| 1. Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009; 36(3):421-443. |
Review/Other-Dx |
N/A |
To review the epidemiology of urinary incontinence, pelvic organ prolapse, anal incontinence, and painful bladder conditions. |
Pelvic floor disorders are common and have a negative impact on a woman's quality of life. Unfortunately most women do not seek care for these debilitating symptoms. Understanding risk factors, particularly modifiable factors, is critical for developing future prevention guidelines and improving the specificity of treatments. |
4 |
| 2. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004; 104(3):489-497. |
Review/Other-Dx |
270 patients |
To estimate the prevalence of pelvic organ prolapse in older women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse. |
In 270 participants, age (mean +/- SD) was 68.3 +/- 5.6 years, body mass index was 30.4 +/- 6.2 kg/m(2), and vaginal parity (median [range]) was 3 (0-12). The proportions of Pelvic Organ Prolapse Quantification stages (95% confidence intervals [CIs]) were stage 0, 2.3% (95% CI 0.8-4.8%); stage I, 33.0% (95% CI 27.4-39.0%); stage II, 62.9% (95% CI 56.8-68.7%); and stage III, 1.9% (95% CI 0.6-4.3%). In 25.2% (95% CI 20.1-30.8%), the leading edge of prolapse was at the hymen or below. Hormone therapy was not associated with prolapse (P =.9). On multivariable analysis, less education (odds ratio [OR] 2.16, 95% CI 1.10-4.24) and higher vaginal parity (OR 1.61, 95% CI 1.03-2.50) were associated with prolapse when defined as stage II or greater. For prolapse defined by the leading edge at or below the hymen, older age had a decreased risk (OR 0.50, 95% CI 0.27-0.92) and less education, and larger babies had an increased risk (OR 2.38, 95% CI 1.31-4.32 and OR 1.97, 95% CI 1.07-3.64, respectively). |
4 |
| 3. Maglinte DD, Kelvin FM, Fitzgerald K, Hale DS, Benson JT. Association of compartment defects in pelvic floor dysfunction. AJR. 1999; 172(2):439-444. |
Review/Other-Dx |
100 patients |
To determine the frequency of associated urinary, genital, and anorectal abnormalities in women with pelvic floor dysfunction. |
Of the 20 patients with symptoms of anterior compartment (urinary) defect, dynamic cystoproctography revealed that 45% had vaginal vault prolapse of more than 50% and that 90% had rectoceles. Of the 45 patients with symptoms of middle compartment (genital) defect, dynamic cystoproctography revealed that 91% had cystoceles, 56% had a hypermobile bladder neck, 82% had rectoceles, 58% had enteroceles, 11% had sigmoidoceles, 20% had rectoanal intussusception, and 16% had anal incontinence. Of the 17 patients with symptoms of posterior compartment (anorectal) defect, dynamic cystoproctography showed that 71% had cystoceles, 65% had a hypermobile bladder neck, and 35% had vaginal vault prolapse of more than 50%. Of the 18 patients with symptoms of defects from a combination of compartments, dynamic cystoproctography revealed that 89% had cystoceles, 56% had a hypermobile bladder neck, 39% had vaginal vault prolapse exceeding 50%, 100% had rectoceles (of which 45% were large), 6% had enteroceles, 6% had sigmoidoceles, 22% had rectoanal intussusception, and 6% had anal incontinence. |
4 |
| 4. Morgan DM, DeLancey JO, Guire KE, Fenner DE. Symptoms of anal incontinence and difficult defecation among women with prolapse and a matched control cohort. Am J Obstet Gynecol. 2007; 197(5):509 e501-506. |
Observational-Dx |
151 women with primary pelvic organ prolapse; 135 women without prolapse |
To quantify the risk for anal incontinence and difficult defecation among women with prolapse by comparing them with women without prolapse of similar age, body mass index, race, and hysterectomy status, and to determine whether there are characteristics or findings in women with prolapse that are associated with greater symptom severity. |
Incontinence of flatus was reported by 23.1% of cases vs 8.3% of control subjects (P = .006). Incontinence of liquid or solid stool was present in 4.7% and 3.5%, respectively, and was not reported by control subjects (P < .001 and .009, respectively). Difficult defecation, which was characterized by pushing on the vaginal walls to complete defecation, was present in 19.7% vs 4.4% of control subjects (P = .001). Cases that reported symptoms were compared with those that did not report symptoms. Among those reporting difficult defecation, the length of the perineal body length was greater when straining (4.0 vs 3.4 cm; P = .020). Among those reporting incontinence of flatus, mean parity was higher (3.3 vs 2.5; P = .012), and a positive standing cough stress test was more likely (39.3% vs 18.5%; P = .025). Symptoms of anal incontinence and/or difficult defecation were present in 35.3% of subjects (52/147). |
