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Gilyadova, Aida, Anton Ishchenko, Elena Puchkova, Elena Mershina, Viktor Petrovichev, and Igor Reshetov. "Diagnostic Value of Dynamic Magnetic Resonance Imaging (dMRI) of the Pelvic Floor in Genital Prolapses." Biomedicines 11, no. 10 (October 20, 2023): 2849. http://dx.doi.org/10.3390/biomedicines11102849.
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Pelvic organ prolapse is a chronic disease resulting from a weakening of the musculoskeletal apparatus of the pelvic organs. For the diagnosis of this pathology, it is insufficient to conduct only a clinical examination. An effective diagnostic tool is the method of dynamic magnetic resonance imaging (MRI) of the pelvic floor, which allows a comprehensive assessment of the anatomical and functional characteristics of the walls of the pelvis and pelvic organs. The aim of the study was to analyze the literature data on the possibilities and limitations of using dynamic MRI in pelvic organ prolapse. The widespread use of the dynamic MRI method is due to the high quality of the resulting image, good reproducibility, and the maximum ability to display the characteristics of the pelvic floor. Dynamic MRI of the small pelvis allows a comprehensive assessment of the anatomical and functional features of the pelvis, excluding the effect of ionizing radiation on the body. The method is characterized by good visualization with high resolution and excellent soft tissue contrast. The method allows for assessing the state of the evacuation function of visualized structures in dynamics. Simultaneous imaging of all three parts of the pelvic floor using dynamic MRI makes it possible to assess multicompartment disorders. The anatomical characteristics of the state of the pelvic organs in the norm and in the event of prolapse are considered. The technique for performing the method and the procedure for analyzing the resulting images are described. The possibilities of diagnosing a multicomponent lesion are considered, while it is noted that dynamic MRI of the pelvic organs provides visualization and functional analysis of all three parts of the pelvis and often allows the choice and correction of tactics for the surgical treatment of pelvic organ prolapse. It is noted that dynamic MRI is characterized by a high resolution of the obtained images, and the advantage of the method is the ability to detect functional changes accompanying the pathology of the pelvic floor.
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Constantinou, C. E., Q. Peng, R. Jones, I. Perkash, Y. Murayama, and S. Omata. "Dynamics of pelvic floor function." Journal of Biomechanics 39 (January 2006): S347. http://dx.doi.org/10.1016/s0021-9290(06)84380-0.
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Rocca Rossetti, Salvatore. "Functional anatomy of pelvic floor." Archivio Italiano di Urologia e Andrologia 88, no. 1 (March 31, 2016): 28. http://dx.doi.org/10.4081/aiua.2016.1.28.
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Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.
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Pinho, M., K. Yoshioka, J. Ortiz, M. Oya, and M. R. B. Keighley. "The effect of age on pelvic floor dynamics." International Journal of Colorectal Disease 5, no. 4 (December 1990): 207–8. http://dx.doi.org/10.1007/bf00303277.
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Knorn, Steffi, Damiano Varagnolo, Ernesto Oliver-Chiva, Reinhilde Melles, and Marieke Dewitte. "Data-driven modelling of pelvic floor muscles dynamics." IFAC-PapersOnLine 51, no. 27 (2018): 321–26. http://dx.doi.org/10.1016/j.ifacol.2018.11.621.
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Blanco-Diaz, Maria, Ana Vielva-Gomez, Marina Legasa-Susperregui, Borja Perez-Dominguez, Esther M. Medrano-Sánchez, and Esther Diaz-Mohedo. "Exploring Pelvic Symptom Dynamics in Relation to the Menstrual Cycle: Implications for Clinical Assessment and Management." Journal of Personalized Medicine 14, no. 3 (February 23, 2024): 239. http://dx.doi.org/10.3390/jpm14030239.
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Background: Pelvic floor dysfunctions (PFDs) encompass an array of conditions with discrepant classification systems, hampering accurate prevalence estimation. Despite potentially affecting up to 25% of women during their lifetime, many remain undiagnosed, underestimating the true extent. Objectives: This cross-sectional study aimed to examine the impacts of the menstrual cycle on PFDs and dysfunctions. Secondary objectives included investigating differences between athletic and nonathletic women. Methods: An online questionnaire examined the effects of the menstrual cycle (MC) on 477 women’s pelvic symptoms (aged 16–63 years), stratified by athletic status. This ad hoc instrument built upon a validated screening tool for female athletes. Results: Most participants reported symptom fluctuations across menstrual phases, with many modifying or reducing exercise participation. A concerning number experienced daily undiagnosed pelvic floor symptoms, emphasizing needs for comprehensive medical evaluation. Conclusions: Exacerbated pelvic symptoms showed complex relationships with menstruation, highlighting the importance of considering the MC in customized clinical management approaches. Symptoms demonstrated differential links to menstruation, indicating needs for individualized evaluation and tailored treatment plans based on symptom profiles and hormonal interactions. Educating professionals and patients remains essential to enhancing awareness, detection, and therapeutic outcomes. Further controlled longitudinal research should elucidate intricate relationships between menstrual cycles and pelvic symptom variability.
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Bhattarai, Aroj, and Manfred Staat. "Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions." Computational and Mathematical Methods in Medicine 2018 (2018): 1–16. http://dx.doi.org/10.1155/2018/9518076.
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After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.
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Dias, Nicholas, Yun Peng, Rose Khavari, Nissrine A. Nakib, Robert M. Sweet, Gerald W. Timm, Arthur G. Erdman, Timothy B. Boone, and Yingchun Zhang. "Pelvic floor dynamics during high-impact athletic activities: A computational modeling study." Clinical Biomechanics 41 (January 2017): 20–27. http://dx.doi.org/10.1016/j.clinbiomech.2016.11.003.
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Fogliata, Arianna, Franco Debernardi, and Alessandra Garassino. "Multifunctional role of the diaphragm: biomechanical analysis and new perspectives." MOJ Sports Medicine 7, no. 1 (January 23, 2024): 9–13. http://dx.doi.org/10.15406/mojsm.2024.07.00155.
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This study explores the complex role of the diaphragm, traditionally considered essential in respiratory physiology, expanding understanding of its multifunctionality. Beyond respiratory mechanics, the diaphragm contributes to postural stabilization, lumbar support, and regulation of intra-abdominal pressure (IAP). By analyzing the diaphragm's eccentric contraction, we introduce two innovative concepts: "Diaphragm Antagonist Muscles" (DAM) and "Centration". DAM represents an evolution of the abdominal belt concept, integrating the pelvic floor and lower posterior trunk muscles. This muscular synergy is vital for respiratory dynamics and functions such as posture and integrity of the musculoskeletal, pressure, and postural systems. Centration, proposed as a conscious modulation skill of IAP, activates a neurophysiological interaction between the diaphragm, lower posterior trunk muscles, and the pelvic floor, revealing new implications of the diaphragm in sports, health, and kinesiological contexts.
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Toktar, L. R., M. R. Orazov, I. A. Samsonova, Z. N. Kamarova, K. I. Li, V. E. Pak, and M. V. Krestinin. "New markers of pelvic organ prolapse." Voprosy ginekologii, akušerstva i perinatologii 22, no. 2 (2023): 98–102. http://dx.doi.org/10.20953/1726-1678-2023-2-98-102.
