An Analysis Of Pelvic Floor Ultrasonic Imaging Changes Of Different Compartments Of Pelvic Organ Prolapse

Objective : Pelvic organ prolapse(POP)is a common disorder which troubles women a lot.This study is aimed at discovering whether there are differences in the ultrasonic indices among different compartments of POP and control group via assessing ultrasonic structures of pelvic floor in states of rest and Valsalva maneuver by translabial two-dimensional ultrasound,and assessing the injuries of different subgroups of levator ani muscle,the volume of perineal body and the integrity of rectovaginal septum etc.by transvaginal three-dimensional ultrasound,so as to provide the basis for the diagnosis and treatment of POP.Materials and Methods: We randomly selected 236 cases of patients with and without POP who visited the Female Pelvic Floor Urinary Reconstructive Center in Dalian Municipal Women and Children's Medical Center from 2015 to 2019.According to the results of POP-Q assessment,POP-Q ? Grade ? as criteria of anterior and posterior compartments of POP groups,C>-4 as criteria of middle compartment of POP,this study included 82 cases with anterior compartment of POP,44 cases with middle compartment of POP,58 cases with posterior compartment of POP,and 52 cases without POP as control group.We analyzed the imaging changes of pelvic floor anatomy among the groups in the aspect of pelvic floor movement via translabial two-dimensional ultrasound in states of rest and Valsalva maneuver.The indicators involved the anterior and posterior diameters of the genital hiatus,the distance from the bladder neck and bladder bottom to the level of the pubic symphysis respectively,the inclination angle of the urethra,the height ofthe perineal body(the distance between the tip of perineal body and the level of the pubic symphysis).The differences of some indicators between the two states were calculated.We compared the difference of pelvic floor anatomy among the groups via transvaginal three-dimensional ultrasound.The indicators involved the area,transvers diameters and anterior and posterior diameters of levator ani muscle hiatus,the area of paravaginal space,the area and diameters of levator ani muscle.In addition,we assessed the integrities of puborectalis muscle,pubococcygeal muscle,iliococcygeal muscle,and rectovaginal septum,the volume of perineum body from different dimensions and levels.Results: There were no significant differences in general data.Among the indicators of two-dimensional ultrasound,the mean anterior and posterior diameters of genital hiatus of POP groups are larger than which of control group in state of Valsalva maneuver(anterior: 61.15±10.51 mm,middle: 60.31±9.03 mm,posterior: 60.48±7.98 mm vs control group: 53.27±8.60 mm,P<0.001).In both states,the mean distance between bladder neck and the level of pubic symphysis of anterior compartment of POP group were the smallest(rest: anterior: 29.55±4.03 mm vs control group: 31.42±3.67 mm,posterior: 31.30±3.62 mm,P < 0.05;Valsalva: anterior: 6.94±9.30 mm vs middle:14.65±7.89 mm,posterior: 16.58±7.86 mm vs control group: 22.66±8.02 mm,P<0.001).The mean difference between the two states of such indicator was significantly greater in the anterior compartment of POP group than in the remaining three groups(anterior:22.31±8.56 mm vs middle: 16.02±7.92 mm,posterior: 15.03±7.03 mm,control group:11.12±16.53 mm,P<0.05).The mean distances between the bladder bottom and pubic symphysis level of the anterior,middle and posterior compartment of POP groups and the control group were increased in degree(13.67±11.92 mm vs 20.30±9.30 mm vs24.80±9.21 mm vs 29.17±8.96 mm,P < 0.05).The mean difference between the two states of such indicator was significantly greater in the anterior compartment of POP group(23.25±9.48mm)than which in middle(18.38±8.58mm)and posterior(16.37±8.52mm)compartment of POP groups,which is greater than that in controlgroup(9.69±6.91mm)(P<0.05).The mean inclination angle of anterior compartment of POP group was the largest in both states,and in state of Valsalva maneuver,such indicator of control group was the smallest(rest: anterior:-8.15±19.16° vs control group:-15.75±15.03°,middle:-17.59±14.31°,posterior:-20.70±14.75°,P<0.05;Valsalva: anterior: 50.61±27.44° vs middle 29.84±37.67°,posterior: 32.05±28.96°vs control group: 6.56±24.57 °,P < 0.05).The analysis of indicators of three-dimensional ultrasound showed that the mean degree of injury in pubococcygeal muscle was severer in anterior compartment of POP group(2.85±1.35)than which in control group(2.08±1.06)and posterior compartment of POP group(2.26±1.18)(P<0.05).The mean degree of injury of iliococcygeal muscle was severer in middle(3.11±1.22)and anterior(2.93±1.17)compartment of POP groups than which in posterior compartment of POP group(2.00±1.35)(P<0.05).Such indicator of middle compartment of POP group was greater than which of control group(3.11±1.22 vs2.31±1.31,P<0.05).The total scores of levator ani injury: the anterior(8.44±2.82)and the middle(7.98±3.01)compartment of POP groups were greater than the control group(6.62±2.63)and the posterior compartment of POP group(6.48±2.79)(P<0.05).There were no significant differences in perineal volume and rectovaginal septal defect among the groups.Conclusion: Translabial two-dimensional ultrasound and transvaginal three-dimensional ultrasound can assist to detect some characteristic changes of pelvic floor anatomy in different compartments of POP,to assess fine anatomical changes of pelvic floor,to improve the capacity of dynamic monitoring of changes in female pelvic floor anatomy and biomechanics via pelvic floor ultrasound technology in the future,to provide objective basis for the choice of treatment for POP.