3 |
| 5. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008; 300(11):1311-1316. |
Review/Other-Dx |
1961 nonpregnant women |
To provide national prevalence estimates of symptomatic pelvic floor disorders in US women. |
The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%-26.2%), with 15.7% of women (95% CI, 13.2%-18.2%) experiencing urinary incontinence, 9.0% of women (95% CI, 7.3%-10.7%) experiencing fecal incontinence, and 2.9% of women (95% CI, 2.1%-3.7%) experiencing pelvic organ prolapse. The proportion of women reporting at least 1 disorder increased incrementally with age, ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older (P < .001), and parity (12.8% [95% CI, 9.0%-16.6%], 18.4% [95% CI, 12.9%-23.9%], 24.6% [95% CI, 19.5%-29.8%], and 32.4% [95% CI, 27.8%-37.1%] for 0, 1, 2, and 3 or more deliveries, respectively; P < .001). Overweight and obese women were more likely to report at least 1 pelvic floor disorder than normal weight women (26.3% [95% CI, 21.7%-30.9%], 30.4% [95% CI, 25.8%-35.0%], and 15.1% [95% CI, 11.6%-18.7%], respectively; P < .001). We detected no differences in prevalence by racial/ethnic group. |
4 |
| 6. Gomelsky A, Penson DF, Dmochowski RR. Pelvic organ prolapse (POP) surgery: the evidence for the repairs. BJU Int. 2011; 107(11):1704-1719. |
Review/Other-Dx |
N/A |
To summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP-repair kits. |
While a role exists for mesh-kit repairs, that role has not been well-defined yet. It is important to remember that mesh characteristics are unique to each product and the biocompatibility profile of a particular mesh is often based on experience with that material in other surgical applications. Judicious patient selection and detailed informed consent before these surgeries is vital. Adequate surgeon training and a solid comfort level with variations in pelvic anatomy can't be overstated. Lastly, the surgeon undertaking these procedures should be comfortable treating complications. |
4 |
| 7. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4):501-506. |
Review/Other-Dx |
149,554 women |
To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. |
The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair. |
4 |
| 8. Ashok K, Petri E. Failures and complications in pelvic floor surgery. World J Urol. 2012; 30(4):487-494. |
Review/Other-Dx |
N/A |
To review current literature on the failures of different surgical approaches in pelvic floor surgery, in particular the use of alloplastic materials, and to analyze complications related to them. |
Use of synthetic materials in pelvic organ prolapse surgery has reduced surgical failures but it is associated with an increased risk of complications compared to traditional surgical repairs. Synthetic mid-urethral slings for stress urinary incontinence seem to have good success rates over long term, but they have unique complication profile including de novo development of overactive bladder, voiding dysfunction, sling exposures, dyspareunia, and long-term pain. However, some of these complications seem to be related to wrong surgical indications and improper surgical techniques, although some complications may be directly related to the use of synthetic material itself. |
4 |
| 9. Nygaard I, Chai TC, Cundiff GW, et al. Summary of Research Recommendations From the Inaugural American Urogynecologic Society Research Summit. Female Pelvic Med Reconstr Surg. 2011; 17(1):4-7. |
Review/Other-Dx |
N/A |
To provide a summary of the research summit which was to identify research topics and directions that are critically important and immediately need to advance the field of female pelvic medicine and reconstructive surgery. |
No results stated in abstract. |
4 |
| 10. Bitti GT, Argiolas GM, Ballicu N, et al. Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities. Radiographics : a review publication of the Radiological Society of North America, Inc 2014;34:429-48. |
Review/Other-Dx |
N/A |
To present high-resolution FSE T2-weighted MR images that permit detailed assessment of anatomic lesions and briefly describe pelvic floor pathophysiology, associated clinical symptoms, and patterns of dysfunction seen with dynamic MR imaging sequences. |
