Ultrasonographic Study Of Pelvic Floor Structures In Women Undergoing Reconstruction Surgery

ObjectiveTo observed the position of pelvic floor organs,pelvic floor supporting structures and mesh used in reconstruction surgery with the application of ultrasound imaging techniques and compare the pelvic floor anatomical changes in different surgery methods,with the purpose of providing imaging support to evaluation of effectiveness of reconstruction surgery and comparision of surgery methods.Methods50 women with pelvic organ prolapse(POP)were recruited and their symptoms and signs associated with POP were evaluated by an experienced gynecologist.All participants were performed transperineal pelvic floor ultrasound to evaluate the pelvic organ position,levator hiatus(LH)and vaginal cross-sectional morphology.All the women were undergoing pelvic floor construction surgery and had follow-up at 3 month and 6 month.The participants were divided into transvaginal mesh repair group(TVM group)and native tissue repair group(NTR group)and pelvic floor structure change was compared pre-and post-operation and between the two groups.Meshes used in reconstruction surgery were observed in vitro and in vivo by different sonographic techniques.ResultsThe prolapsed pelvic organ can be observed by transperineal ultrasound clearly and correlation was confirmed between ultrasound and clinical findings.The position of the pelvic organs decreased and the size of the levater hiatus increased with the increase of prolapse degree.The position of the prolapsed pelvic organs obviously rose after surgery.The position of pelvic organs were higher in TVM group than NTR group,but there was no statistically significant difference.No significant change was found in pelvic organ position in short-term follow-up.The LH was smaller after surgery at rest and on maximal Valsalva maneuver compared to that before surgery,which was more significant in TVM group.The size of LH was larger in NTR group than TVM group after surgery but there no statistically significant difference.No significant change was found in LH in short-term follow-up.The cross-sectional morphology of vagina was abnormal in POP women and paravaginal connective tissue was loose with hiatus occurred.The ultrasound image of vaginal cross-sectional morphology was improved after reconstruction surgery,but was still abnormal.The mesh most commonly appears as a linear echogenic interface with posterior acoustic shadowing and piece of grid in vitro by ultrasound in different sections.Thickening and echo enhancement locally and the change of shape consistent with the mesh can be observed when mesh is curled or folded.The TiLOOP mesh was a echo or high echo line sandwiched between the urethra and the vagina by ultrasound,which ranged from the middle urethra to the back of the bladder wall.The mesh moved along with the pelvic organs at contraction and maximum Valsalva.And the mesh prevented bladder prolapse at maximum ValsalvaMesh in pelvic floor can be observed by several ultrasound examination methods.Transperineal ultrasound is an important method to observe the function of mesh.Both transvaginal ultrasound and biplane intracavitary ultrasound can perform a comprehensive scan of the mesh effectively.ConclusionsEvaluation of pelvic floor organ prolapse by transperineal ultrasound is correlated with POP-Q score,which is an effective imaging method for evaluating pelvic organ prolapse.The pelvic organ position was reset and ballooning of levator hiatus and defect of paravaginal support were improved after reconstruction surgery.No significant difference was found in anatomical reduction of the position of pelvic organs between native tissue repair surgery and transvaginal mesh surgery.Mesh contribute to the reduction of levator hiatus ballooning.Ultrasound is an effective imaging method to evaluate mesh after reconstruction surgery for its ability to image the shape,location and function of the mesh.