Four-Dimensional Introital Ultrasound in Assessing Perioperative Pelvic Floor Muscle Functions of Women with Cystoceles

Abstract

Purpose Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele.

Materials and Methods The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317 women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound.

Results The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P < 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88–42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P < 0.001, OR 0.16, 95 % CI 0.06–0.43) than those without postoperative cystocele postoperatively.

Conclusion 4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.

Zusammenfassung

Ziel Die Forschung über den Einsatz von Ultraschall zur Untersuchung des Beckenbodens bei Frauen wird selten mit Introitus-Sonografie durchgeführt. Ziel dieser Studie war es, die Leistungsfähigkeit der 4-dimensionalen (4D) Introitus-Sonografie bei der perioperativen Beurteilung der Funktion der Beckenbodenmuskulatur (PFM) bei Frauen mit Zystozele zu untersuchen.

Material und Methoden Die Reliabilität und Übereinstimmung der Ultraschallmessungen wurden bei 20 Frauen mittels Intraklassen-Korrelationskoeffizienten (ICC) mit 95 %-Konfidenzintervall und Bland-Altman-Analyse bestimmt. Die Validität der Ultraschallparameter wurde bei 317 Frauen durch Korrelation der Ultraschallmessungen beim Pressen mit der modifizierten Oxford-Skala (MOS) beurteilt. Daten der 4D-Introitus-Sonografie von 241 Frauen mit (n = 29) und ohne (n = 212) postoperative Zystozele in der 12-monatigen postoperativen Erfassung wurden retrospektiv analysiert. Eine Levator-Avulsion wurde mittels tomografischen Ultraschalls diagnostiziert. Die nichtwillentlichen und willentlichen PFM-Funktionen wurden durch dynamische Veränderungen im Blasenhals bzw. im genitalen Hiatus beim Husten und Pressen im 4D-Introital-Ultraschall untersucht.

Ergebnisse Die ICC für die Reliabilität aller untersuchten Ultraschallparameter war gut bis sehr gut. Bei den meisten Ultraschallmessungen waren die Änderungen und die Änderungsverhältnisse zwischen Ruhezustand und Pressen ordentlich mit der MOS korreliert. Frauen mit postoperativer Zystozele zeigten im Vergleich zu Frauen ohne eine höhere Rate an vollständiger Levator-Avulsion (41,3 % vs. 4,7 %; p < 0,001; Odds-Ratio (OR) 14,26; 95 %-Konfidenzintervall (CI) 4,88–42,42) und eine geringere Fähigkeit zur willentlichen PFM-Kontraktion (65,5 % vs. 92,5 %; p < 0,001; OR 0,16; 95 %-CI 0,06–0,43).

Schlussfolgerung Die 4D-Introitus-Sonografie ist zur Beurteilung der perioperativen PFM-Funktion bei Frauen mit Zystozele durchführbar.

Key words

introital ultrasound - levator avulsion - pelvic floor muscle - reliability - validity

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