No results stated in abstract. |
4 |
| 11. Kelvin FM, Hale DS, Maglinte DD, Patten BJ, Benson JT. Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR. 1999; 173(1):31-37. |
Observational-Dx |
170 consecutive patients |
To assess the contribution of dynamic cystoproctography to the evaluation of female pelvic organ prolapse and to compare this contribution with that of physical examination. |
A rectocele was detected by proctography in 155 patients (91%); 119 (77%) of these rectoceles were also found on physical examination. Barium trapping at proctography was related to rectocele size. Proctography showed an enterocele in 47 patients (28%); 24 (51%) of these enteroceles were also found on physical examination. Physical examination also found 44 enteroceles that could not be corroborated radiologically. At proctography, the enteroceles were relatively large, extending an average of 7.3 cm below the vaginal apex. Eight patients had sigmoidoceles, none of which were found on physical examination. A cystocele was shown by cystoproctography in 159 patients (94%); 132 (83%) of these cystoceles were also found on physical examination. |
3 |
| 12. Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J. Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. Journal of Magnetic Resonance Imaging. 9(3):373-7, 1999 Mar. |
Observational-Dx |
35 patients |
To compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. |
Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. |
3 |
| 13. Siegmann KC, Reisenauer C, Speck S, Barth S, Kraemer B, Claussen CD. Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant. Eur J Radiol. 2011; 80(2):182-187. |
Observational-Dx |
15 patients |
To assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh. |
At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed (n=6) or increased (n=6) pelvic organ prolapse in 80% (n=12) of all patients 3 months after pelvic floor repair. Most of them (n=11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly (p<0.05) elevated after anterior repair and rectal bulging was significantly (p=0.036) reduced after posterior pelvic floor repair. |
2 |
| 14. Showalter PR, Zimmern PE, Roehrborn CG, Lemack GE. Standing cystourethrogram: an outcome measure after anti-incontinence procedures and cystocele repair in women. Urology. 58(1):33-7, 2001 Jul. |
Observational-Tx |
76 patients |
To evaluate the standing voiding cystourethrogram (VCUG) with lateral views as an outcome measure to objectively document the correction of the urethral angle and cystocele in women who underwent various types of pelvic surgery. |
Among the control group, the mean +/- SD urethral angle at rest was 12.5 degrees +/- 13.1 degrees and the urethral angle at straining was 24.7 degrees +/- 15.6 degrees (P <0.001). The urethral angle at rest increased significantly from women in their 20s to their 80s. In the UH group (n = 52), the preoperative mean urethral angle at rest and at straining was 25.7 degrees +/- 13.6 degrees and 42.6 degrees +/- 15.9 degrees, respectively, a difference of approximately 20 degrees. The postoperative urethral angles at rest and at straining did not statistically differ from those of the age-matched controls. In the C group (n = 36), the postoperative urethral angle at rest did not statistically differ from that of the age-matched controls. The lateral height of the cystocele demonstrated significant improvement in the UH and C groups. |
2 |
| 15. Pannu HK, Scatarige JC, Eng J. Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse. J Comput Assist Tomogr. 2009; 33(1):125-130. |
Observational-Dx |
82 patients |
To compare supine magnetic resonance imaging (MRI), with and without rectal contrast, with fluoroscopic cystocolpoproctography (CCP) for the diagnosis of pelvic organ prolapse. |
For the entire patient group, the prevalence of cystoceles was 89% on CCP and 80% on MRI; vaginal prolapse was 81% on CCP and 56% on MRI; enteroceles, 38% on CCP and 24% on MRI; and anterior rectoceles, 45% on CCP and 37% on MRI. There were significantly more cystoceles (odds ratio [OR] 4.7, P = 0.003), vaginal prolapses (OR 5.2, P < 0.0005), and enteroceles (OR 3.8, P< 0.0005) on CCP than on MRI. For MRI with rectal contrast versus CCP, the prevalence of cystoceles was 94% on CCP and 91% on MRI; vaginal prolapse, 74% on CCP and 70% on MRI; enteroceles, 36% on CCP and 19% on MRI; and anterior rectoceles, 51% on CCP and 59% on MRI. There was statistical significance only for enteroceles, more of which were found on CCP (OR 7.4, P = 0.003). For MRI without rectal contrast versus CCP, the prevalence of cystoceles was 85% on CCP and 72% on MRI; vaginal prolapse, 86% on CCP and 46% on MRI; enteroceles, 40% on CCP and 28% on MRI; and anterior rectoceles, 39% on CCP and 21% on MRI. There were significantly more cystoceles (OR 6.6, P = 0.003), vaginal prolapses (OR 20.8, P < 0.0005), enteroceles (OR 2.9, P = 0.015), and rectoceles (OR 4.9, P = 0.001) on CCP than on noncontrast MRI. |
