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Pelvic Floor Function in the Female  [PDF]
Christos E. Constantinou
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.414115
Abstract: Pelvic Floor (PF) disorders, such as urinary incontinence and prolapse accounted for over 400,000 operations in the USA in 1987 [1], and nearly a third of these were re-operations. It is estimated that 30% - 50% of women in Europe and the USA are affected by Urinary incontinence [2]. Stress Urinary Incontinence (SUI), the involuntary leakage of urine on coughing, sneezing, exertion or effort, is the most common form of urinary incontinence in women. The scientific understanding of normal PF function is limited and consequently treatment of these prevalent, disabling conditions is, at best, inefficient.
Tactile Imaging Markers to Characterize Female Pelvic Floor Conditions  [PDF]
Heather van Raalte, Vladimir Egorov
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.59073
Abstract: The Vaginal Tactile Imager (VTI) records pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. The objective of this study is to validate tactile imaging and muscle contraction parameters (markers) sensitive to the female pelvic floor conditions. Twenty-two women with normal and prolapse conditions were examined by a vaginal tactile imaging probe. We identified 9 parameters which were sensitive to prolapse conditions (p < 0.05 for one-way ANOVA and/or p < 0.05 for t-test with correlation factor r from -0.73 to -0.56). The list of parameters includes pressure, pressure gradient and dynamic pressure response during muscle contraction at identified locations. These parameters may be used for biomechanical characterization of female pelvic floor conditions to support an effective management of pelvic floor prolapse.
Non-rigid registration of a 3D ultrasound and a MR image data set of the female pelvic floor using a biomechanical model
Janko F Verhey, Josef Wisser, Simon K Warfield, Jan Rexilius, Ron Kikinis
BioMedical Engineering OnLine , 2005, DOI: 10.1186/1475-925x-4-19
Abstract: We present a feasibility study for a non-rigid registration technique based on a biomechanical model for MR and US image data sets of the female anal canal as a base for a new innovative clinical visual representation.It is shown in this case study that the internal and external sphincter region could be registered elastically and the registration partially corrects the compression induced by the ultrasound transducer, so the MR data set showing the native anatomy is used as a frame for the US data set showing the same region with higher resolution but distorted by the transducerThe morphology is of special interest in the assessment of anal incontinence and the non-rigid registration of normal clinical MR and US image data sets is a new field of the adaptation of this method incorporating the advantages of both technologies.In a recent study the advances of 3D sonographical imaging techniques to allow a sophisticated study of anal sphincter and levator ani muscle anatomy were described [1]. Today's common US examiniation techniques using a 7.5 MHz transducer allow a spatial resolution of up to 0.3 mm in each direction [2,3], whereas it is hard to obtain good quality MR images better than 1 mm in a single direction, when imaging the pelvis. Nevertheless, MR is a well established 3D data acquisition technique, which is used as gold standard to describe human anatomy in vivo.It is a clinical necessity to enhance the information contained in imaging for diagnostic and also therapeutic purposes. In the past this led to new imaging techniques (visual representations) which use the information of at least two modalities in order to maximize the benefit for the clinician in diagnosis and treatment [4]. The registration of MR and US is of special interest because sonography is a diagnostic technique which is easy to handle, widely available, and furthermore economic [5]. To combine the best of the two worlds we will show that it is possible to match 3D MR and US for the ass
Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women  [cached]
Tao Ying, Qin Li, Lian Xu, Feifei Liu, Bing Hu
International Journal of Medical Sciences , 2012,
Abstract: The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor.
Surgical management of pelvic floor prolapse in women using mesh
IA Yakasai, RJ Hawthorn
Nigerian Journal of Surgical Research , 2006,
Abstract: Objective: To evaluate surgical handling, prolapse correction and complication rate of polypropylene mesh. Methods: A retrospective review of patients who had pelvic floor repair using polypropylene mesh(PPM) and intra-vaginal sling(IVS), between January 2003 and July 2005. All patients were followed-up for a period of 6weeks to 12months.The effectiveness and complications following PPM insertion were carefully documented. Results: A total of 57 repairs of various types of prosthetic materials were carried out over the study period. 30 patients had polypropylene mesh inserted, while 27had IVS. Of the patients who had PPM inserted 27(90%) had successful repair after 12 months follow-up, while 3(10%) had failed repair. Most of these patients had previous vaginal surgery. The main complication of PPM was vaginal erosion in 3(10%) patients Conclusion: Polypropylene mesh (Prolene) is a simple effective method of treatment of pelvic floor prolapse. It is associated with minimal complications.