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Pelvic organ prolapse (POP) is a very considerable problem not only due to its high prevalence, but also because of the significant decrease in the quality of life of women suffering from this disease. Given the high prevalence, pelvic floor disorders requiring plastic surgery are becoming an economic problem for public health. In recent decades, techniques for the treatment of pelvic floor dysfunction (PFD) have evolved rapidly. However, the pathophysiology of this disease is still poorly understood, which may be the reason for inadequate, untimely, and sometimes ineffective treatment of POP. One of the important findings when analyzing the results of morphological and morphometric studies of the levator ani muscle in PFD and clinical forms of POP became the detection of significant fibrous degradation of the pelvic floor muscular compartment in all the examined samples. Objective. To search for promising biomarkers of muscular and connective tissue remodeling and the interaction of the muscular and fascial compartments of the pelvic floor to predict pelvic organ prolapse. According to the literature, we found at least three candidate markers for assessing the condition of the muscular-fascial compartment of the pelvic floor: tenascin C, hyaluronic acid (HA), and myofibroblasts (MFB). Tenascin C is a non-structural component of the extracellular matrix of both muscular and connective tissue. Its role in the regulation of inflammation pathways has been discovered in recent studies, but in our study, this protein is of interest as a marker of tissue remodeling in case of tissue damage. Hyaluronic acid is one of the most abundant glycosaminoglycans in the connective tissue of vertebrates. HA is ubiquitous in fascial tissue, but its content is particularly high in loose connective tissue and between muscles and deep fascia. In the fascia, HA is not only a key structural component of the extracellular matrix, but also a functional one. The qualitative and quantitative analysis of HA content in pelvic floor fasciae is likely to help more accurately assess the tissue state, identify the nature of myofascial interaction during the formation of the hernia gate and may be the key to determining the treatment tactics for the initial signs of PFD. Myofibroblasts are connective tissue cells that represent an intermediate link between fibroblasts and smooth muscle cells. Their main task is to increase the basal tone and rigidity of the fascia and ensure proper muscular-skeletal dynamics. Normally, this tension is not enough for significant changes in musculature biomechanics, but persistent “hypertonicity” of the fascia quite quickly led to the formation of pathological contractures, which limited the motor activity of the underlying muscles. Thus, it can be assumed that myofibroblasts participate in the process of healing and remodeling of the fascial compartment. And the search for MFB in biopsy specimens of the levator ani muscle in patients with PFD can shed light on connective tissue dysplasia as the most controversial component of POP development. Conclusion. To date, the problem of pelvic organ prolapse remains unresolved in modern gynecology. When studying the literature, it became evident that determining the biochemical and biomechanical properties of the myofascial complex of the pelvic floor is necessary to gain a comprehensive picture of the disease. Although the significance of markers in predicting pelvic organ prolapse has not yet been investigated, we express optimistic expectations to find an ideal biomarker of the rate of PFD and POP development, improving knowledge about the pathogenesis of the disease. Key words: biomarkers, hyaluronic acid, myofibroblasts, pelvic organ prolapse, connective tissue, tenascin C
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Sofoudis, Chrisostomos, and Garyfalia Bitzi. "Urine bladder microbiota predicting uterine prolapse: a comprehensive review." Obstetrics & Gynecology International Journal 15, no. 1 (January 19, 2024): 1–4. http://dx.doi.org/10.15406/ogij.2024.15.00725.
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This research endeavors to elucidate the potential association between urinary microbiota and the prevalence of female pelvic organ prolapse (POP). Leveraging state-of-art metagenomics analysis, we scrutinize the microbial landscape within the urinary tract of individuals with POP, justaposed against a cohort study and summarizing the results of all the correlated papers that approach this subject. Through meticulous study and research, it is aimed to pinpoint distinctive and diverse microbial patterns related with POP development. Findings of the review aspire to shed light on the intricate dynamics between urinary microbiota and female pelvic health, offering nuanced insight into the contributory factors underpinning pelvic organ prolapse. This research not only deepens the understanding of the microbial aspect of POP but also holds promise for informing potential diagnostic and therapeutic avenues in the realm of female pelvic floor disorders.
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Gilmutdinov, Bulat Rashitovich, Ildar Nailevich Daminov, Aydar Rashitovich Gilmutdinov, Rozaliya Amirovna Garifyanova, and Aliya Aydarovna Gabdelkhakova. "The parameters of regional hemodynamics in patients with chronic pelvic pain syndrome against the background of magnetic stimulation and peloid therapy." Fizioterapevt (Physiotherapist), no. 2 (February 1, 2021): 9–15. http://dx.doi.org/10.33920/med-14-2104-01.
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The study of Doppler parameters of hemodynamics of internal genital organs was carried out in 102 patients with chronic pelvic pain syndrome, 54 men and 48 women. It was found that against the background of extracorporeal magnetic stimulation of the neuromuscular apparatus of the pelvic floor and peloid therapy in patients of the main group, there is an improvement in the Doppler parameters of the hemodynamics of the internal genital organs in the form of a decrease in angle-independent indices: systolic-diastolic ratio, resistance and pulsation index, an increase in blood flow velocity on average by 36,2% in men and 42,1% in women from the initial values with the results being preserved for 6 months. In patients of the control group, Doppler measurements of the arteries of the prostate and ovaries showed no significant dynamics of vascular indices and blood flow velocities in the presence of a tendency to unidirectional shifts in parameters with the main group.
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Knorn, Steffi, Damiano Varagnolo, Reinhilde Melles, and Marieke Dewitte. "Data-driven models of pelvic floor muscles dynamics subject to psychological and physiological stimuli." IFAC Journal of Systems and Control 8 (June 2019): 100044. http://dx.doi.org/10.1016/j.ifacsc.2019.100044.
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Stafford, Ryan E., James A. Ashton-Miller, Christos E. Constantinou, and Paul W. Hodges. "Novel Insight into the Dynamics of Male Pelvic Floor Contractions Through Transperineal Ultrasound Imaging." Journal of Urology 188, no. 4 (October 2012): 1224–30. http://dx.doi.org/10.1016/j.juro.2012.06.028.
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Constantinou, Christos E. "Dynamics of female pelvic floor function using urodynamics, ultrasound and Magnetic Resonance Imaging (MRI)." European Journal of Obstetrics & Gynecology and Reproductive Biology 144 (May 2009): S159—S165. http://dx.doi.org/10.1016/j.ejogrb.2009.02.021.
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Costantini, S., F. Esposito, C. Nadalini, D. Lijoi, S. Morano, P. Lantieri, and E. Mistrangelo. "Ultrasound imaging of the female perineum: the effect of vaginal delivery on pelvic floor dynamics." Ultrasound in Obstetrics and Gynecology 27, no. 2 (2006): 183–87. http://dx.doi.org/10.1002/uog.2663.
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BRUSCIANO, Luigi, Antonio BRILLANTINO, Luigi FLAGIELLO, Marianna PENNACCHIO, Claudio GAMBARDELLA, Francesco Saverio LUCIDO, Alessandra PIZZA, Salvatore TOLONE, Gianmattia DEL GENIO, and Ludovico DOCIMO. "EFFECTIVENESS OF PERINEAL PELVIS REHABILITATION COMBINED WITH BIOFEEDBACK AND RADIOFREQUENCY DIATHERMY (RDF) IN ANORECTAL FUNCTIONAL PAIN SYNDROMES ASSOCIATED WITH PARADOXICAL CONTRACTION OF THE LEVATOR ANI MUSCLES. A PROSPECTIVE STUDY." Arquivos de Gastroenterologia 60, no. 2 (June 2023): 201–7. http://dx.doi.org/10.1590/s0004-2803.20230222-150.
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ABSTRACT Background: Anorectal functional pain syndrome, also called chronic proctalgia, represents a neglected clinical entity and often confused with other syndromes such as vulvodynia or acute proctalgia. It is a very often disabling disease with a consequent significant negative impact on the patient’s quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. To improve symptoms in functional anorectal pain syndromes, various rehabilitation techniques are used with the aim of promoting relaxation of the pelvic floor; however, to improve defecatory dynamics in patients with levator ani syndrome, only biofeedback has shown efficacy in a randomized study. The aim of this work is to evaluate whether a rehabilitation protocol with manometric biofeedback and radiofrequency diathermy (mt100 Fremslife emotion Tecar) reduces pain and paradoxical contraction of the levator ani and improves the quality of life in patients with anorectal pain syndromes. functional. Methods: This was a prospective study on 30 patients (20 women and 10 men) with anorectal functional pain syndrome and paradoxical contraction of the pelvic floor enrolled at the UOC of General, Minimally Invasive, Oncological and Obesity Surgery of the AOU “Luigi Vanvitelli” of Naples, Italy, from September 2021 to May 2022. All patients were evaluated with a coloproctological specialist visit followed by anorectal manometry and evaluation of altered clinical physiatric parameters (Brusciano Score). The protocol consisted of 10 rehabilitation sessions of the pelvic floor once a week and lasting approximately 45 minutes. During the sessions the patients were subjected to diathermy / radiofrequency treatment (10 minutes) with a static resistive electrode on the diaphragm, during which they were required to breathe diaphragmatically and to become aware of the perineal muscles, under the supervision of a physiotherapist; followed by application of diathermy with static capacitive (5 minutes) and resistive (10 minutes) electrode at the lumbar level. This was followed by the use of manometric biofeedback (15 minutes of tonic / phasic exercises) in order to instruct the patient on the reflex mechanism to obtain a voluntary relaxation of the external anal sphincter. The variables evaluated were Pain (VAS 0-10) and the questionnaire on the impact of colorectal and anal pathologies on the quality of life (CRAIQ-7) at the beginning, after 3 months and at the end of the treatment. Results: After 10 weeks, the rehabilitation treatment combined with diathermy and manometric biofeedback proved effective in the short term with a reduction in the scores of the Vas scale and CRAIQ-7 questionnaire and an increase in the percentage of release of the anal muscles on anorectal manometry. Conclusion: The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient.
