eRapport

THREE AND FOUR DIMENSIONAL PERINEAL ULTRASOUND IN THE ASSESMENT OF THE PELVIC FLOOR MUSCLE AND PELVIC ORGAN DESCENT

Prosjekt
Prosjektnummer
2008130
Ansvarlig person
Memona Majida
Institusjon
Akershus universitetssykehus HF
Prosjektkategori
Doktorgradsstipend
Helsekategori
Renal and Urogenital
Forskningsaktivitet
4. Detection and Diagnosis
Rapporter
2011 - sluttrapport
Pelvic organ prolapse is a common problem associated with substantial morbidity and reduction in quality of life. Current management strategies are unsatisfactory with high failure rates. More precise diagnostic tools to investigate the morphology and functional anatomy of the pelvic floor are needed in order to individualize management for women with POP. MRI has been the golden standard for direct visualization of pelvic floor but it is costly, not easily accessible. 3D/ 4D transperineal ultrasound is a new diagnostic method, cheap, readily available and with fewer restrictions in patient position has the potential to improve assessment of pelvic floor morphology and function. Studies were required to systematically assess the reliability, validity and clinical use of this diagnostic technique. To our knowledge present studies are the first systematic attempt to assess the reliability and validity of the technique and its possible clinical use in women with pelvic organ prolapse. Results from Study I and II showed that transperineal ultrasound is reliable and valid diagnostic method. Study III and IV assessing the clinical use of this diagnostic tool in women with POP demonstrated relationship between size of levator hiatus; stage, site of POP and presence of pubovisceral muscle defects but no correlations. The findings strengthens the potential of it accepted in daily practice Clinical uses of 3D/4D transperineal ultrasound can base upon various components of this procedure. These three components are, A - Transperineal approach; by using this approach morphology and function of the organs can easily be assessed without applying pressure or distention to the area of interest and by this way avoiding flask results. B -Visualizations ability in sagittal plan; by using sagittal plane one could visualize organs in different compartments and abnormalities can be identified. Surgeons are able to get important information about position of implants used in incontinence procedures in relation to urethra as the success of procedure is found to be associated with position of implants. C - Accessibility of axial plane images; accessibility of axial plane data adds considerable superiority to this diagnostic method. By using this method position and shape of different organs and implants can be visualized in axial plane. Physiotherapists can use 3D/4D transperineal ultrasound to assist in teaching the correct PFMT. Patients with POP have opportunity to get visual feedback by this method. In conclusion, we feel confident about using 3D/4D transperineal ultrsonography as a tool for exploring the anatomy and function of the pelvic floor. In short this technique has potential of improving patient management related to whole pelvic floor disorders spectra.
2010
Bekkenbunnsmuskulatur blir ofte skadet under barnefødselen og kan resultere i urininkontinens, avføringsinkontinens og fremfall. 30 % av de pasientene som blir operert for fremfall kan få tilbakefall av sykdommen. Dette belyser behovet for preoperativ riktig diagnostikk.Målet med dette doktorgradsprosjektet er å validere metoden og vurdere klinisk bruk innen bekkenbunns- patologi. MR har tidligere vært gullstandard men har vært brukt kun i utvalgte tilfeller pga lite tilgjengelighet og kostbarhet. Det har vært vanskelig å gjøre nøyaktig diagnostikk på bekkenbunn pga beliggenhet. Med utvikling av 3D/4D transperineal ultralyd har man fått et nytt diagnostisk verktøy som er lett tilgjenglig, ikke kostbart, kan brukes i alle stillinger og hos gravide. Denne teknikken er ny og det er gjort veldig få valideringsstudier. Resultater av våre studier viser at metoden er reproduserbar og resultatene kan sammenlignes med MR1,2. Studie- resultater viser også at graden og type prolaps har mye å si for størrelsen på åpningen i bekkenbunnsmuskulatur3. I siste del av vår prosjekt skal vi se på skader på bekkenbunnsmuskulatur. REFERENCES 1. Majida M, Braekken IH, Umek W, Bo K, Saltyte BJ, Ellstrom EM. Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function. Ultrasound Obstet Gynecol 2009;33 : 567-573. 2. Majida M, Braekken IH, Bo K, Benth JS, Engh ME. Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest. Ultrasound Obstet Gynecol 2010;35 : 715-722. 3. Majida M, Braekken I, Bo K, Benth J, Engh M. Anterior but not posterior compartment prolapse is associated with levator hiatus area: a three- and four-dimensional transperineal ultrasound study. BJOG 2010.
