination using the pelvic organ prolapse quantification system of the International Continence Society (ICS POP-Q) 18 and assessment of the levator ani muscle by three-dimensional (3D)/4D translabial ultrasound as previously described, 9 using Voluson 730 Expert ultrasound systems. Ultrasound data were acquired with the patient supine and after bladder emptying. For the assessment of muscle integrity, we used volumes obtained on maximal pelvic floor contraction or, in those who were unable to contract, volumes obtained at rest. A levator avulsion injury was diagnosed when there was a discontinuity between the inferior pubic ramus and the puborectalis muscle, evident as a V-shaped loop defining the plane of minimal hiatal dimensions, as previously described. 9 Multislice imaging (tomographic ultrasound) was used to confirm the diagnosis. 19 We consider multislice imaging confirmatory of a complete defect if at least the reference slice (at the level of the plane of minimal dimensions) and the two slices cranial to the reference slice show an avulsion, but it is understood that our definition is arbitrary and impossible to verify at present. The repeatability of the sonographic diagnosis of levator avulsion has been shown to be good (kappa of 0.7 of better) by the authors and others, 9,20 even when using a more basic methodology and less sophisticated equipment. Digital assessment of the levator ani was performed in the context of grading the muscle for strength (modified Oxford grading) 21 to confirm complete avulsion, although the diagnosis of avulsion was only rated as positive if evident on imaging. Examinations for prolapse and levator integrity were undertaken at the same time and by the same operator, making blinding impossible. Figure 1 illustrates the detection of levator avulsion on palpation (left) and axial plane 3D ultrasound (right). Figure 2 shows examples of a normal puborectalis muscle (top), a unilateral avulsion (middle) and a bilateral avulsion (bottom) as obtained on tomographic ultrasound. 19 This study is a subanalysis of a project that was approved by the local Institutional Human Research Ethics Committee (ref ). Statistical analysis was undertaken using SAS Version 9 (SAS Institute Inc., Cary, NC, USA) and Minitab V. 13 (Minitab Inc., State College, PA, USA). The Mantel Haenszel s chi-square test was used to test for trend in the proportion of women with defects by stage of prolapse. Results Of the 934 women seen for assessment, 137 were excluded form further analysis because they had previously undergone antiincontinence or prolapse surgery. A further 16 women were Figure 1. Palpatory (left) and ultrasonic (right) identification of levator avulsion in a rendered volume, axial plane (defect indicated by * on right). Reproduced from: Dietz HP, Shek KL. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J DOI: /s With kind permission of Springer Science and Business Media. 980 ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
3 Levator trauma is associated with prolapse Figure 2. Tomographic ultrasound (axial plane) of a normal puborectalis muscle (A, top three images), a typical right-sided avulsion (B, middle three images) and a bilateral avulsion (C, bottom three images). Defects are indicated by *. The images are obtained at a slice interval of 2.5 mm, at the plane of minimal dimensions (left three images), as well as at 2.5 and 5 mm cranial to this plane (middle and right three images, respectively). Reproduced from: Dietz HP, Shek KL. Single Validity and reproductibility of the digital detection of levtor trauma. Int Urogynecol J DOI: /s With kind permission of Springer Science and Business Media. excluded because they were either not examined clinically due to vaginal scarring, atrophy or refusal (n = 9), or not imaged satisfactorily (n = 7). All analyses presented here refer to the remaining 781 women. Mean age was 53 years (range years), and median parity was 2 (range 0 12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (POP-Q stage II or higher) was diagnosed in 415 women (53%), and 181 women were found to have levator defects (23%). Thirty-nine women could not voluntarily contract the levator ani (5%), and volumes obtained at rest were used for levator assessment in those women. Prolapse was seen in 150/181 (83%) women with defects and in 265/600 (44%) women without defects (P < ), giving a relative risk (RR) of prolapse of 1.9 (95% CI ) among women with defects. When the analysis was performed separately for cystocele, uterine prolapse and rectocele, most of this effect appeared to be due to anterior and central compartment prolapse (Table 1 for RRs of each type of prolapse in women with avulsion). When the analysis was Table 1. RR (95% CI) of each type of significant prolapse (stage II and higher) in women with levator avulsion relative to those with intact levator ani Cystocele (n 5 781) Uterine prolapse (n 5 681)* Rectocele (n 5 781) Unilateral avulsion 2.2 ( ) 2.0 ( ) 1.2 ( ) Bilateral avulsion 2.5 ( ) 7.1 ( ) 1.6 ( ) Any levator avulsion 2.3 ( ) 4.0 ( ) 1.4 ( ) *Excluding 100 women who had had a hysterectomy. ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology 981
