scholarly journals MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique

2017 ◽  
Vol 6 (8) ◽  
pp. 3400
Author(s):  
Anupama Dave ◽  
Ruchi Joshi ◽  
Vibhu Goel ◽  
Atisha Dave
Keyword(s):  
Pelvic Floor ◽  
Clinical Examination ◽  
Pelvic Floor Disorders ◽  
Uterine Prolapse ◽  
Pelvic Floor Dysfunction ◽  
Symptom Relief ◽  
Pelvic Organ ◽  
Posterior Compartment ◽  
Imaging Evaluation ◽  
Middle Compartment

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.

scholarly journals Sexual function in women with pelvic floor disorders

2013 ◽  
Vol 7 (9-10) ◽  
pp. 199 ◽  
Author(s):  
Rebecca G. Rogers
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
The Impact

Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction.

scholarly journals Evaluation of Pelvic Floor Dysfunction for Patient with History of Total Vaginal Hysterectomy at Dr Sardjito General Hospital Yogyakarta

2021 ◽  
Vol 04 (08) ◽  
Author(s):  
Mochammad Andi Gunawan ◽  
Keyword(s):  
Pelvic Floor ◽  
General Hospital ◽  
Vaginal Hysterectomy ◽  
Uterine Prolapse ◽  
Pelvic Floor Dysfunction ◽  
Secondary Data ◽  
Pelvic Organ ◽  
Inclusion Criteria ◽  
Anatomic Structure ◽  
History Of

Introduction: Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of failure of the ligamentous and fascial supports. It often coexist with prolapse of the vaginal walls, involving the bladder or rectum. A surgical treatment for uterine prolapse is hysterectomy. Changes in pelvic anatomic structure due to hysterectomy can result in impaired pelvic function because of nerve or pelvic muscle structure damage during surgery. Objective: This study aims to evaluate the presence of pelvic floor dysfunction in uterine prolapse patients who have undergone Total Vaginal Hysterectomy (TVH) surgery at Dr Sardjito General Hospital, from November 2018 to September 2019. Evaluations were carried out using Pelvic Floor Distress Inventory (PFDI) questionnaire. Methods: This study is an analytical descriptive research, using secondary data taken from patient’s medical records at Dr. Sardjito General Hospital Yogyakarta. It uses The Pelvic Floor Distress Inventory (PFDI) questionnaire, which consisted of 3 assessment groups, those are Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal-Anal Distress Inventory 8m(CRADI 8), and Urinary Distress Inventory 6 (UDI- 6). The inclusion criteria of this study were patients with diagnoses of uterine prolapse, cystocele and rectocele, who could be contacted and gave consent to conduct telephone interview. Results: There were 14 patients that met the inclusion criteria, they are uterine prolapse, cystocele and rectocele patients with a history of TVH procedure, were assessed using PFDI questionnaire. All patients did not have any pelvic floor dysfunction either from the POPDI-6, CRADI-8 or UDI-6 assessment groups. The weakness of this evaluation is that the PFDI postoperative value cannot be compared with before surgery, so it cannot be proven that the absence of pelvic floor dysfunction in the patient concerned is a positive result of the surgery performed, or not give significant changes. Conclusion: There is no pelvic floor dysfunction in patients with a history of TVH procedure on the indication of uterine prolapse, which was performed at Dr Sardjito General Hospital Yogyakarta.

Five-year outcome after pelvic floor reconstructive surgery: evaluation using dynamic magnetic resonance imaging compared to clinical examination and quality-of-life questionnaire

2018 ◽  
Vol 59 (10) ◽  
pp. 1264-1273 ◽  
Author(s):  
Céline D Alt ◽  
Laura Benner ◽  
Theresa Mokry ◽  
Florian Lenz ◽  
Peter Hallscheidt ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Clinical Examination ◽  
Reconstructive Surgery ◽  
De Novo ◽  
Pelvic Organ ◽  
Dynamic Magnetic Resonance Imaging ◽  
Maximum Strain ◽  
Resonance Imaging ◽  
Posterior Compartment

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.

scholarly journals Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

2021 ◽  
Vol 81 (02) ◽  
pp. 183-190
Author(s):  
Gert Naumann
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Professional Training ◽  
Pelvic Floor Dysfunction ◽  
Estrogen Therapy ◽  
Pelvic Organ ◽  
Alloplastic Materials ◽  
Wide Range ◽  
Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

scholarly journals How Do We Assess Patient Skills in a Competence-Based Program? Assessment of Patient Competences Using the Spanish Version of the Prolapse and Incontinence Knowledge Questionnaire and Real Practical Cases in Women with Pelvic Floor Disorders