2009
Pelvic floor dysfunction may cause a health problem such as genital prolapse, faecal and urinary incontinence.The pelvic floor muscle lies hidden in the pelvis and is difficult to assess.3D-4D eprineal ultrasound is new diagnostic method. Aim: validation of 3D-4D transperineal ultrasound and clinical use in women with pelvic organ prolapseIt has been estimated that half of the women who have given birth, loose pelvic floor support, resulting in some degree of pelvic organ prolapse (POP), and of these 10-20% will seek medical attention . Symptoms of POP usually come from four primary areas: urinary symptoms such as urine incontinence and voiding dysfunction, bowel symptoms such as difficulties with defecation or faecal incontinence, sexual symptoms such as dyspareunia and other symptoms such as sensation of “something coming down”, heaviness and vaginal pain. By the introduction of three and four (3/4 D) perineal ultrasound it is possible to get access to the axial plane, thereby adding information to the clinical examination. The importance of such additional information may be considerable but it yet unknown. To our knowledge, there are no studies of the pelvic floor anatomy comparing information from 2 D and 3/4 D ultrasound examinations. The aim of this study is therefore To evaluate the potential of 3/4 D perineal ultrasound in pelvic floor imaging through: Study I Inter observer/tester reliability study Study II Comparison of the 3/4 D perineal ultrasound technique to magnet resonance imaging Study III Comparing the area of the levator opening as measured by 3/4 D perineal ultrasound with severity of POP as measured by standardized clinical examination Study IV Comparing the 3/4 D perineal ultrasound assessment of detachment of the levator ani complex from the pelvic sidewalls with standardized clinical examination.
2008
With the technological advances in the three and four dimensional (3D / 4D) perineal ultrasound, a new diagnostic tool has become available. Since few studies on 3/4 D perineal ultrasound technique have been performed the first effort must be to compare and validate it with already established diagnostic techniquesTo evaluate the potential of 3/4 D perineal ultrasound in pelvic floor imaging through: Study I Inter observer/tester reliability study Study II Comparison of the 3/4 D perineal ultrasound technique to magnet resonance imaging Study III Comparison of the 3/4 D perineal ultrasound technique to 2 D perineal ultrasound Study IV Comparing the area of the levator opening as measured by 3/4 D perineal ultrasound with severity of POP as measured by standardized clinical examination Study V Comparing the 3/4 D perineal ultrasound assessment of detachment of the levator ani complex from the pelvic sidewalls with standardized clinical examination. In study I, 17 healthy female volunteers was recruited. Participants have been examined twice by 3-4 D perineal ultrasound by 1- 3 weeks interval. Analyses of 2D, 3D, and 4D ultrasound volumes and cine loops were conducted offline on a laptop using the software “4D View v 5.0” (GE Healthcare, Zipf Austria). The analyses were performed with the observers blinded to clinical data and to one another’s measurements. The inter-observer reliability tests were performed independently by two investigators (MM and IHB). Study I is completed and results are published in international journals. This study illustrate that 3/4D perineal ultrasound technique has good to very good intera and interrater reproducibility. Study II. A sample of 18 female volunteers was recruited. 18 participants have undergone 3-4 D perineal ultrasound and MRI examination. Included women were capable of understanding the Norwegian language and had no claustrophobic tendencies disabling them to undergo a MRI. No volunteers were excluded. Written informed consent was obtained and all participants filled in a questionnaire covering personal data, obstetrical history and subjective symptoms of pelvic floor dysfunction. The time interval between MRI and perineal ultrasound examinations was 1-3 weeks. Regional ethical committee and Norwegian social science data services approved the study. Data is collected and analysis performed. We are working on article writing. Results of this study show that biometrics measurements of levator ani measured with 3 D perineal ultrasound has good.correlation with the golden standard MRI. We are working on the patient data collection for study III, IV and study V.
Vitenskapelige artikler
Majida M, Braekken IH, Bø K, Benth Jš, Engh Me

