Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population

Rizk, Diaa E. E.; Czechowski, Janusz; Ekelund, Leif

doi:10.1016/j.ajog.2003.12.041

Cited by 38 publications

(47 citation statements)

References 21 publications

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“…Older (>29 years of age) and parous women were excluded to avoid the confounding effect of age and vaginal delivery, respectively, on pelvic floor integrity (5,7,10). Subjects who agreed to participate gave written informed consent and were screened for the presence of support-related pelvic floor issues using the validated short form of the Pelvic Floor Distress Inventory (PFDI-20) (13).…”

Section: Methodsmentioning

confidence: 99%

“…The prevalence of support-related pelvic floor dysfunctions is affected by racial and ethnic origin, with a higher risk observed in Caucasians than in other populations (8)(9)(10). This may be explained by genetic, environmental and/or anatomical differences (8)(9)(10). Ethnic variation in the integrity of the pelvic floor connective tissue may be the possible genetic mechanism (10).…”

Section: Introductionmentioning

confidence: 99%

“…The latter depends on a critical balance between collagen degradation and production that is controlled by a group of enzymes, matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) (1,3,5). The prevalence of support-related pelvic floor dysfunctions is affected by racial and ethnic origin, with a higher risk observed in Caucasians than in other populations (8)(9)(10). This may be explained by genetic, environmental and/or anatomical differences (8-10).…”

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confidence: 99%

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Circulating matrix metalloproteinases and their tissue inhibitors as markers for ethnic variation in pelvic floor tissue integrity

et al. 2018

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Abstract. The purpose of the present study was to measure the plasma levels of matrix metalloproteinases (MMP)-2 and -9 and their tissue inhibitors (TIMP)-1 and -2, as surrogate biomarkers for pelvic floor tissue integrity in young, healthy multi-ethnic women. This was hoped to elucidate ethnic vulnerability to support-related pelvic floor dysfunctions. The plasma levels of MMP-2 and -9 and TIMP-1 and -2 were measured by sandwich ELISA in nulliparous, young (18-29 years) women volunteers (n=85) from five ethnic groups [n=17/group; Bahrainis, other Arabs, Filipinos, Indians/Pakistanis and Caucasians (Italians)] and compared with levels in Italians as the reference group. It was identified that the levels of plasma MMP-2 were significantly higher in Italians than in Bahrainis (P<0.001) and Filipinos (P<0.001), but significantly lower than in Indians/Pakistanis (P=0.013); whereas, the levels of plasma MMP-9 were significantly higher in Italians than in Bahrainis (P=0.009) and Indians/Pakistanis (P<0.015). The levels of plasma TIMP-2 were significantly lower in Italians than in Indians/Pakistanis (P=0.003), but the levels of plasma TIMP-1 were significantly higher in Italians than in all other groups (P<0.05) excluding Bahrainis. Although MMP-2 correlated negatively with TIMP-2 and MMP-9 correlated positively with TIMP-1, both correlations were not significant (r=0. 071, P=0.533 and r=0.197, P=0.8, respectively). In all ethnic groups, MMP-9 level correlated positively with BMI (r=0.26, P=0.02), and TIMP-2 level with age (r=0.23, P=0.045). Overall, the trends for higher levels of MMP-2 and -9 and lower levels of TIMP-2 in the plasma of Caucasian women may indicate a greater tendency for collagenolysis and weaker connective tissue with increased risk of developing pelvic floor dysfunctions, and thus may potentially serve as biomarkers for pelvic floor tissue integrity. IntroductionSupport-related pelvic floor dysfunctions including pelvic organ prolapse (POP), stress urinary incontinence (SUI) and faecal incontinence are caused by structural defects in the complex supportive apparatus formed by the connective tissue and striated muscles of the pelvic floor (1-7). The role of the connective tissue component is to counteract both stretch and compression of the pelvic floor exerted by the gravitational and inertial forces of the intra-abdominal pressure and to repair damaged tissues (2,4,6). This supportive function is determined by the tensile strength of collagen in the extracellular matrix that is maintained by continuous remodelling of collagen (1,3). The latter depends on a critical balance between collagen degradation and production that is controlled by a group of enzymes, matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) (1,3,5). The prevalence of support-related pelvic floor dysfunctions is affected by racial and ethnic origin, with a higher risk observed in Caucasians than in other populations (8)(9)(10). This may be explained by genetic, environmental and/or anatomical difference...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Circulating matrix metalloproteinases and their tissue inhibitors as markers for ethnic variation in pelvic floor tissue integrity

et al. 2018

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“…24) [44][45][46]. If alternative landmarks are used in scientific papers they should be clearly described (Fig.…”