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Liu, Xiaohong, Qin Wang, Yanling Chen, Jiamao Luo, and Yifeng Wan. "Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6–8 Weeks Postpartum." Urogynecology 29, no. 10 (April 17, 2023): 844–50. http://dx.doi.org/10.1097/spv.0000000000001353.
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Importance In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. Objective This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. Study Design A total of 301 patients diagnosed with female PFD who were 6–8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. Results A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery (P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy (P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. Conclusions A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.
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Stafford, Ryan E., Stuart Mazzone, James A. Ashton-Miller, Christos Constantinou, and Paul W. Hodges. "Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs." Journal of Applied Physiology 116, no. 8 (April 15, 2014): 953–60. http://dx.doi.org/10.1152/japplphysiol.01225.2013.
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Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28–42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.
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Zar-Kessler, Claire, Braden Kuo, Elizabeth Cole, Anna Benedix, and Jaime Belkind-Gerson. "Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation." Digestive Diseases 37, no. 6 (2019): 478–85. http://dx.doi.org/10.1159/000500121.
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Objectives: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation. Methods: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response. Results: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention. Conclusion: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low muscle tone.
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Cowley, David, Ryan E. Stafford, and Paul W. Hodges. "Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men." Neurourology and Urodynamics 39, no. 3 (March 2020): 954–61. http://dx.doi.org/10.1002/nau.24301.
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Do, Yerim, Youngeun Lim, Soohyun Lee, and Haneul Lee. "The Correlation between Transperineal Shear-Wave Elastography and Transabdominal Ultrasound When Assessing Pelvic Floor Function in Nulliparous Women." Diagnostics 13, no. 18 (September 20, 2023): 3002. http://dx.doi.org/10.3390/diagnostics13183002.
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Pelvic floor muscles (PFMs) play a crucial role in maintaining pelvic organ support and continence. However, pelvic floor dysfunction (PFD), often resulting from insufficient PFM control, poses a substantial global health challenge for women. This study aims to explore the relationship between levator ani muscle elasticity when assessed through transperineal shear-wave elastography (SWE) and bladder base displacement, quantified using transabdominal ultrasonography (TAUS), as a means to comprehensively evaluate PFM function. A total of 42 nulliparous women participated in this study. Participants received instructions on proper PFM contractions using Kegel exercises. Levator ani muscle elasticity was assessed both at rest and during contractions using transperineal SWE, while bladder base displacement was simultaneously measured through TAUS. Repeated measures demonstrated strong intraclass correlation coefficients of 0.906 at rest and 0.687 during contractions for levator ani muscle elasticity. The mean elasticity values were 24.7 ± 4.5 kPa at rest and 62.1 ± 10.4 kPa during contractions. Additionally, the mean bladder base displacement was 7.2 ± 2.5 mm, and the normalized bladder base displacement via body mass index was 0.3 ± 0.1 mm. Significantly, a moderate correlation was identified between the PFM function, represented by the difference in levator ani elasticity during contractions and resting, and bladder base displacement (r = 0.486, p = 0.001). These findings underscore the potential utility of transperineal SWE as a reliable and noninvasive method to assess levator ani muscle elasticity and, consequently, PFM function. In conclusion, this study sheds light on the interplay between PFM elasticity and bladder base displacement, offering insights into PFM function assessments. The observed correlation suggests the clinical relevance of SWE in providing valuable information for treatment planning in PFD. These findings contribute to a deeper understanding of PFM dynamics, ultimately aiding in the effective management of PFD among women.
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Lyadov, K. V., K. V. Kotenko, and E. N. Zhumanova. "Vasocorrigating effect of general magnetotherapy and electromyostimulation with biofeedback in combination with fractional microablative co2 laser therapy in patients with posterior vaginal wall prolapse after surgery." Russian Journal of Physiotherapy, Balneology and Rehabilitation 19, no. 2 (December 27, 2020): 116–22. http://dx.doi.org/10.17816/1681-3456-2020-19-2-8.
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Background. The high recurrence rate after surgical treatment of pelvic organ prolapse makes it necessary to improve therapeutic methods.
Objective: to develop and scientifically substantiate the use of a rehabilitation complex, including general magnetotherapy, electromyostimulation with biofeedback in combination with fractional microablative therapy with a CO2 laser, in patients of different age groups with rectocele after surgery.
Methods. The article presents the treatment data for 100 women of childbearing, peri- and menopausal age with rectocele IIIII degree, which were divided into 2 groups comparable in terms of clinical and functional characteristics (main and control), within each group they were divided by 2 subgroups: subgroup A included women of childbearing age, subgroup B included women of peri- and menopausal age. The patients of the main group in the early postoperative period after plastic surgery for rectocella (from 1 day) underwent a course of general magnetotherapy and in the late postoperative period (one month after the operation) they performed a set of measures consisting of a course of electromyostimulation with biological connection of the pelvic floor muscles and a special complex physiotherapy exercises and 2 intravaginal procedures of fractional microablative CO2 laser therapy with an interval of 45 weeks. Patients in the control group after surgical treatment of rectocele in the late postoperative period received symptomatic therapy, including painkillers and antispasmodics, which served as a backdrop for patients of the main group.
Results. As a result of the studies, it was found that regardless of the age and severity of uterine blood flow disorders in the uterine arteries in patients with rectocele, the most pronounced dynamics was observed in patients of the main group, which, in our opinion, is associated primarily with the vasoactive effects of general magnetotherapy, manifested in the removal of spasm from arteries and arterioles, improving the contractility of the veins and increasing venous outflow, which in combination with electrical stimulation, exercises to strengthen the muscles of the pelvis bottom and fractional microablative therapy allowed to obtain such a pronounced vasocorrigating effect.
Conclusions. Due to the pathogenetic effect of the developed complex (electrical stimulation, exercises to strengthen the pelvic floor muscles and fractional microablative therapy) on one of the main mechanisms of the development of the disease, a pronounced vasocorrecting effect was obtained.
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Zachovajevienė, Brigita, Laimonas Šiupšinskas, Pavelas Zachovajevas, and Daimantas Milonas. "Dynamics of pelvic floor muscle functional parameters and their correlations with urinary incontinence in men after radical prostatectomy." Neurourology and Urodynamics 36, no. 1 (September 30, 2015): 126–31. http://dx.doi.org/10.1002/nau.22887.
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Al-Zamil, M. Kh, N. G. Kulikova, E. S. Vasilieva, I. A. Minenko, and D. M. Zalozhnev. "Efficacy of transcutaneous electroneurostimulation in treatment of erectile dysfunction associated with Covid-19." Fizioterapevt (Physiotherapist), no. 2 (March 25, 2023): 16–24. http://dx.doi.org/10.33920/med-14-2302-02.
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Background: Many studies provide data on the development of erectile dysfunction in patients after COVID-19. In most cases, the authors associated this complication with depression. However, in rare cases, erectile dysfunction is organic in nature as a result of pudendal neuropathy. Materials and methods: We examined 29 patients with the development of sexual erectile dysfunction after COVID-19. In all patients, entrapment of the pudendal nerve was detected using pudendal evoked potentials and needle electromyography of pelvic floor. All patients underwent standard medical therapy for the treatment of sexual dysfunction after recovery from COVID-19. In addition to drug therapy, 9 patients underwent TENS of the pudendal nerve using monophasic square wave pulses with a frequency of 1 Hz and a duration of 100 μs with small amplitude below the threshold of sensory fibers (sham-TENS group). 10 patients underwent the same impulses with a frequency of 1 Hz and a duration of 100 μs with amplitude higher threshold level of sensory fibers (low-frequency TENS group), and 10 patients underwent TENS with frequency of 100 Hz and duration of 100 μs with amplitude higher threshold level of sensory fibers (high-frequency TENS group). International Index of Erectile Function questionnaire, QLS-H (Questions on Life Satisfaction), pudendal somatosensory evoked potentials, and needle electromyography of pelvic floor were used before and after treatment. Results: In patients after direct TENS of the pudendal nerve, erectile function improved in high-frequency TENS group and in low-frequency TENS group by 56 % and 27 % respectively. A remarkable increase in the quality of life satisfaction was noted by 95 % of patients after high-frequency TENS and by 35 % of patients after low-frequency TENS. There were no significant changes in erectile function and quality of life satisfaction in patients after sham stimulation. Partial recovery of latency and amplitudes of pudendal somatosensory evoked potentials N1 N2 was recorded in 6 patients only after high-frequency TENS. Conclusion: Direct high-frequency TENS of pudendal nerve is highly effective in treatment of erectile dysfunction associated with COVID-19. The high-frequency TENS proved 2 times more efficient than the low-frequency TENS. Notably, positive neurophysiological dynamics, determined using needle electromyography of the pelvic floor and pudendal somatosensory evoked potentials, was detected only against the background of high-frequency TENS.
