Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review

Gao, Yuanjing; Zhao, Zhiwei; Yang, Yanlin; Zhang, Meiqin; Wu, Jiang; Miao, Yong

doi:10.1007/s00192-019-04066-w

Cited by 21 publications

(30 citation statements)

References 55 publications

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“…Thus, the inferior margin of the PS was considered the fixed point, and all measures were done in only one ultrasound field. The horizontal line (HL) crossing the lower edge of the PS was considered the reference level for all ultrasound measures (10). The urinary bladder neck, also known as the urethrovesical junction, is indicated as BN and identified as the point of meeting between the most inferior part of the urinary bladder and the most superior part of the urethra.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, there are claims of vaginal mesh contracture although reports of shorttime follow-up indicated no contracture [6][7][8]. The value of radiologic imaging of pelvic mesh by computerized tomography CT scan and magnetic resonance imaging (MRI) is limited, and it does not provide optimal visualization of synthetic mesh implants [9][10][11][12]. Thus, ultrasound has been used in diagnosis of pelvic organ prolapse, voiding dysfunction, and evaluation of synthetic vaginal meshes for pelvic organ prolapse and urinary incontinence [9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

Poutakidis

Marsk²,

Altman

et al. 2021

Int Urogynecol J

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Introduction and hypothesis Vaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes. Methods Seventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C ≥ stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain. Results Original mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 ± 5.2 to 29.2 ± 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r − 0.254 and − 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r − 0.245). Conclusions Five years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

Poutakidis

Marsk²,

Altman

et al. 2021

Int Urogynecol J

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“…Since POP is a highly patient-specific anatomical condition, pelvic ultrasounds such as 3D endovaginal ultrasound (EVUS), 2D perineal pelvic floor ultrasound (pPFUS), transperineal ultrasound (TPUS), and translabial ultrasound (TLUS) [ 90 , 91 ] can potentially help identify the optimal size of implant required by the patient. The CAD model thus generated can be transformed into a transplantable 3D vasculature using 3D bioprinting ( Figure 6 ), which might lead to future POP application.…”

Section: New Generation Of Meshes For Pop Surgerymentioning

confidence: 99%

“…Apart from development of surgical devices, there is significant advancement in diagnostic devices that are developed through 3D printing as well as ultrasound methods for identifying POP and locating the weakened vaginal location. Pelvic floor ultrasound has emerged as a dynamic assessment tool for selecting appropriate patients for conservative or surgical management, thereby aiding in the counselling of patients on realistic expectations and strengthening the clinical examination of prolapse symptoms based on a current quantification known as POP-Q [ 90 ]. The diagnosis of levator defect after vaginal childbirth can be facilitated using pelvic floor ultrasound, particularly the identification of anatomical defect location.…”

Section: Future Directionsmentioning

confidence: 99%

“…Fine-tuning of these parameters to achieve optimal scaffolds for POP will require intensive engineering-based research before they can be considered for clinical application. Since POP is a highly patient-specific anatomical condition, pelvic ultrasounds such as 3D endovaginal ultrasound (EVUS), 2D perineal pelvic floor ultrasound (pPFUS), transperineal ultrasound (TPUS), and translabial ultrasound (TLUS) [90,91] can potentially help identify the optimal size of implant required by the patient. The CAD model thus generated can be transformed into a transplanTable 3D vasculature using 3D bioprinting (Figure 6), which might lead to future POP Since POP is a highly patient-specific anatomical condition, pelvic ultrasounds such as 3D endovaginal ultrasound (EVUS), 2D perineal pelvic floor ultrasound (pPFUS), transperineal ultrasound (TPUS), and translabial ultrasound (TLUS) [90,91] can potentially help identify the optimal size of implant required by the patient.…”

Section: Mesh Fabrication Using 3d Printing and 3d Bioprintingmentioning

confidence: 99%

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Emerging Nano/Micro-Structured Degradable Polymeric Meshes for Pelvic Floor Reconstruction

et al. 2020

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Pelvic organ prolapse (POP) is a hidden women’s health disorder that impacts 1 in 4 women across all age groups. Surgical intervention has been the only treatment option, often involving non-degradable meshes, with variable results. However, recent reports have highlighted the adverse effects of meshes in the long term, which involve unacceptable rates of erosion, chronic infection and severe pain related to mesh shrinkage. Therefore, there is an urgent unmet need to fabricate of new class of biocompatible meshes for the treatment of POP. This review focuses on the causes for the downfall of commercial meshes, and discusses the use of emerging technologies such as electrospinning and 3D printing to design new meshes. Furthermore, we discuss the impact and advantage of nano-/microstructured alternative meshes over commercial meshes with respect to their tissue integration performance. Considering the key challenges of current meshes, we discuss the potential of cell-based tissue engineering strategies to augment the new class of meshes to improve biocompatibility and immunomodulation. Finally, this review highlights the future direction in designing the new class of mesh to overcome the hurdles of foreign body rejection faced by the traditional meshes, in order to have safe and effective treatment for women in the long term.

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Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women

Lakovschek

Trutnovsky

Obermayer–Pietsch

et al. 2021

J of Ultrasound Medicine

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Objectives To investigate the changes in the pelvic floor before, during, and after pregnancy in the same collective of nulliparous women. Methods In a prospective observational pilot study between April 2015 and June 2019 in nulliparous women with planned pregnancy, we used the pelvic organ prolapse quantification (POP‐Q) system; a 2‐dimensional (2D) sonography to investigate the bladder neck, cervix, and anorectal junction positions; and a 3D/4D sonography to measure the hiatus of the levator ani muscle (LH area) during Valsalva maneuver. Five visits were planned: 1 before, 3 during, and 1 visit after pregnancy. Results Twenty‐four women participated in the study. We achieved a minimum of 2 visit measurements from 10 women who became pregnant. The LH area decreased during the first trimester and then increased until the third trimester. Postpartum, the LH area reached the prepregnancy state. We observed changes in the bladder neck mobility, bladder neck position, cervix, and anorectal junction from the first trimester. Postpartum, the bladder neck mobility was higher, and the position of the bladder neck and anorectal junction was lower than before pregnancy. We observed no remarkable changes in the POP‐Q state during pregnancy. Conclusion This was the first study to investigate pelvic floor characteristics in the same collective before, during, and after pregnancy. We observed pelvic floor changes from the prepregnancy state to the first trimester to postpartum. The study results need to be confirmed in a larger study.

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Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review

Cited by 21 publications

References 55 publications

Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

Emerging Nano/Micro-Structured Degradable Polymeric Meshes for Pelvic Floor Reconstruction

Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women

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