3 |
| 16. Dobben AC, Terra MP, Deutekom M, et al. The role of endoluminal imaging in clinical outcome of overlapping anterior anal sphincter repair in patients with fecal incontinence. AJR. 2007; 189(2):W70-77. |
Observational-Dx |
30 patients |
To investigate whether endoluminal imaging can identify determinants that play a role in the outcome of sphincter repair. |
After surgery, the mean Vaizey score in 30 patients (97% females; mean age, 50 years) had improved from 18 to 13 (p < 0.001). MRI showed that baseline measurement of preserved EAS thickness correlated with a better outcome (r = 0.42; p = 0.03). Clinical outcome did not differ between patients with and those without a persistent EAS defect (p = 0.54) or EAS atrophy (p = 0.26) depicted on MRI. Patients with a visible overlap and less than 20% fat tissue had a better outcome than patients with nonvisible, fatty overlap (decrease in Vaizey score, 7 vs 2 points, respectively; p = 0.04). Sonography showed that patients with a persistent EAS defect had a worse outcome than those without an EAS defect (17 vs 10 points, respectively; p = 0.003). |
3 |
| 17. Maglinte DD, Hale DS, Sandrasegaran K. Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: Which is the "functional" examination for anorectal and pelvic floor dysfunction? Abdom Imaging. 2013;38(5):952-973. |
Review/Other-Dx |
N/A |
A review to analyze the pros and cons between DCP and dynamic pelvic floor MRI, addresses imaging and interpretive controversies, and their relevance to clinical management. |
Rectal emptying performed with DCP provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing defecatory disorders, this method of examination demonstrates maximum pelvic organ descent and provides organ-specific quantification of organ prolapse, information that is only inferred by means of physical examination. It has been found to be of clinical value in patients with defecation disorders and the diagnosis of associated prolapse in other compartments that are frequently unrecognized by history taking and the limitations of physical examination. Pelvic floor anatomy is complex and DCP does not show the anatomical details pelvic magnetic resonance imaging (MRI) provides. Technical advances allowing acquisition of dynamic rapid MRI sequences has been applied to pelvic floor imaging. Early reports have shown that pelvic MRI may be a useful tool in pre-operative planning of these disorders and may lead to a change in surgical therapy. Predictions of hypothetical increase cancer incidence and deaths in patients exposed to radiation, the emergence of pelvic floor MRI in addition to questions relating to the clinical significance of DCP findings have added to these controversies. |
4 |
| 18. Murad-Regadas SM, Regadas FS, Rodrigues LV, Silva FR, Soares FA, Escalante RD. A novel three-dimensional dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation, a comparison with defecography. Surgical Endoscopy. 22(4):974-9, 2008 Apr. |
Observational-Dx |
30 women |
To test the effectiveness of echodefecography, the dynamic 3D anorectal ultrasonography technique -(EDF). To assess women with obstructed defecation (OD), as compared with conventional defecography (DF). |
Six patients were normal at DF and five were normal at EDF. Defecography identified grade I rectocele in five patients (average size: 1.8 cm), grade II in seven (average size: 2.9 cm) and grade III in 12 (average size: 4.6 cm). Different sizes of anorectocele were also observed at EDF and quantified according to DF classification (grade I: </=0.6 cm; grade II: 0.7-1.3 cm; grade III: >1.3 cm). Significant differences were observed between anorectocele sizes (p < 0.05) and between normal patients and grade I (p < 0.001). The level of agreement between the techniques was high (kappa = 0.902), with only one normal case wrongly identified as anorectocele III at EDF. Rectal intussusception was identified in five patients at DF; EDF confirmed these cases and revealed seven others, demonstrating moderate agreement (kappa = 0.462). Anismus was identified in nine patients in DF and in eight in EDF (kappa = 0.901). |
