Study Of Pelvic Floor Ultrasound In Nulliparas And Pelvic Organ Prolapse Women

Objectives Pelvic organ prolapse is a common problem significantly affecting women’s quality of life, particularly in later years. To data, the ultimate method to the symptomatic pelvic organ prolapse is surgery, which has been improved and innovated continually,but still recurrence rate is high as the statistical data has shown. One of the important cause is lack of enough information of pelvic floor preoperation,which prompts us it crucial for improving surgery effect to study an effective imaging technique for the morphological observation of pelvic floor.After studying the anatomy of the female pelvic floor by anatomizing 5 female cadavers,this paper studied the pelvic organs position and mobility,and three-dimensional ultrasound image of levator ani, urogenital hiatus and paravaginal supports in 50 nulliparous women and 50 pelvic organ prolapse women, combined with two- and three-dimensional ultrasound,and went on to compare findings obtained by ultrasound quantification of prolapse with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS) to evaluate the use of ultrasound in the quantification of prolapse.Part One The anatomy of female cadaveric pelvic supportMethods Five female cadavers (4 dipped in 10% formalin,1 fresh body) were anatomized to study the anatomy of the female pelvic floor.The anatomical routes of pelvic floor support includes perineal anatomy from superficial to deep and pelvic cavity anatomy from above downward.Results The pelvic support is composed of pelvic floor muscle and pelvic floor connective tissue.The levator ani muscles,the most important part of the pelvic floor muscle , is subdevided into two portions.The anterior pubovisceral portions form a space called urogenital hiatus,and the posterior coccygeal portions together with iliococcygeus form a relatively flat,horizontal shelf (called levator plate)on which the pelvic organs rest,supporting the rectum and upper two thirds of the vagina above it.On each side of the pelvis,the pelvic connective tissue which is most abundant around the vaginal attaches the pelvic organ to the pelvic wall.Paravaginal supports,the pelvic connective tissue around the vaginal,are different in different vaginal level,which make the vagina different configuration according to different level.The pelvic fascia forms a single divider in the middle of the pelvis and divides the pelvis into anterior, middle, and posterior compartments in vertical.Conclusions Normal pelvic organ position depends on normal structure and function of pelvic support composed of pelvic floor muscles and pelvic connective tissue.Part Two The study of pelvic floor ultrasound in nulliparasMethods Fifty nulliparas were examined by translabial ultrasound,using two- and three-dimensional ultrasound.Results The pelvic organs are in a higher position according to the numerical findings of the position of urethrovesical junction, leading edge of cervix,and anorectum junction relative to the inferior margin of the symphysis pubica at rest in nulliparous women.The pelvic organ is cranioventral shift on levator ani contraction and dorsocaudal displacement on maximal Valsalva,but still above the level of inferoposterior margin of the symphysis pubica.The angle of incline of urethra is dorsal rotation with the angle of anus and rectum bigger on maximal Valsalva while things are on the contrary on levator ani contraction.The urogenital hiatus between pubovisceral and pubic ramus through which the urethra,vagina,and rectum pass is rhombic in nulliparous women,with the pubovisceral muscles symmetrical continuous non-avulsion,perivaginal support intact and tenting present . The urogenital hiatus enlarges on maximal Valsalva with pubovisceral muscles thinner and pubovisceral muscles angle bigger, while things are on the contrary on levator ani contraction.Conclusions Transperineal ultrasonography combined with two- and three-dimensional ultrasound can be used for the assessment of female pelvic floor for anatomy,morphology and mobility, two-dimensional ultrasonography for the pelvic organ position and mobility , while three-dimensional ultrasonography for the pelvic floor support in multidimensional view.The images of pelvic floor ultrasound in nulliparous women show no pelvic organ prolapse, high pelvic organs position,limit mobility,little morphology change and intact perivaginal support.The study of pelvic floor ultrasound in nulliparas provides the basis of methodology and iconography for ultrasound quantification of prolapse. Part Three The study of pelvic floor ultrasound in pelvic organ prolapse womenMethods Fifty pelvic organ prolapse women were examined by translabial ultrasound , combined with two- and three-dimensional ultrasound,and findings obtained by ultrasound quantification of prolapse were compared with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS).Results The pelvic organs are in a lower position at rest in pelvic organ prolapse women,and much lower on maximal Valsalva even below the level of inferrior margin of the symphysis pubica.The pelvic organ shows a less cranioventral shift on levator contraction and a more dorsocaudal displacement on maximal Valsalva.The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse,including cystocele, urethral hypermobility,uterus prolapse, enterocele,rectocele and perineal hypermobility.The urogenital hiatus in pelvic organ prolapse women becomes bigger and oval,with pubovisceral thinner, rupture or avulsion off the symphysis pubica , perivaginal defects and tenting absent.The good correlation between ultrasound quantification of prolapse and the International Continence Society prolapse assessment system demonstrates that translabial ultrasound can be used to quantify female pelvic organ prolapse.Conclusions The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse , including cystocele,urethral hypermobility,uterus prolapse,enterocele, rectocele and perineal hypermobility,with large urogenital hiatus, thinner pubovisceral muscle, rupture or avulsion off the symphysis pubica,perivaginal defects and tenting absent.Ultrasound quantification of prolapse used for the assessment of pelvic floor morphology and prolapse can provide objective credible evidence for clinical medical to choose proper therapy.