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- TEXT HERE
4D Translabial ultrasound concordance with digital palpation and - - PowerPoint PPT Presentation
4D Translabial ultrasound concordance with digital palpation and - - PowerPoint PPT Presentation
TEXT HERE AUTHORS: Martinho N, Botelho S, Nagib A, Jales R, Juliato C, Turel F, Caagbay D, Riccetto C. 4D Translabial ultrasound concordance with digital palpation and superficial electromyography during dynamic pelvic floor muscles
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Introduction
Deegan et al. Neurourol Urodyn 2018;37:33-45
PFM assessment is strongly recommended.
Bo et al. Neurourol Urodyn. 2017;36:221-244
ü There is no gold standard method; ü Little is known about the correlation between imaging methods and other PFM assessment methods.
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Objective
- Pelvic
floor morphological changes
- btained
through 4D translabial ultrasound (4D TLUS)
- PFM strength assessed by digital
palpation
- PFM
electromyography activity assesed by sEMG
Concordance between:
Secondary objective: Which ultrasound parameters better predicts digital palpation?
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Methods
Cross sectional study
Approved by the local Human Research Ethics Committe (CAAE: 42456114.8.0000.5404)
Digital palpation (graded by the MOS)
Laycock; Jerwood. Physiother. 2001;87:631-642
Superficial EMG (Mean RMS of 3 contractions)
Botelho et al. Neurourol Urodyn. 2013;32(5):420-423
4D translabial ultrasound (at rest and during contraction)
Dietz et al. Clin Obstet Gynecol. 2017;60(1):58–81
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Methods
v Levator plate angle v Bladder neck elevation Calculated the difference between measurements at rest and during PFM contraction.
4D TRANSLABIAL ULTRASOUND
v Hiatal area v Puborectal strain
Dietz et al., 2001; Braekken et al., 2008;; Majida et al., 2009 Dietz et al., 2005; Thyer et al., 2008
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Results
83.3% were multiparous (median parity: 2.0) 68.6% were SUI (mean ICIQ UI-SF: 9.4±7.1)
279 women were recruited FINAL SAMPLE (n=210 women) Mean age: 45.8 years old (range from 20 to 70) Mean BMI: 25.7 kg/m2 (range from 15.2 to 46.0) EXCLUDED (n=69)
- Current urinary tract infection (n=3)
- Cognitive, physical or neurological disorders (n=2)
- Brachytherapy or neovagina (n=4)
- SUI or/and pelvic organ prolapse surgical history (n=18)
- Any pelvic organ prolapse exceeding the vaginal opening (n=7)
- PFM contraction grade either zero or one (n=29)
- Unable to retrieve ultrasound or EMG data (n=6)
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Results
p=0.04 r=0.1
Figure 1. Scatter plot of the correlation between pelvic floor muscles electromyography (PFM sEMG) and the change in levator plate angle.
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Table 1. Mean changes in ultrasound values in relation to each category of the Modified Oxford Scale.
Results
Modified Oxford Scale - M±SD (Min-Max) p-value1 Multiple comparisons 2 (n=105) 3 (n=75) 4 (n=29) Change in levator plate angle (degree) 5.82±7.02 (-12.03 –26.61) 10±8.08 (-15.63 - 28.08) 11.56±6.93 (-4.4 – 29.43) <.0001 3,4 > 2 Bladder neck elevation (cm) 0.47±0.28 (0.02 - 1.27) 0.65±0.34 (0.08 - 1.47) 0.68±0.30 (0.10 - 1.36) <.0001 3,4 > 2 Change in hiatal area (%) 15.32±10.62 (-12.77 – 46.76) 23.21±11.85 (-8.44 – 50.45) 23.89±12.38 (-1.85 – 49.91) <.0001 3,4 > 2 Puborectal strain (cm)
- 0.13±0.08
(-0.34 - 0.09)
- 0.20±0.09
(-0.38- 0.03)
- 0.22±0.11
(-0.47 - -0.01) <.0001 2 > 3,4
1Kruskal-Wallis test. 2Dunn test.
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Table 2. Univariate and multivariate analyzes to test which ultrasound parameters predicts the PFM contractility assessed by digital palpation.
Results
UNIVARIATE ANALYSIS p-value Grade 2 x 31 Grade 2 x 41 OR 95% CI OR 95% CI Change in levator plate angle 0.0001 1.081 1.035 – 1.129 1.112 1.048 – 1.180 Bladder neck elevation 0.0001 7.652 2.696 – 21.721 9.893 2.572 – 38.055 Change in hiatal area <.0001 1.857 1.394 - 2.474 1.957 1.333 - 2.875 Puborectal strain¶ <.0001 2.475 1.701 - 3.600 2.923 1.780 - 4.831 MULTIVARIATE ANALYSIS R2 = 21.77% Change in levator plate angle 0.0169 1.055 1.008 – 1.104 1.081 1.016 – 1.150 Puborectal strain¶ <.0001 0.452 0.307 – 0.665 0.403 0.240 – 0.674
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Conclusion
ü 4D TLUS significantly correlate with digital palpation and sEMG, being the change in levator plate angle the parameter that best correlates with both methods; ü We recommend 4D TLUS as a beneficial non-invasive clinical tool for evaluation of pelvic floor additional in-depth information.
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Acknowledgements