3 |
| 19. Regadas FS, Haas EM, Abbas MA, et al. Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation. Dis Colon Rectum. 2011; 54(6):686-692. |
Observational-Dx |
86 women |
To validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation. |
Eighty-six women were evaluated: median Wexner constipation score, 13.4 (range, 6-23); median age, 53.4 (range, 26-77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; kappa = 0.61; 95% CI = 0.48-0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (kappa = 0.79; 95% CI = 0.57-1.0). Intussusception was associated with rectocele in 28 patients for both methods (kappa = 0.62; 95% CI = 0.41-0.83). There was substantial agreement for anismus (kappa = 0.61; 95% CI = 0.40-0.81) and for rectocele combined with anismus (kappa = 0.61; 95% CI = 0.40-0.82). Agreement for grade III enterocele was classified as almost perfect (kappa = 0.87; 95% CI = 0.66-1.0). |
2 |
| 20. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010; 21(1):5-26. |
Review/Other-Dx |
N/A |
To explain a consensus-based terminology report for female pelvic floor dysfunction. |
A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. |
4 |
| 21. Colaiacomo MC, Masselli G, Polettini E, et al. Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics. 2009; 29(3):e35. |
Review/Other-Dx |
N/A |
A pictorial essay to review MR imaging findings of pelvic organ prolapse, fecal incontinence, and obstructed defecation. |
Pelvic floor dysfunctions are frequent but complex conditions that can involve some or all pelvic viscera. As abnormalities of the three pelvic compartments are frequently associated, a complete survey of the entire pelvis is necessary before surgical repair. Dynamic MR imaging of the pelvic floor is an excellent modality for assessing functional disorders of the pelvic floor in cases of pelvic organ prolapse, outlet obstruction, and incontinence. Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach. |
4 |
| 22. Maglinte DD, Bartram CI, Hale DA, et al. Functional imaging of the pelvic floor. Radiology. 2011; 258(1):23-39. |
Review/Other-Dx |
N/A |
To describe the technique used when performing DCP, define the radiographic criteria used for diagnosis, and discuss the limitations and clinical utility of DCP. |
No results stated in abstract. |
4 |
| 23. Faucheron JL, Barot S, Collomb D, Hohn N, Anglade D, Dubreuil A. Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study. Colorectal Disease. 16(7):O240-7, 2014 Jul. |
Observational-Dx |
50 patients |
To compare the accuracy of dynamic cystocolpoproctography (DCP) and dynamic MRI were in diagnosing posterior pelvic floor disorders. |
Full-thickness rectal prolapse was best diagnosed by clinical examination. Internal rectal prolapse and peritoneocele were best diagnosed by DCP. A better agreement with the operative diagnosis, which is not true superiority, was observed for DCP compared with functional pelvic MRI for full-thickness rectal prolapse, internal rectal prolapse and peritoneocele. There was no significant difference between DCP and functional pelvic MRI in the diagnosis of internal rectal prolapse (P = 0.125) or peritoneocele (P = 0.10). |
1 |
| 24. Wu YR, Christie AL, Lavelle RS, Alhalabi F, Khatri G, Zimmern PE. Bladder Prolapse Configuration on Baseline Standing Cystogram Can Predict Anterior Vaginal Wall Suspension Procedure Outcomes. Urology. 103:73-78, 2017 May. |
Observational-Dx |
79 patients |
To evaluate whether bladder prolapse shape on lateral voiding cystourethrogram (VCUG) is an accurate predictor of anterior vaginal wall suspension (AVWS) procedure outcomes. |
Between 1997 and 2013, 79 women met the study criteria. All 3 reviewers had moderate to high intra-rater reliability (??=?1.00, 0.82, and 0.79). Inter-rater reliability among the 3 reviewers was significant (??=?0.76), with 81% (64 out of 79) ratings in perfect concordance and 19% (15 out of 79) with 1 reviewer discordance. Prolapse recurrence-free probability between round- and crescent-shaped cystoceles was statistically significant (P?=?.0304). |
4 |
| 25. Kumar NM, Khatri G, Christie AL, Sims R, Pedrosa I, Zimmern PE. Supine magnetic resonance defecography for evaluation of anterior compartment prolapse: Comparison with upright voiding cystourethrogram. European Journal of Radiology. 117:95-101, 2019 Aug. |