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Epifanov, Vitaly A., Valery Y. Illarionov, and Ekaterina N. Zhumanova. "The main clinical symptoms in patients with posterior vaginal wall prolapse and modern non-drug technologies for its relief." Russian Journal of Physiotherapy, Balneology and Rehabilitation 17, no. 6 (November 2, 2018): 332–38. http://dx.doi.org/10.17816/1681-3456-2018-17-6-332-338.
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Background. Rectocele is one of the leading causes of abnormal position and dysfunction of the pelvic floor and rectum.
Objective: to develop and scientifically substantiate the use of a rehabilitation complex, including general magnetotherapy, electromyostimulation with biofeedback in combination with fractional microablative CO2 laser therapy in patients of different age groups with rectocele after surgery.
Methods. The article presents the results of treatment of 100 women with rectocele, who were divided into main and control groups, within each group, depending on their age, they were divided into 2 subgroups: women of childbearing age were included in subgroup A, and women of peri- and menopausal age were included in subgroup B. Patients of the main group in the early postoperative period after plastic surgery for rectocele (from 1 day) were given a course of General magnetotherapy and in the late postoperative period (one month after the operation) a set of measures was performed, consisting of a course of electromyostimulation with biological connection of the pelvic floor muscles 2 intravaginal procedures of fractional microablative CO2 laser therapy at intervals of 45 weeks. Patients of the control group after surgical treatment of rectocele in the late postoperative period received symptomatic therapy, including painkillers and spasmolytics and a set of Kegel exercises.
Results. Significant improvements in postoperative treatment were observed in patients of the main group: pelvic pain and periodic pain in the lower abdomen and lower back disappeared in 100% of cases; the main complaints related to violation of rectal emptying and urination were preserved in no more than 57% of cases, sexual complaints in 5%; in 95% of cases, general, vegetative and pre-climacteric complaints disappeared.
Conclusion. As a result of the conducted research, it is shown that under the influence of the developed rehabilitation complex, regardless of age, there was a highly reliable dynamics of all complaints due to the influence of physical factors included in it on various pathogenetic links in the development of the disease.
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Soljanik, Irina, Ricarda M. Bauer, Armin J. Becker, Christian G. Stief, Christian Gozzi, Olga Soljanik, and Sonja M. Kirchhoff. "Morphology and dynamics of the male pelvic floor before and after retrourethral transobturator sling placement: first insight using MRI." World Journal of Urology 31, no. 3 (June 19, 2012): 629–38. http://dx.doi.org/10.1007/s00345-012-0884-3.
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Lukianov, A. S., A. Yu Titov, O. M. Biryukov, A. A. Mudrov, and I. V. Kostarev. "Methods for Mesh Implantation Efficacy Assessment in Rectocele." Russian Journal of Gastroenterology, Hepatology, Coloproctology 31, no. 3 (October 8, 2021): 17–25. http://dx.doi.org/10.22416/1382-4376-2021-31-3-17-25.
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Aim. A methodological review on mesh implantation efficacy assessment in surgery for rectocele.Key points. Specialised quiz surveys are among the most appropriate methods to assess surgical intervention efficacy. The questionnaires that enable pre- and postsurgery rectocele grading include PFDI-20 (Pelvic Floor Distress Inventory), the colonic evacuation disorder scale and Cleveland Constipation Scoring System. These surveys determine the surgical intervention efficacy dynamically in conjunction with instrumental surgery assessment techniques.Conclusion. Clinical practice at the Ryzhikh National Medical Research Centre for Coloproctology combines the originally developed colonic evacuation disorder scale (2003) and PFDI-20. The combined scales allow for a comprehensive symptom assessment in patients with rectocele and other descending perineum syndrome manifestations prior to surgery, as well as symptom dynamics evaluation postoperatively, which, in link with defecography, enables a complete appraisal of the surgical effect.
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Vardanyan, Vardan G., Alexandr I. Alekhin, Natalya A. Mezhlumova, Galina Yu Pevgova, and Anton A. Alekhin. "New aspects in the surgical correction of pelvic organ prolapse." RUDN Journal of Medicine 26, no. 4 (December 23, 2022): 373–81. http://dx.doi.org/10.22363/2313-0245-2022-26-4-373-381.
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Relevance . The relevance of the problem of pelvic prolapse is due to the prevalence of the disease, the tendency to rejuvenation and progression. This, according to the survey, affects the quality of life of women, leads to disruption of sexual functioning, and reduces the ability to work. The methods of surgical treatment that exist in the arsenal of modern operative gynecology can contribute to the development of cicatricial adhesions, infectious complications and recurrence of prolapse, which creates the need for repeated interventions. The development and introduction into practice of new methods of treatment is a natural necessity. The most effective technique for the surgical treatment of genital prolapse is laparoscopic sacrocolpopexy using titanium silk implants. Materials and Methods. A prospective cohort study of 30 patients aged 37 to 74 years with clinical manifestations of grade II-IV prolapse, statistical data analysis and analysis of the results of a survey of patients in the postoperative period in dynamics over 3-6-12 months from 2019 to 2021 was carried out. The study used a three-stage method of surgical assistance (patent dated September 15, 2020 No. 2020130382/14 (054923) in the volume - laparoscopic promontofixation, MacCoul sacro-uterine ligament plasty, colporrhaphy, colpoperineorrhaphy, levatoroplasty. Results and Discussion. It has been established that pregnancy and childbirth are among the main factors provoking the development of pelvic floor muscle failure. The duration of postoperative follow-up in our study was 3-14 months. No complications were diagnosed during this period. In 12 patients (40.0 %) during the first month there were periodic pulling pains in the lower abdomen and perineum, in 2 (6.6 %) - urinary incontinence. Titanium silk has a lower affinity for surrounding tissues compared to polypropylene scaffold systems, which makes it possible to consider it as an alternative material to synthetic analogues and reduce the risk of mesh-associated complications. The resistance of the titanium endoprosthesis to antiseptics and microbial agents predisposes to its long-term use and the absence of the need for replacement. Conclusion. The data obtained make it possible to judge the high efficiency of the developed technique for the surgical treatment of pelvic prolapse of pelvic floor defects in patients with rectocele and cystocele, minimizing the recurrence of the disease and the risk of developing mesh-associated complications, which allows choosing a personalized management strategy for this cohort of patients.
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Solyanik, I., S. M. Kirchhoff, R. M. Bauer, C. Gozzi, and A. J. Becker. "281 Dynamics of the pelvic floor in continent and stress urinary incontinent men after radical prostatectomy: A functional MRI study." European Urology Supplements 11, no. 1 (February 2012): e281. http://dx.doi.org/10.1016/s1569-9056(12)60278-4.
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Thiry, Paul, Olivier Nocent, Fabien Buisseret, William Bertucci, André Thevenon, and Emilie Simoneau-Buessinger. "Sample Entropy as a Tool to Assess Lumbo-Pelvic Movements in a Clinical Test for Low-Back-Pain Patients." Entropy 24, no. 4 (March 22, 2022): 437. http://dx.doi.org/10.3390/e24040437.
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Low back pain (LBP) obviously reduces the quality of life but is also the world’s leading cause of years lived with disability. Alterations in motor response and changes in movement patterns are expected in LBP patients when compared to healthy people. Such changes in dynamics may be assessed by the nonlinear analysis of kinematical time series recorded from one patient’s motion. Since sample entropy (SampEn) has emerged as a relevant index measuring the complexity of a given time series, we propose the development of a clinical test based on SampEn of a time series recorded by a wearable inertial measurement unit for repeated bending and returns (b and r) of the trunk. Twenty-three healthy participants were asked to perform, in random order, 50 repetitions of this movement by touching a stool and another 50 repetitions by touching a box on the floor. The angular amplitude of the b and r movement and the sample entropy of the three components of the angular velocity and acceleration were computed. We showed that the repetitive b and r “touch the stool” test could indeed be the basis of a clinical test for the evaluation of low-back-pain patients, with an optimal duration of 70 s, acceptable in daily clinical practice.