4 Dietz, Simpson Figure 3. Distribution of women with no, unilateral and bilateral defects among women with stage 0, I, II and III cystocele (A), uterine prolapse (B) and rectocele (C). inverted to determine the risk of avulsion in women with prolapse, the result was a RR of 4.3 (95% CI ) and an odds ratio of 6.2 (95% CI ), P < Figure 3 shows the distribution of women with no, unilateral and bilateral defects among those with stage 0, I, II and III of anterior, central and posterior compartment prolapse. While only 10 and 11% of women with no or firstdegree cystocele were diagnosed with an avulsion injury, this percentage rose to 31% in those with second-degree cystocele and to 56% in third-degree cystocele (P < ). For uterine prolapse, the figures were 14% in women without uterine descent, 40% in first-degree, 60% in second-degree and 42% in third-degree uterine prolapse (P < ). For rectocele, defects were seen in 19% of women with normal support, 23% in first-degree rectocele, 28% in second-degree rectocele and 34% in third-degree rectocele (P =0.003). Discussion It has long been accepted that vaginal childbirth is a factor in the pathogenesis of female pelvic organ prolapse. Large epidemiological studies leave little doubt that childbirth can impair pelvic organ support. 13,22 This study was designed to quantify the role of a newly identified aetiological factor, direct trauma to the insertion of the inferior part of the levator ani, the puborectalis muscle, on the inferior pubic ramus. Such trauma is common 5,9 and clearly linked to vaginal delivery. 3,4 Among women attending a tertiary clinic, the presence of an identified levator defect approximately doubled the risk of significant prolapse (RR 1.9, 95% CI ). The prevalence of levator avulsion was about four times greater in women with significant clinically diagnosed pelvic organ prolapse (POP-Q stage II or higher) than in those without prolapse. The association was strongest for the anterior and central compartments, and women with bilateral avulsion were particularly likely to suffer from uterine prolapse (RR of 7.1). Our findings are consistent with results obtained by magnetic resonance imaging where women with prolapse were more likely to have major levator ani defects than controls (55 compared with 16%), with an adjusted odds ratio of 7.3 (95% CI ). 8 When we analysed our data to allow for comparison of data, we obtained an unadjusted odds ratio of 6.1 (95% CI ), with 150/415 (36%) women with prolapse showing an avulsion compared with 31/366 (8%) without significant prolapse. Together, these data further strengthen the aetiological link between childbirth and female pelvic organ prolapse. It now seems likely that delivery-related major levator trauma (avulsion injury) may be a significant factor in the pathogenesis of prolapse. This seems particularly likely for cystocele and uterine prolapse. It is understood that levator avulsion may not be the only mechanism by which pelvic floor muscle function may be impaired. Childbirth clearly leads to an enlargement of the levator hiatus, even if avulsion injury does not ensue, 1 and such overdistension of an intact muscle may equally predispose to prolapse. Finally, it is likely that congenital factors and/or fascial trauma play a role in some women, even if both may be more difficult to identify than muscular trauma as shown for rectocele. 23 Regardless of whether other aetiological factors coexist in a population or an individual woman, it now appears very likely that major levator trauma is a significant aetiological factor for female pelvic organ prolapse. This finding opens up novel opportunities for prevention because levator avulsion is likely to be a useful intermediate outcome variable for intervention studies. Any change in clinical practice resulting in a reduced prevalence of levator avulsion, detectable a few weeks or months after childbirth by palpation or imaging, would be expected to have a positive effect on the prevalence of significant prolapse later in life. We are currently undertaking two randomised controlled trials aimed at reducing the incidence of levator avulsion in childbirth, using antenatal intervention strategies. 982 ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