Observational-Dx |
51 patients |
To compare utility of supine Magnetic Resonance Defecography (MRD) with upright Voiding Cystourethrogram (VCUG) for evaluation of cystocele and urethral hypermobility (UHM). |
The mean cystocele extent was 1.58?cm lower (more inferior to the reference point) (95% CI for the mean difference: 1.21, 1.94;p?<?0.0001) on MRD (-2.73 ± 1.99 cm) than on VCUG (-1.16 ± 1.75 cm). Mean UAS on MRD (72.29 ± 26.45) was 31.8 degrees higher compared to that on VCUG (40.45 ± 21.41), (95% CI for mean difference in UAS: 37.57, 26.11; p?<?0.0001). Mean UAS-UAR on MRD (74.30 ± 28.50) was 58.6 degrees higher compared to that on VCUG (15.70 ± 11.27) (95% CI for mean difference in UAS-UAR 65.94, 51.26; p?<?0.0001). Cystocele size was upgraded in 22 (43.3%) patients on MRD compared to VCUG. Five (9.8%) patients demonstrated UHM on VCUG; 48 (94.1%) patients demonstrated UHM on MRD. The differences between VCUG and MRD scores persisted across the range of VCUG measurements. Cystocele size was significantly larger in POP (+) patients than in POP (-) patients on MRD (p?=? 0.005) but not on VCUG (p?=? 0.06). |
3 |
| 26. Arif-Tiwari H, Twiss CO, Lin FC, et al. Improved Detection of Pelvic Organ Prolapse: Comparative Utility of Defecography Phase Sequence to Nondefecography Valsalva Maneuvers in Dynamic Pelvic Floor Magnetic Resonance Imaging. Current Problems in Diagnostic Radiology. 48(4):342-347, 2019 Jul - Aug. |
Observational-Dx |
237 patients |
To evaluate the utility of a defecography phase (DP) sequence in dynamic pelvic floor MRI (DPMRI), in comparison to DPMRI utilizing only non-defecography Valsalva maneuvers (VM). |
DPMRI with DP detected significantly more number of patients than VM (p<0.0001) with vaginal prolapse (231/237, 97.5% vs. 177/237, 74.7%), anorectal prolapse (227/237, 95.8% vs. 197/237, 83.1%), cystocele (197/237, 83.1% vs. 108/237, 45.6%), and rectocele (154/237, 65% vs. 93/237, 39.2%). The median cycstocele (3.2cm vs. 1cm), vaginal prolapse (3cm vs. 1.5cm), anorectal prolapse (5.4cm vs. 4.2cm), H-line (8cm vs. 7.2cm) and M-line (5.3cm vs. 3.9cm) were significantly higher with DP than VM (p<0.0001). |
3 |
| 27. Bhan SN, Mnatzakanian GN, Nisenbaum R, Lee AB, Colak E. MRI for pelvic floor dysfunction: can the strain phase be eliminated?. Abdom Radiol. 41(2):215-20, 2016 Feb. |
Observational-Dx |
80 patients |
To determine if the strain phase of an MR defecography (MRD) protocol is redundant and can be eliminated without a loss of diagnostic information. |
The evacuation phase identified all abnormalities identified on the strain phase and also identified both additional and more pronounced abnormalities, including an additional 34 cystoceles, 20 cases of urethral hypermobility, 13 uterovaginal prolapses, 36 rectoceles, 5 rectal intussusceptions, and 6 enteroceles (all p < 0.02). The mean posterior compartment descent was 24.1 mm greater on the evacuation phase than the strain phase (p < 0.0001). |
3 |
| 28. Flusberg M, Sahni VA, Erturk SM, Mortele KJ. Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR. 2011; 196(4):W394-399. |
Observational-Dx |
83 patients |
To assess the usefulness of the defecation phase during dynamic MR defecography. |
Compared with images obtained in the other phases, defecation phase images helped in identification of additional cases of abnormal bladder descent in 43 examinations (50.6%), abnormal vaginal descent in 52 examinations (61.2%), and abnormal rectal descent in 11 examinations (12.9%). Similarly, only defecation phase images depicted previously undetected rectoceles 2 cm or larger in 31 examinations (36.5%), enteroceles in 34 examinations (40%), and intussusceptions in 22 examinations (25.9%). The number of additional cases of abnormalities identified on defecation phase images was significantly greater than the number identified on images obtained in the other phases (p < 0.005). The average total scores for the rest, squeeze, strain, and defecation phases were 1.4, 0.7, 2.3, and 6.6. The average total defecation phase score was significantly greater than the average total score in any of the other phases (p < 0.001). |
3 |
| 29. Khatri G, Kumar NM, Xi Y, et al. Defecation versus pre- and post-defecation Valsalva maneuvers for dynamic MR assessment of pelvic floor dysfunction. Abdom Radiol (NY) 2019. |
Observational-Dx |
30 patients |