Anterior but not posterior compartment prolapse is associated with levator hiatus area: a three- and four-dimensional transperineal ultrasound study.

BJOG 2011 Feb;118(3):329-37. Epub 2010 des 7

PMID: 21134101 - Inngår i doktorgradsavhandlingen

Braekken Ingeborg Hoff, Hoff Braekken Ingeborg, Majida Memona, Engh Marie Ellström, Bø Kari

Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial.

Obstet Gynecol 2010 Feb;115(2 Pt 1):317-24.

PMID: 20093905

Majida M, Braekken I H, Bø K, Benth J Saltyte, Engh M E

Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest.

Ultrasound Obstet Gynecol 2010 Jun;35(6):715-22.

PMID: 20178105 - Inngår i doktorgradsavhandlingen

Braekken Ingeborg Hoff, Majida Memona, Engh Marie Ellström, Bø Kari

Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial.

Am J Obstet Gynecol 2010 Aug;203(2):170.e1-7. Epub 2010 mai 1

PMID: 20435294

Bø Kari, Braekken Ingeborg H, Majida Memona, Engh Marie E

Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study.

Int Urogynecol J Pelvic Floor Dysfunct 2009 Jan;20(1):27-32. Epub 2008 sep 20

PMID: 18806912

Braekken Ingeborg Hoff, Majida Memona, Engh Marie Ellström, Bø Kari

Test-retest reliability of pelvic floor muscle contraction measured by 4D ultrasound.

Neurourol Urodyn 2009;28(1):68-73.

PMID: 18932174

Braekken I H, Majida M, Ellström Engh M, Holme I M, Bø K

Pelvic floor function is independently associated with pelvic organ prolapse.

BJOG 2009 Dec;116(13):1706-14.

PMID: 19906017

Majida M, Braekken I H, Umek W, Bø K, Saltyte Benth J, Ellstrøm Engh M

Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function.

Ultrasound Obstet Gynecol 2009 May;33(5):567-73.

PMID: 19402120

Braekken Ingeborg Hoff, Majida Memona, Ellstrøm-Engh Marie, Dietz Hans Peter, Umek Wolfgang, Bø Kari

Test-retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function.

Int Urogynecol J Pelvic Floor Dysfunct 2008 Feb;19(2):227-35. Epub 2007 jun 29

PMID: 17599234

Majida M1,3, Brækken IH3, Bø K3, 1, Engh ME1, 3

SAMMENLIKNING AV LEVATOR HIATUS DIMENSJONER OG BEKKENBUNNS FUNKSJON HOS KVINNER MED OG UTEN SKADE AV PUBOVISCERAL MUSKELEN, ET T

GYnekologen 2011, 24;3

Bø K, Majida M, Engh ME.

Does a ring pessary in situ influence the pelvic floor muscle function of women with pelvic organ prolapse when tested in supine

Int Urogynecol J. 2011 Nov 16. [Epub ahead of print]

Majida M,Brækken IB,Bø k, Ellstrøm Engh M

Anterior compartment but not posterior compartment prolapse is associated with levator histus area. A 3D/4D transperineal ultras

Gynekologen 23-3 .2010

Majida M, Hoff Brækken I, Umek W, Bø K, Engh M

Comparetive study of the pubovisceral muscle at rest using three dimensional perinea ultrasound and magnetic resonance imagingl

Podium presentation. International Continence Socitey 38th Annual Meeting. Abstract book Abstract .61

Majida M, Hoff Brækken I, Bø K, Engh M

Valdation of three Dimensional perineal ultrasound and mangnetic resonance imaging measurments of the pubovisceral muscle at res

Accepted in journal ultrasound in Obstetrics and gynecology

3. M. Majida, I.H. Brækken, K. Bø, W. Umek, H.P. Dietz, M. Ellstrøm Engh

Two, Three, and four-dimensional ultrasound of pelvic Floor muscle during valsalva: a study on intraobserver reliability

International Urogynecology and pelvic floor Dysfunction Journal.2007 vol 18 suppl.1

1. M.Majida,. Hoff Brækken, K.BØ,W.Umek,H.P.Dietz,Ellstøm

3D and 4D ultrasound of pelvic Floor.

International urogynecology journal. 2006 vol 17 suppl.2 s .136.

7. M. Majida, I.H. Brækken, K. Bø, W. Umek, M. Ellstrøm Engh

Kompativt Studium av Pubovisceral Muskelen ved bruk av Tre- Diemsjonal parineal ultralyd og magnetisk resonans imaging.

Gynekologen- Tidskrift for Norsk Gynekologisk Forening. 2008 21-3. Abstrakt nr.29

Majida Memona, Braekken Ingeborg Hoff, Bø Kari, Engh Marie Ellström.

INTER-OBSERVER REPEATABILITY OF THREE AND FOUR-DIMENSIONAL PERINEAL ULTRASOUND OF

(Ref.: UOG-2008-0171.R2)

eRapport er utarbeidet av Sølvi Lerfald og Reidar Thorstensen, Regionalt kompetansesenter for klinisk forskning, Helse Vest RHF, og videreutvikles av de fire RHF-ene i fellesskap, med støtte fra Helse Vest IKT

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