Expression of estrogen receptors in the pelvic floor of pre- and post-menopausal women presenting pelvic organ prolapse  [cached]
Monika Zbucka-Kretowska,Naama Marcus-Braun,Cyril Eboue,Geneviève Abeguile
Folia Histochemica et Cytobiologica , 2011, DOI: 10.5603/9449
Abstract: The precise role of estrogen in the pathogenesis of pelvic organ prolapse (POP) is still unclear, while the results concerning the effect of selective estrogen receptor modulators on pelvic organ prolapse are contradictory. Our aim was to test whether alteration in the expression of estrogen receptors in the pelvic floor of preand post-menopausal women is related to genital prolapse status. The mRNA levels of ERα and ERβ in 60 biopsy specimens were measured. Significantly higher expression of ERα and higher ERα/ERβ ratio were demonstrated in post-menopausal women compared to pre-menopausal women. Higher expression of ERα and higher ERα/ERβ ratio were detected in all studied groups with POP, thus it did not reach significance in the post-menopausal group. Pre-menopausal and post-menopausal women presenting pelvic organ prolapse had no difference in the ERα expression. Our preliminary study may indicate that pelvic organ prolapse is associated with higher expression of ERα/ERβ in the pelvic floor of both pre- and post-menopausal women; thus not reaching statistical significance in the post-menopausal women was probably due to the group’s size. We believe that the inevitable changes in the estrogen receptor expression over women’s different lifetimes may affect the risk of genital prolapse progression, and might contribute to the further search for appropriate selective estrogen receptor modulators as a treatment for women with pelvic organ prolapse. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 3, pp. 521–527)
Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial
Bernardes, Bruno Teixeira;Resende, Ana Paula Magalh?es;Stüpp, Liliana;Oliveira, Emerson;Castro, Rodrigo Aquino;Jármy di Bella, Zsuzsanna Ilona Katalin;Gir?o, Manoel Jo?o Batista Castello;Sartori, Marair Gracio Ferreira;
Sao Paulo Medical Journal , 2012, DOI: 10.1590/S1516-31802012000100002
Abstract: context and objective: previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (csa) of the levator ani muscle. one way to assess the effects of training programs is to measure the csa of the muscle, using ultrasonography. the aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the csa of the levator ani muscle in women with pelvic organ prolapse. design and setting: prospective randomized controlled trial at the urogynecology outpatient clinic of universidade federal de s?o paulo. methods: fifty-eight women with stage ii pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (gi); a hypopressive exercise group (gii); and a control group (giii). the patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 mhz. the (csa) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. results: the groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. statistically significant differences in csa were found in gi and gii from before to after the treatment (p < 0.001), but not in relation to giii (p = 0.816). conclusions: the csa of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. pelvic floor muscle training and hypopressive exercises produced similar improvements in the csa of the levator ani muscle.
ADVANCED DIAGNOSTIC TESTING FOR FEMALE PELVIC FLOOR DYSFUNCTIONS
G. Vignoli
Urogynaecologia International Journal , 2010, DOI: 10.4081/uij.2009.1.5
Abstract: The word “pelvic floor dysfunction” has different meanings in different specialties, i.e. radiology, urology, gynaecology, coloproctology. Despite the fact that the concept of perineology is not exactly new, most clinicians have only slowly adapted their practice to this transversal view. The multidisciplinary approach (several specialists dealing with various pelvic floor problems) still prevails over the interdisciplinary one (one specialist explaining what is happening) with several problems in the choice of therapeutic strategies. Obviously, the interdisciplinary approach requires a wide knowledge of the principles and techniques of each specialty. This monographic issue reviews advanced diagnostic testing for female pelvic floor dysfunctions from the perspective of a single specialist, namely a urologist.
The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse
Simmi K Ratan, Kamal Rattan, Poonam Jhajhria, Yogesh Mathur, Atul Jhanwar, Dimple Kondal
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-44
Abstract: Study design: ProspectiveSetting: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, RohtakSubjects: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006Methodology: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-upsStatistical Methods: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value < 0.05 was considered statistically significant.The mean number of sittings in the completely cured group (n = 28(64%)) was (12.4 ± 7.8) and was comparable with very poor responder (n = 6(13%). There was higher percentage of relief (76%) at the first follow up (at 15 days) in completely cured Vs other (37%) and also the poor responders showed (20%) Vs other (68%) and was statistically significant.With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get curedRectal prolapse is a common condition in children in the underdeveloped nations, albeit with unclear etiology. The commonest predisposing factors are the diseases leading to malnutrition (e.g. amebiasis, giardiasis, worms) leading to disappearance of the ischio-rectal fat and causing lack of rectal supp
Prevalence of Female Sexual Dysfunction among Women with Pelvic Organ Prolapse Diagnosed by Pisq-12 and Related Factors in Hung Vuong Hospital, Vietnam  [PDF]
Huynh Nguyen Khanh Trang, Pham Hung Cuong, Hoang Thi Diem Tuyet
Open Journal of Obstetrics and Gynecology (OJOG) , 2019, DOI: 10.4236/ojog.2019.97098
Abstract: Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sexual activity. Methods: There is a cross-sectional study on sexual dysfunction in 296 women with pelvic organ prolapse grade II and III followed up at gynecological-pelvic floor unit of Hung Vuong hospital from 09/2017 to 06/2018. Results: The prevalence of female sexual dysfunction in PISQ-12 was 76.4% and 95% CI [71.6 - 81.2]. The rate of female sexual dysfunction in turn is: 1) Behavioral-Emotional: 93.6% 95% CI [90.8 - 96.4]. 2) Physiology: 62.2% CI 95% [56.7 - 67.7]. 3) Relationship to partner: 89.5% 95% CI [86.0 - 93.0]. Factor related to sexual dysfunction in women with pelvic organs (p < 0.05) is general sexual dysfunction: 1) Age group: women over age 55 increased generally the risk of sexual dysfunction, OR = 5.89, 95% CI [1.38 - 25.20]. 2) Diabetes mellitus increased the risk of sexual dysfunction with OR = 5.03, 95% CI [1.42 - 17.82]. 3) Patients with previous abortions reduced the risk of sexual dysfunction with OR = 0.49 95% CI [0.27 - 0.90]. Conclusion: Research on quality of life in pelvic organ prolapse should be considered more in the future.
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