To compare prevalence and severity of multi-compartment pelvic floor dysfunction between supine magnetic resonance defecography with defecation (MRD) and supine dynamic MRI during Valsalva, both with and without rectal distention. |
Higher prevalence of cystocele, vaginal prolapse, enterocele, AR descent grade 2 or higher, rectocele grade 2 or higher, and RI were seen on Def compared to Post-DV and Pre-DV. Cystocele, vaginal prolapse, enterocele, AR descent, and rectocele sizes were significantly larger on Def compared to Post-DV by 0.7-1.95 cm (p </= 0.007). Prolapse in all compartments and rectocele size were significantly larger on Def compared to Pre-DV (p < 0.0001). Cystocele, vaginal prolapse, and enterocele sizes were significantly larger on Post-DV compared to Pre-DV (p < 0.0001). There were significant differences in grading of all types of prolapse and rectocele between the various acquisitions of MRD (p < 0.0001). Cystocele, AR descent, and rectocele grades were significantly higher on Def compared to Post-DV (p range </= 0.0002). Grading of all types of prolapse and rectocele was significantly higher on Def compared to Pre-DV (p < 0.0001). Cystocele, vaginal prolapse, and enterocele grades were all significantly higher on Post-DV compared to Pre-DV (p </= 0.0007). |
3 |
| 30. Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR. Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology. 2002; 223(2):501-508. |
Observational-Dx |
38 patients |
To compare open-magnet magnetic resonance (MR) imaging performed with the patient sitting with dynamic closed-magnet MR imaging of the pelvic floor performed with the patient supine. |
All intussusceptions were missed at supine MR imaging. With sitting MR imaging as the reference standard, the sensitivity of supine MR imaging was 79% for depiction of bladder descents. When MR findings were graded and clinically irrelevant MR findings were excluded, sensitivity increased to 100% for depiction of bladder descents and anterior rectoceles and to 96% for depiction of rectal descents. |
2 |
| 31. Fiaschetti V, Pastorelli D, Squillaci E, et al. Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet. Clin Radiol. 68(6):e293-300, 2013 Jun. |
Observational-Dx |
49 patients |
To assess the feasibility of magnetic resonance defaecography (MRD) in pelvic floor disorders using an open tilting magnet with a 0.25 T static field and to compare the results obtained from the same patient both in supine and orthostatic positions. |
The comparison between CD and MRD found statistically significant differences in the evaluation of anterior and posterior rectocoele during defaecation in both positions and of rectal prolapse under the pubo-coccygeal line (PCL) during evacuation, only in the supine position (versus MRD orthostatic: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.008; versus CD: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.01). The value of intra-observer intra-class correlation coefficient (ICC) ranged from good to excellent; the interobserver ICC from moderate to excellent. |
3 |
| 32. Iacobellis F, Brillantino A, Renzi A, et al. MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position. Gastroenterology research & practice. 2016:6594152, 2016. |
Observational-Dx |
31 patients |
To compare the results of static and dynamic pelvic MR performed in supine position versus sitting position, using a new MR prototype machine, in the diagnosis of pelvic floor descent. |
In rest and squeezing phases, positions of bladder, vagina, and ARJ were significantly different when the patient was imaged in supine versus sitting position. In the defecation phase, a significant difference for the bladder and vagina position was detected between the two exams whereas a significant difference for the ARJ was not found. A statistically significant difference exists when the pelvic floor descent is evaluated in sitting versus supine position. |
3 |
| 33. Tumbarello JA, Hsu Y, Lewicky-Gaupp C, Rohrer S, DeLancey JO. Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J. 2010; 21(10):1247-1251. |
Review/Other-Dx |
40 patients |
To quantify differences in anterior vaginal wall prolapse during sequential Valsalva attempts on dynamic magnetic resonance imaging (MRI). |
Forty percent of women had a greater than 2-cm increase in prolapse size from their first to third Valsalva attempt. Ninety-five percent of women extended their prolapse further with a third Valsalva. |
4 |
| 34. Lin FC, Funk JT, Tiwari HA, Kalb BT, Twiss CO. Dynamic Pelvic Magnetic Resonance Imaging Evaluation of Pelvic Organ Prolapse Compared to Physical Examination Findings. Urology. 119:49-54, 2018 Sep. |