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En'kova, Е. V., К. I. Obernikhin, Е. V. Belov, Е. S. Dukhanina, N. N. Patlataya, and D. V. Sudakov. "Ultrasound Morphometry of the Pelvic Floor Muscles in Women of Reproductive Age." Journal of Anatomy and Histopathology 13, no. 1 (April 7, 2024): 66–70. http://dx.doi.org/10.18499/2225-7357-2024-13-1-66-70.
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Biometric studies in nulliparous women conducted to date are limited by small sample sizes. The pelvic floor muscles perform an important function throughout a woman’s life. They provide fixation and maintenance of the pelvic organs, stretches during childbirth, ensuring the formation of the birth canal, and are a potential site for the formation of a hernia in the female body. Impaired function of this muscle group can lead to either excessive muscle contraction (chronic pelvic pain syndrome) or excessive stretching (pelvic organ prolapse). The purpose of the study is to assess the morphometric properties of the pelvic floor muscles in nulliparous women using 3D ultrasound scanning (sonography). Material and methods. The observation group consisted of 60 women of middle reproductive age who applied for an appointment with an obstetriciangynecologist with complaints of pain of various types localized in the perineum and pelvis, decreased desire and quality of sexual life, clinically confirmed by a diagnosis of incompetence of the pelvic floor muscles. The control group consisted of 30 women without dysfunction of the pelvic floor muscles according to clinical examination. The main criterion for inclusion of patients in the study was reproductive age - 18–45 years and natural childbirth in obstetric and gynecological history. Results. We found that the absence of visible sonographic markers of changes in the myofascial structures of the pelvis is not a prognostically significant criterion for muscle dysfunction, since predominantly changes in morphometric parameters are a reliable sign of the formation of pelvic floor muscle failure. Conclusion. The ultrasound morphometry method, which allows one to assess dynamic changes in the size of muscle and fascial structures, can be used in the clinical practice of an obstetrician-gynecologist. Early diagnosis of a violation of the structure of pelvis myofascial complex will allow early implementation of measures aimed at prevention and timely treatment.
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Parezanovic-Ilic, Katarina, Branislav Jeremic, Ljiljana Mladenovic-Segedi, Slobodan Arsenijevic, and Milorad Jevtic. "Physical therapy in the treatment of stress urinary incontinence." Srpski arhiv za celokupno lekarstvo 139, no. 9-10 (2011): 638–44. http://dx.doi.org/10.2298/sarh1110638p.
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Introduction. Stress urinary incontinence (SUI) is an involuntary release of urine through the urethra during the increase of abdominal pressure in the absence of m. detrusor contraction. The exercise of pelvic floor muscles is recommended as the first line of cure. It is the least invasive and the only method without any undesirable side effects, which leads to either improvement or complete cure of SUI in 80-85% of cases. Objective. The aim of this study was to establish whether the strengthening of pelvic floor muscles using proprioceptive neural facilitation (PNF) spiral dynamic technique was more efficient in comparison to classical Kegel exercise. Methods. The research was carried out at the Centre for Physical Medicine and Rehabilitation, Clinical Centre Kragujevac. Sixty-six female patients with the symptoms of SUI were monitored in the period of two years. Thirty-four patients did pelvic floor muscle exercises twice a day, in the morning and in the evening, with 15-20 contractions. Thirty-two patients used PNF spiral dynamic technique for strengthening pelvic floor muscles. The patients who used the spiral dynamic technique also did some exercises from the program; they exercised twice a day, in the morning and in the evening, following the prescribed schedule. Treatment outcome was assessed by measuring the pelvic floor muscles by a vaginal dynamometer. Results. The values of the pelvic floor muscle force that were measured using the vaginal dynamometer in both examined groups (PNF spiral dynamic technique or Kegel exercise) were statistically significantly higher after the implemented exercise program (t-test; p=0.000). No statistically significant difference in pelvic floor muscle values was found between the patients who applied PNF spiral dynamic technique and those who did Kegel exercise either before or after the exercise (two-factor analysis of variance with repeated measurements, factor of exercise type; p=0.899). Conclusion. Strengthening of pelvic floor muscles by exercises results in a significant increase of pelvic floor muscle strength and reduction of SUI symptoms, regardless of the used exercise program, PNF spiral dynamic technique or Kegel exercise program.
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Ahmed, Ali Ismai. "Impact of MRI Defectography on Surgical Approach in Patients with Pelvic Floor Dysfunction." Women's Health Science Journal 7, no. 1 (2023): 1–16. http://dx.doi.org/10.23880/whsj-16000174.
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Background: Surgical treatment of pelvic floor dysfunctions carries frequent recurrences. The aim of the study was to evaluate the role dynamic MRI defecography in demonstrating the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients to guide surgical approach and minimize failure. Methods: Patients underwent perineal examination, conventional defecography, anorectal manometry, colonoscopy, and MRI defecography. The different pelvic floor morphologies were recorded. The type of treatment, whether conservative or surgical, was also recorded. Results: In total, 33 patients were included, with mean age 46.78 ± 10.51 years and the majority (69.7 %) of patients were female. 31 patients (93.9 %) with perineal descent, 21 patients (63.6 %) with rectoceles , 19 patients (57.57 %) with cystoceles, 4 patients (12.1 %) with enteroceles, 15 patients (45.4 %) with intussusceptions, 14 patients (42.2 %) with uterine prolapse and 12 patients with dyskinetic puborectalis muscle. The findings of dynamic MRI defecography were consistent with clinical results in 54.54 % with additional diagnostic parameters in 45.45 % of patients. Dynamic MRI findings changed treatment decision in 15 (45.5 %) patients with surgical treatment performed in 21 patients (63.6 %) and conservative treatment in 12 patients (36.3 %). Conclusion: Dynamic MRI defecography represents an essential diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of the pelvic floor organs during defecation. In addition to the clinical assessment, dynamic MRI defecography had clinical impact in pelvic floor dysfunction and interdisciplinary treatment decisions
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Dave, Anupama, Ruchi Joshi, Vibhu Goel, and Atisha Dave. "MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 8 (July 26, 2017): 3400. http://dx.doi.org/10.18203/2320-1770.ijrcog20173451.
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Background: MRI is the newest technique used to evaluate patients with pelvic floor disorders. It allows relatively non-invasive, dynamic evaluation of all pelvic organs in multiple planes and can directly visualize the muscular and ligamentous pelvic floor support structures. Using MRI to evaluate pelvic floor disorders may be most helpful in patients with multicompartment findings or symptoms, posterior compartment abnormalities, severe prolapse, or recurrent pelvic floor symptoms after prior surgical repair. MRI is often able to reveal more extensive organ prolapse than physical examination alone.Methods: The present study was carried out in the Department of Radiodiagnosis and Obstetrics and Gynecology of Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh from November 2014 to October 2015. A total of 43 patients who had symptoms of pelvic floor dysfunction like uterine prolapse, urinary or rectal dysfunction were evaluated by high resolution USG. Patients with low lying uterus on USG were subjected to MRI. Before MRI, these patients were assessed by a Gynecologist, and a clinical diagnosis in form of the organ/organs prolapsed and the grade of individual prolapse was assigned and tabled in the prefixed format.Results: Prolapse is more common in patients with greater than 50 years age (63% patients). MRI picked up more lesions compared to clinical examination, 90% as compared to 82.5% on clinical examination. MRI has good correlation with surgery in diagnosing prolapse. Concomitant prolapse of the Anterior and Middle compartment is the most common clinical entity diagnosed on 52.5% patients in our set up. MRI has poor sensitivity in identifying posterior compartment prolapse. There is good agreement between the clinical grading and MRI grading (81.8% correlation).Conclusions: T MRI offers a novel approach of simultaneous imaging of all compartments of the female pelvis at a single setting. With lesser intraobserver variation and better visualization of the pelvic anatomy MRI would help in accurate staging and hence better outcomes in patients in terms of symptom relief.
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Alt, Céline D., Laura Benner, Theresa Mokry, Florian Lenz, Peter Hallscheidt, Christof Sohn, Hans-Ulrich Kauczor, and Kerstin A. Brocker. "Five-year outcome after pelvic floor reconstructive surgery: evaluation using dynamic magnetic resonance imaging compared to clinical examination and quality-of-life questionnaire." Acta Radiologica 59, no. 10 (February 6, 2018): 1264–73. http://dx.doi.org/10.1177/0284185118756459.