5 Levator trauma is associated with prolapse One of the more obvious weaknesses of our study is the fact that it was undertaken in a urogynaecological population. While the majority of our women did not complain of symptoms of prolapse, they were certainly not asymptomatic because they presented with other urogynaecological complaints such as urinary incontinence, voiding dysfunction or recurrent urinary tract infections. It remains to be shown to what extent these results are applicable to the general population. Furthermore, operators were not blinded against prolapse findings when they assessed for levator defects. We do not expect this bias to be significant: in an unrelated study examining the repeatability of the digital detection of levator trauma, the association between prolapse and defects was in fact stronger for the examiner who was blinded against clinical data than in the operator who undertook the levator assessment immediately after examining for prolapse (unpublished own data). However, we cannot exclude that bias may have contributed to the association observed in this population. It would therefore be preferable to confirm findings by using a study design that separates prolapse assessment and the diagnosis of levator injury, allowing for blinding of separate operators, and we intend to conduct such a study in the future. Conclusions Women presenting to a urogynaecological clinic with levator avulsion injury were approximately twice as likely to show significant pelvic organ prolapse than those with an intact levator muscle, especially cystocele and uterine prolapse. Women with significant prolapse show a four-fold higher prevalence of levator avulsion injury than those without. These findings are further evidence for the importance of childbirth-related levator trauma in the aetiology of female pelvic organ prolapse. Contribution to authorship H.P.D.: Study design, data entry, analysis, writing of manuscript and final approval. J.M.S.: Data analysis, writing of manuscript and final approval. Details of ethics approval This study is a subanalysis of a project that was approved by the Local Institutional Human Research Ethics Committee (ref ). Acknowledgements The authors thank Dr Clara Shek, Nepean Hospital, Penrith, NSW, Australia, for help with data entry. j References 1 Dietz H, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106: Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR. Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 2001;185: Dietz H, Gillespie A, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol 2007;47: Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 2004;103: Kearney R, Miller J, Ashton-Miller J, Delancey J. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 2006;107: Dietz H. Does delayed childbearing increase the risk of levator injury in labour? ANZJOG 2007;47: Otcenasek M, Krofta L, Baca V, Grill R, Kucera E, Herman H, et al. Bilateral avulsion of the puborectal muscle: magnetic resonance imaging-based three-dimensional reconstruction and comparison with a model of a healthy nulliparous woman. Ultrasound Obstet Gynecol 2007;29: DeLancey J, Morgan D, Fenner D, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 2007;109: Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 2006;113: Singh K, Jakab M, Reid W, Berger LA, Hoyte L. Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse. Am J Obstet Gynecol 2003; 188: Adekanmi OA, Freeman R, Puckett M, Jackson S. Cystocele: does anterior repair fail because we fail to correct the fascial defects? A clinical and radiological study. Int Urogynecol J 2005;16:S Dietz H, Hansell N, Grace M, Eldridge AM, Clarke B, Martin NG. Bladder neck mobility is a heritable trait. BJOG 2005;112: DeLancey J. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 2005;192: Gainey HL. Post-partum observation of pelvic tissue damage. Am J Obstet Gynecol 1943;46: Dietz HP, Hyland G, Hay-Smith J. The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound. Neurourol Urodyn 2006;25: Kearney R, Miller JM, Delancey JO. Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 2006;25: Dietz HP, Shek K. Validity and reproducibility of the digital detection of levator trauma. Int Urogynecol J 2008; DOI: /s [E-pub ahead of print]. 18 Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175: Dietz H. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 2007;29: ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology 983
6 Dietz, Simpson 20 Weinstein MM, Pretorius D, Nager CW, Mittal R. Inter-rater reliability of pelvic floor muscle imaging abnormalities with 3D ultrasound. Ultrasound Obstet Gynecol 2007;30: Laycock J. Assessment and Treatment of Pelvic Floor Dysfunction. Bradford: Postgraduate School of Biomedical Sciences, University of Bradford, Patel D, Xu X, Thomason A, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 2006;195: Dietz HP, Steensma A. The role of childbirth in the aetiology of rectocele. BJOG 2006;113: ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
Minimal 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 informationBallooning 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 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 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 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 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 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 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 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 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 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 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 informationIs pelvic organ support different between young nulliparous African and Caucasian women?