2021 ◽  
Vol 18 (5) ◽  
pp. 2377
Author(s):  
Beatriz Sánchez-Sánchez ◽  
Beatriz Arranz-Martín ◽  
Beatriz Navarro-Brazález ◽  
Fernando Vergara-Pérez ◽  
Javier Bailón-Cerezo ◽  
...  
Keyword(s):  
Decision Making ◽  
Pelvic Floor ◽  
Discriminant Validity ◽  
Pelvic Floor Disorders ◽  
Assessment Tool ◽  
Pelvic Organ ◽  
Assessment Tools ◽  
Measurement Properties ◽  
Competence Assessment ◽  
Knowledge Questionnaire

Therapeutic patient education programs must assess the competences that patients achieve. Evaluation in the pedagogical domain ensures that learning has taken place among patients. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a tool for assessing patient knowledge about urinary (UI) and pelvic organ prolapse (POP) conditions. The aim of this study was to translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Spanish and test its measurement properties, as well as propose real practical cases as a competence assessment tool. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Measurement properties analysis was performed by assessing the validity, reliability, responsiveness, and interpretability. A total of 275 women were recruited. The discriminant validity showed statistically significant differences in the PIKQ scores between patients and expert groups. Cronbach’s alpha revealed good internal consistency. The test–retest reliability showed excellent correlation with UI and POP scales. Regarding responsiveness, the effect size, and standardized response mean demonstrated excellent values. No floor or ceiling effects were shown. In addition, three “real practical cases” evaluating skills in identifying and analyzing, decision making, and problem-solving were developed and tested. The Spanish PIKQ is a comprehensible, valid, reliable, and responsive tool for the Spanish population. Real practical cases are useful competence assessment tools that are well accepted by women with pelvic floor disorders (PFD), improving their understanding and their decision-making regarding PFD.

scholarly journals Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 387
Author(s):  
Karolina Eva Romeikienė ◽  
Daiva Bartkevičienė
Keyword(s):  
Clinical Trials ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Randomized Clinical Trials ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Cochrane Library ◽  
Muscle Training

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

scholarly journals Is evacuation proctography still the gold standard for the diagnosis of posterior compartment pelvic floor disorders?

2017 ◽  
Vol 211 ◽  
pp. 202
Author(s):  
Isabelle van Gruting ◽  
Aleksandra Stankiewicz ◽  
Kirsten Kluivers ◽  
Helena Blake ◽  
Ranee Thakar ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Gold Standard ◽  
Pelvic Floor Disorders ◽  
Posterior Compartment ◽  
Evacuation Proctography

scholarly journals bFGF Activates Integrin β1 and Subsequently Upregulates Collagens via the p-MEK1/2/p-ERK1/2 Signaling Pathway in L929 Cells

2021 ◽  
Author(s):  
Lian Yang ◽  
Shasha Hong ◽  
Yang Li ◽  
Tingting Wang ◽  
Li Hong
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Signaling Pathway ◽  
Pelvic Floor Dysfunction ◽  
Underlying Mechanism ◽  
Pelvic Organ ◽  
Integrin Β1 ◽  
L929 Cells ◽  
Signal Transduction Protein ◽  
Special Project

Abstract The substantial loss of collagen in the supporting tissues of the pelvic floor is characteristic of pelvic organ prolapse (POP). A bFGF-induced collagen increase has been widely recognized by scholars, but the role of bFGF in pelvic floor dysfunction and the mechanism by which bFGF promotes collagen have not been reported. Here, we elucidated this mechanism. After bFGF stimulation, L929 cells showed significantly increased expression of collagen, integrin β1, and MEK1/2 signaling proteins. Our previous studies showed that integrin β1 plays an important role in electric stimulation-induced collagen expression, which suggests an underlying mechanism. By overexpressing and silencing integrin β1, we proved that integrin β1 is also an important signal transduction protein of bFGF that promotes collagen through the MEK1/2 pathway, which is a classic collagen-promoting pathway. In summary, these findings suggest that bFGF can stimulate the expression of collagen through the integrin β1/p-MEK1/2/p-ERK/1/2 signaling pathway in L929 cells. Keyword Pelvic organ prolapse; bFGF; integrinβ1; ERK1/2; Collagen Special project for Chinese women's pelvic floor dysfunction prevention and treatment (no. 201817092) and the Natural Science Foundation of Hubei Province（no.2019CFB149）.

scholarly journals Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Moussa ◽  
Y I Abdelkhaleq ◽  
S M Botros ◽  
A A Montasser
Keyword(s):  
Pelvic Organ Prolapse ◽  
Physical Examination ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Magnetic Resonance Defecography ◽  
Facial Defect ◽  
Floor Failure ◽  
Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

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