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Background Dynamic magnetic resonance imaging (dMRI) captures the entire pelvis during Valsalva maneuver and helps diagnosing pelvic floor changes after reconstructive surgery. Purpose To evaluate therapeutic outcome five years after reconstructive surgery using clinical examination, dMRI, and quality-of-life (QOL) questionnaire. Material and Methods Clinical examination, dMRI, and QOL questionnaire were conducted before surgery and in the follow-ups at 12 weeks, one year, and five years in women with pelvic organ prolapse (POP) stage ≥2. dMRI was performed at 1.5-T using a predefined protocol including sagittal T2-weighted (T2W) sequence at rest and sagittal T2W true-FISP sequence at maximum strain for metric POP measurements (reference points = bladder, cervix, pouch, rectum). Pelvic organ mobility (POM) was defined as the difference of the metric measurement at maximum strain and at rest. Results Twenty-six women with 104 MRI examinations were available for analysis. dMRI results mostly differ to clinical examination regarding the overall five-year outcome and the posterior compartment in particular. dMRI diagnosed substantially more patients with recurrent or de novo POP in the posterior compartment (n = 17) compared to clinical examination (n = 4). POM after five years aligns to preoperative status except for the bladder. POM reflects best the QOL results regarding defecation disorders. Conclusion A tendency for recurrent and de novo POP was seen in all diagnostic modalities applied. dMRI objectively visualizes the interaction of the pelvic organs and the pelvic floor after reconstructive surgery and POM correlated best with the women’s personal impression on pelvic floor complaints.
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Pham, Cecile T., Jordan E. Cohen, and Manish I. Patel. "Ultrasound-Based Prognostic Anatomical Parameters for Post-Prostatectomy Incontinence: A Systematic Review." Société Internationale d’Urologie Journal 5, no. 1 (February 18, 2024): 64–75. http://dx.doi.org/10.3390/siuj5010012.
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Background: A number of assessment methods for the pelvic floor have been described. Male pelvic floor ultrasound is an accessible, noninvasive assessment tool. Objective: To evaluate current published literature on anatomical parameters on pre- and postoperative ultrasound imaging of the male pelvic floor and correlation with continence status following radical prostatectomy (RP). Methods: A comprehensive literature search was conducted using the PRISMA guidelines to identify publications up to November 2022. Exclusion criteria consisted of animal studies, non-English articles, case reports, reviews and abstracts or reports from conferences. A full-text review was performed on 12 papers using ultrasound to assess pelvic floor anatomy and correlation with continence status following RP. Results: A total of 18 anatomical parameters were evaluated using US. Membranous urethral length (MUL), striated urethral sphincter (SUS) morphology and activation were most commonly studied. Shorter pre- and postoperative MUL, decreased preoperative SUS thickness and vascularity, postoperative discontinuity of SUS muscle fibres and decreased SUS activation are associated with post-prostatectomy incontinence (PPI). There is a paucity of data comparing anatomical changes in men prior to and following RP. The benefits of transperineal ultrasound are that it is minimally invasive, accessible, provides dynamic imaging of all three striated muscle complexes simultaneously and includes a bony landmark to reference measures of pelvic floor muscle displacement. Conclusions: Ultrasound evaluation of the male pelvic floor is an evolving field as there is development in technology and understanding of pelvic floor anatomy. It is an accessible and dynamic imaging modality, which allows both morphological and functional assessment of pelvic floor anatomy and its role in PPI. MUL and SUS morphology and activation are associated with continence status following RP. Several other anatomical parameters that may predict PPI were identified. Current literature is limited by small, single-centre studies with heterogeneous cohorts and methodologies.
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Zbar, A. "Dynamic magnetic resonance imaging and transperineal sonography in the assessment of patients presenting primarily with evacuatory difficulty: A short position paper." Acta chirurgica Iugoslavica 57, no. 3 (2010): 97–104. http://dx.doi.org/10.2298/aci1003097z.
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Patients presenting with primary evacuatory difficulty have a multiplicity of pelvic floor and perineal soft tissue anomalies. The radiological assessment of these patients requires modalities which monitor the dynamic interaction of pelvic organs during provocative manoeuvres such as straining and simulated defaecation. The advantages and disadvantages of these complementary modalities, (dynamic magnetic resonance imaging, dynamic transperineal sonography and dynamic 2- and 3-dimensional endoanal sonography) are provided in this position paper.
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Iacobellis, Francesca, Antonio Brillantino, Adolfo Renzi, Luigi Monaco, Nicola Serra, Beatrice Feragalli, Aniello Iacomino, Luca Brunese, and Salvatore Cappabianca. "MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position." Gastroenterology Research and Practice 2016 (2016): 1–12. http://dx.doi.org/10.1155/2016/6594152.
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Introduction. Functional disorders of the pelvic floor represent have a significant impact on the quality of life. The advent of open-configuration systems allowed for the evaluation of defecation with MR imaging in sitting position. The purpose of the present study is to compare the results of static and dynamic pelvic MR performed in supine position versus sitting position, using a new MR prototype machine, in the diagnosis of pelvic floor descent.Materials and Methods. Thirty-one patients with pelvic floor disorders were enrolled, and underwent MR Defecography in supine position with 1.5 T closed magnet (MAGNETOM Symphony, Siemens, Germany) and in sitting position with a 0.25-Tesla open magnet system (G-Scan ESAOTE, Italy).Results. In rest and squeezing phases, positions of bladder, vagina, and ARJ were significantly different when the patient was imaged in supine versus sitting position. In the defecation phase, a significant difference for the bladder and vagina position was detected between the two exams whereas a significant difference for the ARJ was not found. A statistically significant difference exists when the pelvic floor descent is evaluated in sitting versus supine position.Conclusion. Our results show that MR Defecography in sitting position may represent a useful tool to correctly diagnose and grade the pelvic organ descent.
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Ishchenko, A. I., I. V. Shulchina, A. D. Komarova, A. A. Ishchenko, I. D. Khokhlova, T. A. Dzhibladze, E. G. Malyuta, et al. "Postoperative recurrences of pelvic organ prolapse and their combined non-surgical correction." Voprosy ginekologii, akušerstva i perinatologii 23, no. 1 (2024): 24–32. http://dx.doi.org/10.20953/1726-1678-2024-1-24-32.
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Objective. To study the efficacy and safety of combined (laser + electromyostimulation + pelvic floor muscle training) nonsurgical correction of pelvic organ prolapse (POP) recurrences in the late postoperative period in reproductive-aged, pre- and postmenopausal patients with different types of POP. Patients and methods. A comprehensive clinical examination, surgical treatment, and dynamic outpatient follow-up (at 1, 6, 12, 24, 36, and 48 months) of 523 patients with different types and severity of POP were performed. Disease recurrences were diagnosed in 69 (13.2%) women, 52 of whom underwent a combined non-surgical corrective therapy (laser + electromyostimulation + pelvic floor muscle training) with subsequent efficacy evaluation after 6 and 12 months. Results. Postoperative recurrences of POP were most often observed 12–36 months after surgical intervention using only own tissues (26.6%), less frequently – when synthetic implants were used (12.7%) and, extremely rarely, when titanium endoprostheses were inserted (1.6%). The positive effect of combined non-surgical correction in 32 (61.5%) women was expressed in a lower number and intensity of symptoms, improvement in the quality of life according to the PFDI-20 scale, optimization of gynecological examination data and quantitative parameters according to the POP-Q classification system. Conclusion. Combined non-surgical therapy (laser + electromyostimulation + pelvic floor muscle training) for postoperative recurrences of POP contributed to the optimization of clinical picture, dynamic improvement of the quantitative parameters of postoperative prolapse according to the POP-Q classification system, improvement of the quality of life of women, their social and sexual rehabilitation, which demonstrates the efficacy and safety of the implemented therapeutic program. Key words: postoperative recurrences of pelvic organ prolapse, combined non-surgical therapy, fractional CO2 laser, electromyostimulation, pelvic floor muscle training
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Ortega, AdriÁN E., Nancy Klipfel, Rebecca Kelso, Patrizio Petrone, Ivan RomÁN, Alberto DÍAz, Brenda Ávalos, and Howards Kaufman. "Changing Concepts in the Pathogenesis, Evaluation, and Management of Solitary Rectal Ulcer Syndrome." American Surgeon 74, no. 10 (October 2008): 967–72. http://dx.doi.org/10.1177/000313480807401018.