Ultrasound Obstet Gynecol 2016; 47: 774 778 Published online 2 May 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.15811 Is pelvic organ support different between young nulliparous
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationAmong parous women, cesarean birth reduces the
Pelvic Floor Disorders After Vaginal Birth Effect of Episiotomy, Perineal Laceration, and Operative Birth Victoria L. Handa, MD, MHS, Joan L. Blomquist, MD, Kelly C. McDermott, BS, Sarah Friedman, MD,
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 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 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 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 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 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 informationGynecology Dr. Sallama Lecture 3 Genital Prolapse
Gynecology Dr. Sallama Lecture 3 Genital Prolapse Genital(utero-vaginal )prolapse is extremely common, with an estimated 11% of women undergoing at least one operation for this condition. Definition: A
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 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 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 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 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 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 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 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 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 informationChildbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse
DOI: 10.1111/1471-0528.12075 www.bjog.org Epidemiology Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse C Glazener, a A Elders, a C MacArthur,
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 informationThe circumferential obstetric fistula: characteristics, management and outcomes
DOI: 10.1111/j.1471-0528.2007.01329.x www.blackwellpublishing.com/bjog Short communication The circumferential obstetric fistula: characteristics, management and outcomes A Browning Barhirdar Hamlin Fistula
More informationSurgical repair of vaginal wall prolapse using mesh
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Surgical repair of vaginal wall prolapse using mesh Vaginal wall prolapse happens when the normal support
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 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 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 informationBilateral sacrospinous fixation after second recurrence of vaginal vault prolapse:
Bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: efficacy and impact on quality of life and sexuality. Salvatore Giovanni Vitale 1, Diego Rossetti 2, Marco Noventa 3,
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 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 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 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 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 informationThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page
The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 216 225 Role of Dynamic Magnetic Resonance Imaging in Assessment of Female Pelvic Floor Dysfunction Aliaa S Sheha, MSc*, Ola M Nouh,
More informationRelevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women
Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women Marwa Abdulaziz 1 ; Alex Kavanagh 2 ; Lynn Stothers 3 ; Andrew Macnab 2,3 1 PhD Candidate,
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 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 informationMATERIALS AND METHODS We recruited 8 older women with weekly FI aged years (older incontinent
Fecal incontinence in older women: are levator ani defects a factor? Christina LewickyGaupp, MD; Cynthia Brincat, MD; Aisha Yousuf, MD; Divya A. Patel, PhD; John O. L. Delancey, MD; Dee E. Fenner, MD OBJECTIVE:
More informationInternational Federation of Gynecology and Obstetrics
International Federation of Gynecology and Obstetrics COMMITTEE FOR UROGYNAECOLOGY AND PELVIC FLOOR MEMBER: TSUNG-HSIEN (CHARLES) SU, CHAIR (TAIWAN) DAVID RICHMOND, CO-CHAIR (UK) CHITTARANJAN PURANDARE,
More informationPredicting Treatment Choice for Patients With Pelvic Organ Prolapse
Predicting Treatment Choice for Patients With Pelvic Organ Prolapse Michael Heit, MD, MSPH, Chris Rosenquist, MD, Patrick Culligan, MD, Carol Graham, MD, Miles Murphy, MD, and Susan Shott, PhD OBJECTIVE:
More informationChildbirth Trauma & Its Complications 23/ Mr Stergios K. Doumouchtsis
Mr Stergios K. Doumouchtsis Consultant Obstetrician Gynaecologist & Urogynaecologist Childbirth Trauma & Its Complications Over eighty per cent of women sustain some degree of perineal trauma during childbirth.
