The Application Of Real-time Three-dimensioral Transperineal Ultrasonography In Pelvic Organ Prolapse

Part I The Value of Quantitative Analysis with Real-time Three-dimensional Transperineal Ultrasonography in Anterior and Middle pelvic organ prolapseObjective:To find the value of quantitative analysis of pelvic floor structure biology with real-time three-dimensional transperineal ultrasonography in the diagnosis of anterior and middle pelvic organ prolapse.Methods:This was a retrospective analysis that was made on the patients with suspected pelvic floor disorder who underwent transperineal ultrasonography in Tong Ren Hospital Shanghai Jiao Tong University School of Medicine from August 2018 to July 2019.The position of the bladder neck and the lowest point of uterus,the bladder neck descent(BND)and the left-to-right diameter of levator hiatus(LR),the anteroposterior diameter(AP)and the area of levator hiatus(LHA)were measured in resting status and Valsalva status respectively.The parameters of resting status and Valsalva status between POP patients and non-POP patients were compared.RESULTS:160 women with an average age of 44.43±14.71 years were enrolled in this study.1.Resting status:The position of the bladder neck and the lowest point of uterus in group prolapse were lower than those in group non-prolapse,while the LR,AP and LHA in group prolapse were larger,with P<0.05.2.Valsalva status:The position of the bladder neck,the lowest points of bladder and uterus in group prolapse were significantly lower than those in group non-prolapse,while the BND was significantly higher.The LR,AP and LHA were significantly larger than those in group non-prolapse,with P<0.05.3.The expansion of the LR,AP and LHA in group prolapse was greater than that in group non-prolapse.But the ratio between LR in resting and Valsalva status was no significant difference between the two group.4.The cut-off value of BND,LHA in Valsalva status and the difference between LHA in resting status and Valsalva status were 23.15mm,20.56 cm2,8.09 cm2,respectively.When any one of them was larger than the cut-off value,it was considered positive.The sensitivity,specificity,positive predictive value,negative predictive value and the diagnostic coincidence rate of POP diagnosis were 88.51%,78.08%,82.80%,85.07%,83.75%,respectively.Conclusion:Real-time three-dimensional transperineal ultrasound has a certain value in the diagnosis of pelvic organ prolapse.The increase of the parameters of the hiatus has certain predictive value for pelvic organ prolapse.Part II The Value of Real-time Three-dimensional Transperineal Ultrasonography in the diagnosis of the Different Types of CystoceleObjective:To find the value of real-time three-dimensional transperineal ultrasonography in the different types of cystocele by quantitative analysis of clinical data and the measurements of the pelvic floor structure of patients with the different types of cystocele.Methods:This was a retrospective analysis that was made on the patients with suspected pelvic floor disorder who underwent transperineal ultrasonography in Tong Ren Hospital Shanghai Jiao Tong University School of Medicine from August 2018 to July 2019.The position of the bladder neck and the lowest point of uterus,the bladder neck descent(BND)and the left-to-right diameter of levator hiatus(LR),the anteroposterior diameter(AP)and the area of levator hiatus(LHA)were measured in resting status and Valsalva status respectively.The differences of parameters between patients with Green type Ⅱ cystocele and Green type Ⅲ cystocele in resting and Valsalva status were compared.Results:64 patients were enrolled in this study.According to the results of ultrasonography,they were divided into Group Green Ⅱ and Group Green Ⅲ.There were 48 cases in Group Green Ⅱ and 16 cases in Group Green Ⅲ.1.Resting status:There was no significant difference in the position of the bladder neck and LR between the two groups(P values were 0.926 and 0.960,respectively).The lowest point of uterus in Group Green Ⅱ was higher than that in Group Green III,but there was no significant difference between the two groups(P=0.293).The AP and LHA in Group Green Ⅱ were significantly smaller than those in Group Green Ⅲ(P<0.05),2.Valsalva status:There was no difference between the two groups in the position of the bladder neck and BND.The lowest position of uterus in Group Green Ⅲ was lower than that in Group Green Ⅱ,but there was no significant difference.The parameters of the hiatus in Group Green Ⅲ were significantly larger than those in Group Green Ⅱ,except for the AP(P<0.05).The position of the bladder neck and the lowest point of bladder in Green type Ⅱ cystocele with uterine prolapse was significantly lower than those without uterine prolapse,while the BND and the parameters of hiatus were larger.Besides the BND and the AP,the other parameters of the hiatus were significantly different between the two subgroups of Green type Ⅱ cystocele(P<0.05).3.Although the difference and ratio between the LHA in resting status and Valsalva status in Group Green Ⅲ were larger than that in Group Green Ⅲ the expansion of the AP was smaller than the latter while the expansion of the LR was larger.Conclusion:Real-time three-dimensional transperineal ultrasonography has certain value in the diagnosis of the different types of cystocele,especially in Green type Ⅲ.When Green type Ⅱ cystocele combined with uterine prolapse,the organ position is lower,and the diameter and area of the hiatus are larger than those without uterine prolapse.