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The purpose of this study was to assess the impact of new technology on both the understanding of the underlying pathophysiology and treatment of solitary rectal ulcer syndrome (SRUS). This study is a retrospective review of patients with a histologic diagnosis of SRUS (1993 to 2007) complimented with a prospective database of those patients studied with defecography and dynamic pelvic MRI. Thirty patients were available for evaluation. A polyp or mass was present in 74 per cent. Ulcers were found in only 23 per cent. All 12 patients undergoing defecography demonstrated rectorectal intussusception. Dynamic MRI of the pelvis revealed pronounced anorectal redundancy and lack of mesorectosacral fixation with mild to severe pelvic floor descent in all four patients studied. Fiber with or without stool softeners was the initial treatment in all patients with resolution of symptoms in 65 per cent. One patient with refractory symptoms underwent a stapled transanal rectal resection with complete resolution of symptoms. Occult rectorectal intussusception appears to be the operant anatomic pathology in SRUS. Anorectal redundancy with lack of mesorectosacral fixation may contribute to the process. All patients should be studied with defecography and dynamic MRI. Stapled transanal rectal resection may offer a promising surgical option.
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MURAD-REGADAS, Sthela Maria, Adjra da Silva VILARINHO, Livia BORGES, Lara Burlamarqui VERAS, Milena MACEDO, and Doryane Maria dos Reis LIMA. "CORRELATION BETWEEN PELVIC FLOOR DYSFUNCTION ON DYNAMIC 3D ULTRASOUND AND VAGINAL DELIVERY, PARITY, AND AGE IN WOMEN WITH OBSTRUCTED DEFECATION SYMPTOMS." Arquivos de Gastroenterologia 58, no. 3 (September 2021): 302–7. http://dx.doi.org/10.1590/s0004-2803.202100000-52.
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ABSTRACT BACKGROUND: Few studies have investigated the constipation or obstructed defecation symptoms identified by using imaging, as dynamic three-dimensional ultrasound and correlate vaginal delivery, parity, and age. OBJECTIVE: The aim of this study was to assess the prevalence of pelvic floor dysfunctions in female patients with obstructed defection symptoms and to determine whether specific pelvic floor dysfunctions identified by dynamic three-dimensional ultrasonography (echodefecography) are correlated with vaginal delivery, parity, and age. The secondary goal is to report the prevalence of coexisting pelvic floor dysfunctions. METHODS: This is a retrospective cohort study including patients with obstructed defecation symptoms underwent echodefecographyto evaluate pelvic floor dysfunctions in the posterior compartment and correlate with vaginal delivery, parity, and age. RESULTS: Of 889 female: 552 (62%) had had vaginal delivery and 337 (38%) were nulliparous. The prevalence of dysfunctions identified by echodefecography (rectocele, intussusception, enterocele/sigmoidocele, and dyssynergia) was similar between the two groups and was not associated with number of deliveriesor age. However, the prevalence of sphincter defects showed higher rates in women with vaginal delivery and increased with the parity. Up to 33% of patients had coexisting dysfunctions. CONCLUSION: The prevalence of dysfunctions such as rectocele, intussusception, dyssynergia, and enterocele/sigmoidocele assessed by echodefecography in patients with obstructed defecation symptoms are found similar regardless of vaginal delivery, number of deliveries or stratified-age. In vaginal delivery, number of deliveries does impact on detection of sphincter defects and liability to fecal incontinence.
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Korula, Deepa Rebecca, Anuradha Chandramohan, Reetu John, and Anu Eapen. "Barium Defecating Proctography and Dynamic Magnetic Resonance Proctography: Their Role and Patient’s Perception." Journal of Clinical Imaging Science 11 (June 4, 2021): 31. http://dx.doi.org/10.25259/jcis_56_2021.
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Objectives: The objectives of the study were to compare the imaging findings and patient’s perception of barium defecating proctography and dynamic magnetic resonance (MR) proctography in patients with pelvic floor disorders. Material and Methods: This is a prospective study conducted on patients with pelvic floor disorders who consented to undergo both barium proctography and dynamic MR proctography. Imaging findings of both the procedures were compared. Inter-observer agreement (IOA) for key imaging features was assessed. Patient’s perception of these procedures was assessed using a short questionnaire and a visual analog scale. Results: Forty patients (M: F =19:21) with a mean age of 43.65 years and range of 21–75 years were included for final analysis. Mean patient experience score was significantly better for MR imaging (MRI) (p < 0.001). However, patients perceived significantly higher difficulty in rectal evacuation during MRI studies (p = 0.003). While significantly higher number of rectoceles (p = 0.014) were diagnosed on MRI, a greater number of pelvic floor descent (p = 0.02) and intra-rectal intussusception (p = 0.011) were diagnosed on barium proctography. The IOA for barium proctography was substantial for identifying rectoceles, rectal prolapse and for determining M line, p < 0.001. There was excellent IOA for MRI interpretation of cystoceles, peritoneoceles, and uterine prolapse and substantial to excellent IOA for determining anal canal length and anorectal angle, p < 0.001. The mean study time for the barium and MRI study was 12 minutes and 15 minutes, respectively. Conclusion: Barium proctography was more sensitive than MRI for detecting pelvic floor descent and intrarectal intussusception. Although patients perceived better rectal emptying with barium proctography, the overall patient experience was better for dynamic MRI proctography.
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Kavanagh, D. O., H. Imran, A. Almoudaris, P. Ziprin, and O. Faiz. "Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen." Case Reports in Medicine 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/752357.
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A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.
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Rafiq, Suhail, Sheema Posh, Fahad Shafi, and Sheikh Riyaz. "Role of MRI defecography in assessment of pelvic floor pathologies." International Journal of Advances in Medicine 6, no. 4 (July 24, 2019): 1003. http://dx.doi.org/10.18203/2349-3933.ijam20193250.
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Background: Functional disorders of the pelvic floor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspecific symptoms such as constipation or incontinence, remain difficult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic floor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.
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Martin, Liam C., Megan R. Routzong, Steven D. Abramowitch, and Ghazaleh Rostaminia. "Effect of Squeeze, Cough, and Strain on Dynamic Urethral Function in Nulligravid Asymptomatic Women: A Cross-Sectional Cohort Study." Urogynecology 29, no. 9 (March 11, 2023): 740–47. http://dx.doi.org/10.1097/spv.0000000000001345.
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Importance In the past, urethral shape, mobility, and urodynamics have been used to retrospectively demonstrate correlations with stress urinary incontinence. Our previous work has shown a relationship between urethral function and shape in symptomatic women. Objective This study aimed to characterize the effect of pelvic floor squeeze and strain maneuvers on urethral shapes and pressure in a cohort of patients without pelvic floor disorders. Study Design In this cross-sectional study, volunteers underwent dynamic pelvic floor ultrasound examination, and a modified urodynamic study. Urethral length, thickness, and proximal and distal swing angles were measured at rest, squeeze, and strain. The midsagittal urethral walls were traced so that a statistical shape model could be performed. Means and standard deviations of imaging and urodynamic measures were calculated. Results Data from 19 participants were analyzed. On average during squeeze compared with rest, urethral length increased by 6%, thickness decreased by 42% (distal, P < 0.001), 10% (middle), and urethral pressure increased by 14%. Opposite shape changes—length decreased by 10% (P = 0.001), thickness increased by 57% (distal, P < 0.001), 20% (middle, P < 0.001)—and increased urethral mobility were observed during strain, with larger pressure increases occurring (29%, P < 0.001). Fifty-one percent of the total shape variance described the differences between maneuvers. These differences were statistically different between groups (P < 0.001 for comparisons, all others P > 0.05). Conclusions Dynamic ultrasound and urodynamics allow for the establishment of baseline ranges in urethral metrics (2-dimensional measures, shape, and pressure) and how they are altered during maneuvers. These data can allow for a more objective identification of incontinence via ultrasound and urodynamic testing.
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Kaminskyi, V. V., K. V. Chaika, Yu V. Lavreniuk, O. O. Diadyk, Yu I. Beketova, and O. P. Baryshnikova. "Comparative efficacy оf non-surgical correction of early-onset genital prolapse based on differentiated approach." Reproductive health of woman 3 (May 3, 2021): 75–80. http://dx.doi.org/10.30841/2708-8731.3.2021.234254.
