The Diagnostic Value Of Transperineal Sonography For Pelvic Organ Prolapse

Objective: To evaluate the diagnostic value of transperineal sonography for pelvic organ prolapse by Meta-analysis.Then to seek the evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction.Providing new ideas and basis for preoperative assessment?operation selection and postoperative follow-up of women who have pelvic organ prolapse.Methods: 1.The first part: meta-analysis of diagnostic value of translabial ultrasound for pelvic organ prolapse.Use computer to retrieve English database: Pub Med,Cochrane Library,Embase,EBM,Cochrane Database;Chinese database:CNKI,Wanfang database,VIP database from inception to 2017 January.The literature were imported into End Note X7 software,and the literature were screened according to the inclusion and exclusion criteria.The final literature were included in the Reman5.3,according to the latest QUADAS-2 bias risk assessment system to evaluate the quality of the literature and the heterogeneity of the literature data.Diagnostic analysis of meta using Meta-Disc 1.4 statistical software,obtained the combined sensitivity,specificity,positive and negative likelihood ratio,diagnostic odds ratio,SROC curve and calculate the area under the SROC curveb by perineal sonography in diagnosis of pelvic organ prolapse.2.The second part: evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction.Eighty-three patients with Severe POP(pelvic organ prolapse)received surgeries in our hospital from September 2015 to September 2016,dividing into two groups: 27 patients were selected to receive TVM(transvaginal placement of surgical mesh)Pelvic Floor Reconstruction Surgery with TVT-A(tension-free vaginal tape-Abbrevo)Incontinence Surgery,named TVM+TVT-A group;56 patients were selected to receive TVM Pelvic Floor Reconstruction surgery only,named TVM group.We observed and measured the parameters at rest,on contraction and Valsalva condition respectively,including the bladder neck descent(BND),urethral rotation angle,retrovesical angle,levator urethra gap,the existence of bladder neck funneling,position of the tape,etc.by using 2D and 3D transperineal ultrasound.We analyzed the relationship between these parameters and the occurrence of lower urinary tract symptoms after operation by self-control design.Results: 1.The first part: meta-analysis of diagnostic value of translabial ultrasound for pelvic organ prolapse.According to the inclusion criteria and exclusion criteria,19 articles were included in this study,including English literature in 19,and Chinese literature in 0.There were 16 articles about anterior compartment prolapse,a total of 6646 cases;11 articles about central compartment prolapse,a total of 5353 cases;16 articles about posterior compartment prolapse,a total of 6916 cases.Anterior compartment prolapse:combined sensitivity was 76.5%(95%CI:0.750-0.779),combined specificity was 83.1%(95%CI:0.818-0.843),combined positive likelihood ratio was 4.833(95% CI: 3.618-6.456),combined negative likelihood ratio was 0.239(95%CI:0.197-0.291),combined diagnostic odds ratio(DOR)was 21.227(95%CI: 14.580-30.904),and the area under the SROC curve(AUC)was 0.8883.Central compartment prolapse:combined sensitivity was 56.7%(CI:0.546-0.589),combined specificity was 65.3%(95%CI:0.635-0.668),combined positive likelihood ratio was(95%CI:1.450-2.209),combined negative likelihood ratio was 0.605(CI:0.506-0.723),combined diagnostic odds ratio(DOR)was(95%CI:2.081-4.626),and the area under the SROC curve(AUC)was 0.6726.Posterior compartment prolapse:combined sensitivity was 72.5%(95% CI:0.711-0.739),combined specificity was 83.3%(95%CI:0.819-0.846),and combined positive likelihood ratio was 4.538(95%CI:3.296 6.249),combined negative likelihood ratio of 0.313(95%CI:0.251-0.390),combined diagnostic odds ratio(DOR)15.011(95%CI:9.365-24.059),and the area under the SROC curve(AUC)was 0.8469.2.The second part: evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction.The two groups were compared with the ultrasonic parameters before and after operation:Two groups of patients with postoperative BND were significantly reduced,the difference was statistically significant(P=0.02,P<0.01).The two groups of RVA and LUG before and after operation both had significant difference by maximum Valsalva(P < 0.05).There was statistical significance difference of ?? in TVM+TVT-A group by maximum Valsalva(p=0.01).Observation of morphology:(1)2 patients with difficulty in urination in TVM+TVT-A group,ultrasound showed when the position of the bladder down the urethral discount;4 patients with SUI(stress urinary incontinence),ultrasound showed Slings off or release.(2)1 patient with difficulty in urination in TVM group,but ultrasound showed lower urethral anatomy was normal;5 patients with SUI,ultrasound showed the position of the bladder neck was significantly lower in 3 patients,showing high mobility,and the other 2 patients had a larger urethral diameter,showing a tendency of natural deletion.Conclusions: 1.The results of meta analysis show that the accuracy of transperineal ultrasound in the diagnosis of pelvic organ prolapse is: Anterior compartment prolapse>Posterior compartment prolapse>Central compartment prolapse;2.There is a near linear relationship between sonographic and clinical measures of prolapse.Previously proposed cut-offs to define ‘significant prolapse' on ultrasound(cystocele?10mm below the symphysis pubis,uterine position of 15 mm above the symphysis pubis,rectocele?15mm below the symphysis pubis)are plausible and mutually consistent.On the basis of our results we propose that a hiatal area on Valsalva of 25–29.9cm2 can be defined as‘mild'.3.Anatomy of the lower urethra can be clearly showed by transperineal sonography.This can provide imaging support for the diagnosis of lower urinary tract symptoms after pelvic floor reconstruction.4.TVM Pelvic Floor Reconstruction Surgery is playing a limited role on limiting the expansion of the levator hiatus.The mechanisms of anti-urinary incontinence might be connected to the repair of under urethra vaginal hammock.