Section: C: Magnetic Resonance Imaging (Mri) Of the Pelvic Floormentioning

confidence: 99%

Erratum to: An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)

et al. 2016

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“…The hypothesis is biologically plausible since variations in pelvic inclination alter the direction of intraabdominal vector forces and the degree of transmission of abdominal pressure onto the pelvic floor, thereby influencing the development of pelvic floor weakness and subsequent prolapse [7]. The PICS line, a new reference line, is a significant novelty in the standardization of pelvic floor measurements using MRI.…”

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confidence: 99%

Standardization of dynamic magnetic resonance imaging measurements of pelvic organ prolapse: can the PICS line help?

Rizk

Tunn

2013

Int Urogynecol J

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Dynamic magnetic resonance imaging (MRI) of the pelvis has been rapidly introduced into urogynecological research and practice in recent years mainly to address the shortcomings of clinical assessment systems in women with pelvic organ prolapse (POP). The primary objective was to better select candidates for surgical intervention and choose the appropriate procedure in order to reduce recurrences by allowing accurate identification and objective measurement of prolapse and simultaneous topographic assessment of the pelvis at rest and straining [1][2][3][4][5]. MRI is particularly indicated in women with multi-compartment POP and in those who had undergone previous repair, as imaging can reveal more extensive prolapse than physical examination alone with detection rates similar to other conventional fluoroscopic and ultrasound methods [1,3,4]. Staging of POP using MRI has also been suggested by measuring the perpendicular distance between several reference points and lines in each compartment at rest and after straining [1][2][3][4][5]. The two most commonly used lines are one connecting the inferior aspect of the pubic symphysis to the last coccygeal joint, the pubococcygeal line (PCL), and one extending caudally along the long axis of the symphysis pubis, the midpubic line (MPL). Several MRI staging systems have been published for both of these lines [1,3,4].Despite the widely accepted role of MRI in supplementing clinical evaluation and management of women with POP, this imaging modality has certain limitations. Most importantly, so far, there has been no standardized technique for performing MRI examination of the pelvis. Imaging protocols vary according to patient positioning, filling media, pelvic organ opacification, patient maneuvers (i.e., rest, Kegel, Valsalva, evacuation) and MRI sequences and planes [1][2][3][4][5]. Most of the available imaging systems are unable to demonstrate the full extent of POP because patients are examined in a supine position promoting current efforts to image patients in the sitting and upright position using open-magnet MRI units [1,[3][4][5]. In fact, sagittal plane images of women with POP that are commonly displayed in the literature as if taken in the upright position had been made in the supine position [6]. A further major problem with MRI studies of the pelvis is the incomplete reproducibility and lack of standardization of the patient effort exerted during straining [3][4][5].The anatomical landmarks used for pelvic measurements are easily identified in MRI and this is expected to increase the validity of measurement [5]. The intra-and inter-observer reliability of most MRI measurements is, however, rarely described in POP studies [2]. Furthermore, the reference line used for MRI interpretation of POP is not consistent in all studies as this is often based on radiologist experience and referring physician preference [1,5]. In a recent systematic review, seven different reference lines in relation to a wide variety of reference points have been used in different stud...

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Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population

Cited by 38 publications

References 21 publications

Circulating matrix metalloproteinases and their tissue inhibitors as markers for ethnic variation in pelvic floor tissue integrity

Circulating matrix metalloproteinases and their tissue inhibitors as markers for ethnic variation in pelvic floor tissue integrity

Erratum to: An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)

Standardization of dynamic magnetic resonance imaging measurements of pelvic organ prolapse: can the PICS line help?

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