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The paper presents the results of the comparative efficacy of non-surgical correction of early-onset genital prolapse (GP) in women of perimenopausal and menopausal age using differentiated approach. The objective: to study morphological traits of the vaginal walls and to compare the effectiveness of non-surgical techniques of GP correction. Materials and methods. The study involved 120 patients with early-onset GP. The treatment group (Group 1) consisted of 90 women with GP who were divided into three subgroups depending on the non-surgical correction technique chosen (utility model patent No.145380 from 10.12.2020): 1a (n=30) – GP correction by platelet-rich autoplasma, 1b (n=30) – GP correction by hyaluronic acid-based agent, 1c (n=30) GP correction using СО2 laser radiation. The experimental group (Group 2) consisted of 30 patients who underwent GP correction by training the pelvic floor muscles individually according to the standard method.Results. Three months after the treatment according to the patented method, the number of patients with GP of grade 2 decreased by 16.7% in group 1a, by 31.3% in group 1b and by 41.2% in group 1c. In patients of 1c subgroup, where the presence of the combined type (cystorectocele) of GP prevailed, in 19 women (63.3%) after the treatment there was an improvement in the morphological structure of the vaginal wall, which was manifested by a pronounced diffuse improvement in angiogenesis (in all layers) due to neoangiogenesis, preserved structure of collagen fibers with increasing density of the latter in the absence of signs of edema and mild degenerative changes. It should be noted that in subgroup 1b, three months after the treatment 17 (56.6%) women had no complaints which was associated with a significant improvement in the indicator of the size of elastin and collagen fibers, and only in 9 patients (30%) this indicator remained without changes. In subgroup 1a, the evaluation of the effectiveness of the non-surgical technique showed that only 10 (33.3%) women had a slight improvement in quality of life compared to baseline before treatment. In the experimental group, there was no positive dynamics, and in 9 women (30%) three months after the treatment there was an increase in manifestations of GP and symptoms associated with it, which was confirmed by such morphological changes as minimal focal signs of neoangiogenesis, thinned, significantly swollen collagen fibers, surrounded by interlayers of connective tissue.Conclusions. This algorithmic approach in non-surgical correction of GP contributes not only to the effective treatment of early-onset GP, prevention of further progression, but also to a significant improvement in quality of life.
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Su, Dongfang, Yufang Wen, and Qing Lin. "Particle Swarm Algorithm-Based Analysis of Pelvic Dynamic MRI Images in Female Stress Urinary Incontinence." Contrast Media & Molecular Imaging 2021 (July 30, 2021): 1–7. http://dx.doi.org/10.1155/2021/8233511.
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This work aimed to study the application of pelvic floor dynamic images of magnetic resonance imaging (MRI) based on the particle swarm optimization (PSO) algorithm in female stress urinary incontinence (SUI). 20 SUI female patients were selected as experimental group, and another 20 healthy females were taken as controls. PSO algorithm, K-nearest neighbor (KNN) algorithm, and back propagation neural network (BPNN) algorithm were adopted to construct the evaluation models for comparative analysis, which were then applied to 40 cases of female pelvic floor dynamic MRI images. It was found that the model proposed had relatively high prediction accuracy in both the training set (87.67%) and the test set (88.46%). In contrast to the control group, there were considerable differences in abnormal urethral displacement, urethral length changes, bladder prolapse, and uterine prolapse in experimental patients ( P < 0.05 ). After surgery, the change of urethral inclination angle was evidently reduced ( P < 0.05 ). To sum up, MRI images can be adopted to assess the occurrence of female SUI with abnormal urethral displacement, shortening of urethra length, bladder prolapse, and uterine prolapse. After surgery, the abnormal urethral movement was slightly improved, but there was no obvious impact on bladder prolapse and uterine prolapse.
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Pacini, G., S. Paolino, F. Goegan, P. F. Bica, E. Alessandri, C. Pizzorni, A. Sulli, et al. "THU0359 GENDER IMPACT ON LOWER URINARY TRACT INVOLVEMENT IN SYSTEMIC SCLEROSIS PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 410.1–411. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4701.
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Background:Lower urinary tract symptoms (LUTS) are an underdiagnosed but frequent manifestation in systemic sclerosis (SSc) [1]. LUTS pathogenesis in SSc is undetermined, mainly involving dysautonomia, fibrosis and a possible antibody-mediated damage [2]. Divergently from general population, female sex and advanced age are not reported to significantly impact LUTS in SSc [2].Objectives:To evaluate the potential influence of gender and hormone-related factors in LUTS prevalence and severity among SSc patients (Pts).Methods:A population of 42 SSc Pts and 50 age- and sex-matched healthy subjects (HSs) was evaluated. SSc diagnosis was based on 2013 ACR/EULAR criteria. Demographic data, medications interfering with pelvic floor dynamics and general comorbidities commonly associated with LUTS – diabetes mellitus, chronic heart failure, chronic obstructive pulmonary disease, peripheral neuropathy, pelvic organ prolapse, fecal incontinence – were recorded. Validated self-reported questionnaires derived from the International Conference on Incontinence were used to assess prevalence and severity of LUTS, namely of urinary incontinence (UI) and overactive bladder (OAB) [3]. Data were analysed using non-parametric tests. Apvalue <0.05 and a confidence interval (CI) of 95% were considered statistically significant.Results:There were no significant differences in main demographic data between SSc Pts and HSs. Specifically, median age was 61 years (IQR 21-85)vs57 years (IQR 28-93) and female prevalence 83%vs84% in SSc PtsvsHSs, respectively. Amongst the female population, 83% of SSc Ptsvs84% of HSs was in post-menopausal state, with a median of 1 (IQR 0-3)vs1 (IQR 0-4) pregnancy by natural route, respectively. No woman of the study had received hormone replacement therapy or local hormonal therapies prior to the study. Similarly, there were not any significant differences in analysed comorbidities, while ongoing treatment was significantly different between the two populations, SSc patients more frequently receiving calcium channel blockers and glucocorticoids than healthy subjects (p< 0.001). In SSc Pts, statistically significant correlation was observed between stress UI and sex, with an increased female-to-male ratio (p< 0.005), but any significant difference was observed in US distribution depending on parity and menopausal state, nor on other analysed variables. Interestingly, female dominance has not resulted as a significant predictive factor for LUTS prevalence or severity in SSc Pts. In fact, in the regression analysis, SSc disease was the only significant predictor for LUTS (OR 3.45, 95% CI 1.41-7.95; p< 0.01), independently of other analysed variables, particularly of gender and hormone-related factors.Conclusion:This study confirms the absence of pathogenic female-gender participation in LUTS prevalence among SSc Pts. However, consistently with findings on general population, a significant increased prevalence of urinary symptoms, particularly of stress UI, in SSc female Pts has emerged [4]. It is therefore conceivable that hormonal factors may act as a catalytic circumstance rather than pathogenic players in LUTS progression during SSc disease.References:[1]John G et al. Arthritis Care Res (Hoboken) 2018;70(8):1218–27.[2]John G. Clin Rheumatol. 2020;39(1):5–8[3]Abrams P et al, J Urol. 2006;175:1063–6[4]Abelson B et al. Biol Sex Differ. 2018;9(1):45Disclosure of Interests:Greta Pacini: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Pietro Francesco Bica: None declared, Elisa Alessandri: None declared, Carmen Pizzorni: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Emanuele Gotelli: None declared, Francesco Cattelan: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha
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Murad-Regadas, Sthela Maria, Francisco Sergio P. Regadas, Lusmar Veras Rodrigues, Débora Couto Furtado, Ana Cecília Gondim, and Íris Daiana Dealcanfreitas. "Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions." Arquivos de Gastroenterologia 48, no. 4 (December 2011): 265–69. http://dx.doi.org/10.1590/s0004-28032011000400009.
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CONTEXT: The correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. OBJECTIVES: To determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. METHODS: Four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3D ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade II or III, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade III). In addition, sphincter damage was evaluated. Patients were grouped according to age (<50y x >50y) and stratified by mode of delivery and parity: group I (<50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group II (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. Additionally, patients were stratified by number of vaginal deliveries: 0 - nulliparous (n = 135), 1 - vaginal (n = 46), >1 - vaginal (n = 166). RESULTS: Rectocele grade II or III, intussusception, rectocele + intussusception and sphincter damage were more prevalent in Group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001). The stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. Entero/sigmoidocele was more prevalent in the vaginal group <50y and in the nulliparous and vaginal groups >50y. No correlation was found between rectocele and the number of vaginal deliveries. CONCLUSION: Higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. However, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.