More informationPregnancy and childbirth: the effects on pelvic floor muscles
Page 1 of 9 Pregnancy and childbirth: the effects on pelvic floor muscles 26 February, 2009 Stress incontinence can follow childbirth as pelvic floor muscles are damaged AUTHOR Julia Herbert, MSc, MCSP,
More informationContent. Terminology Anatomy Aetiology Presentation Classification Management
Prolapse Content Terminology Anatomy Aetiology Presentation Classification Management Terminology Prolapse Descent of pelvic organs into the vagina Cystocele ant. vaginal wall involving bladder Uterine
More informationThe relationship between urinary symptom questionnaires and urodynamic diagnoses: an analysis of two methods of questionnaire administration
BJOG: an International Journal of Obstetrics and Gynaecology May 2004, Vol. 111, pp. 468 474 DOI: 1 0. 1111/j.1471-0528.2004.00126.x The relationship between urinary symptom questionnaires and urodynamic
More informationKeywords De novo prolapse, mesh, surgery, untreated compartment,
DOI: 10.1111/j.1471-0528.2011.03231.x www.bjog.org Urogynaecology Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of
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 informationJohn Laughlin 4 th year Cardiff University Medical Student
John Laughlin 4 th year Cardiff University Medical Student Prolapse/incontinence You need to know: Pelvic floor anatomy in relation to uterovaginal support and continence The classification of uterovaginal
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 informationAN INTERNATIONAL CONTINENCE SOCIETY (ICS) / INTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR CHILDBIRTH TRAUMA
AN INTERNATIONAL CONTINENCE SOCIETY (ICS) / INTERNATIONAL UROGYNAECOLOGICAL ASSOCIATION (IUGA) JOINT REPORT ON THE TERMINOLOGY FOR CHILDBIRTH TRAUMA NEED FOR A WORKING GROUP ON CHILDBIRTH TRAUMA A: Background
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 informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Correlation of Digital Examination Vs Perineometry in Measuring the Pelvic Floor Muscles Strength
More informationTest-Retest Reliability of an Instrumented Speculum for Measuring Vaginal Closure Force
Neurourology and Urodynamics 26:858 863 (2007) Test-Retest Reliability of an Instrumented Speculum for Measuring Vaginal Closure Force J.M. Miller, 1,4 * y J.A. Ashton-Miller, 2{ D. Perruchini, 3 and J.O.L.
More informationAppendix B Protocol for management of obstetric anal sphincter injury THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS
Appendix B Protocol for management of obstetric anal sphincter injury Document Type: THE MANAGEMENT OF THIRD- AND FOURTH-DEGREE PERINEAL TEARS PURPOSE & SCOPE To provide a guideline that will assist in
More informationPost operative voiding dysfunction and the Value of Urodynamics. Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist
Post operative voiding dysfunction and the Value of Urodynamics Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist Learning objectives: v Pathophysiology of post op voiding dysfunction.
More informationMr. GIT KAH ANN. Pakar Klinikal Urologi Hospital Kuala Lumpur.
Mr. GIT KAH ANN Pakar Klinikal Urologi Hospital Kuala Lumpur drgitka@yahoo.com 25 Jan 2007 HIGHLIGHTS Introduction ICS Definition Making a Diagnosis Voiding Chart Investigation Urodynamics Ancillary Investigations
More informationReview Article Pelvic Floor Dysfunction, Body Excreta Incontinence and Continence
Cronicon OPEN ACCESS GYNAECOLOGY Review Article Pelvic Floor Dysfunction, Body Excreta Incontinence and Continence Abdel Karim M El Hemaly 1 * and Laila ASE Mousa 1 1 Professor of Obstetrics and gynaecology,
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 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 information