Observational-Dx |
178 patients |
To compare dynamic magnetic resonance imaging (dMRI) defecography phase findings with physical examination (PE) grading in the evaluation of pelvic organ prolapse (POP). |
A total of 178 female patients were included. Anatomically insignificant and significant cystoceles had a 26.4% (19/72) and 84.6% (66/78) agreement respectively. Anatomically insignificant and significant apical prolapse had a 2.0% (2/100) and 62.9% (17/27) agreement respectively. Anatomically insignificant and significant posterior prolapse had a 49.5% (51/103) and 78.7% (59/75) agreement respectively. PE detected only 30% (9/30) of total dMRI detected enteroceles and misdiagnosed 10% (3/30) of these patients with a rectocele. |
3 |
| 35. Al-Najar MS, Ghanem AF, AlRyalat SAS, Al-Ryalat NT, Alhajahjeh SO. The usefulness of MR defecography in the evaluation of pelvic floor dysfunction: our experience using 3T MRI. Abdominal Radiology. 42(9):2219-2224, 2017 09. |
Review/Other-Dx |
95 patients |
To assess the usefulness of MR defecography in evaluating pelvic floor dysfunction, and to correlate several pelvic organ abnormalities with each other and with patients' symptoms and characteristics. |
Anorectal junction descent and anterior rectocele were most commonly observed, predominantly manifesting in female patients. Both were associated with abnormalities from all compartments. The middle compartment was the least affected, and its abnormality of uterine/vaginal descent tended to occur in association with the anterior compartment abnormality (cystocele). Anismus was low in incidence, and was not associated with other compartments abnormalities. Both enterocele/peritoneocele and intussusception were uncommon. |
4 |
| 36. Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Furst A. Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Diseases of the Colon & Rectum. 44(7):999-1007, 2001 Jul. |
Observational-Dx |
20 Patients |
To review the potentials of dynamic magnetic resonance imaging defecography to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in proctologic patients. |
In dynamic magnetic resonance imaging defecography of the pelvic floor, 12 patients with descending perineum, 10 rectoceles (10 females), 6 cystoceles (6 females), 4 enteroceles (4 females), 8 intussusceptions (5 females), and a dyskinetic puborectalis muscle in 3 males were detected. In 11 females and 3 males multifocal disorders were found, involving more than one compartment in females, whereas in males complex defects were restricted to the posterior compartment. Magnetic resonance imaging defecography revealed diagnoses consistent with clinical results in 77.3 percent and defects in addition to clinical diagnoses in combined pelvic floor disorders in 34 percent. |
4 |
| 37. el-Sayed RF, Morsy MM, el-Mashed SM, Abdel-Azim MS. Anatomy of the urethral supporting ligaments defined by dissection, histology, and MRI of female cadavers and MRI of healthy nulliparous women. AJR. 2007; 189(5):1145-1157. |
Review/Other-Dx |
7 formalin-preserved cadavers; MRI of 17 healthy nulliparous women |
To define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers. |
At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively. |
4 |
| 38. Berger MB, Kolenic GE, Fenner DE, Morgan DM, DeLancey JOL. Structural, functional, and symptomatic differences between women with rectocele versus cystocele and normal support. American Journal of Obstetrics & Gynecology. 218(5):510.e1-510.e8, 2018 05. |
Observational-Tx |
253 patients |
To compare the associations between the following: (1) apical support, (2) levator ani muscles, and (3) pelvic floor symptoms in women with posterior-predominant prolapse, anterior-predominant prolapse, and normal support. |
Mean point C location in controls was -6.9 cm [1.5] (mean [standard deviation]); and was higher in posterior prolapse (-4.7 cm [2.7], 2.2 cm below controls) than the anterior prolapse group (-1.2 cm [4.1]; 5.6 cm below controls, P < .001 for all comparisons). Normal-appearing muscles (ie, muscle without a visible defect) occurred at similar frequencies in posterior prolapse (45%) and controls (51%, P = .43) but less often in anterior prolapse (28%, P = .03 for pairwise comparisons). Major levator ani defects occurred at similar rates in women with posterior (33%) and anterior prolapse (42%, P = .27) but less often in controls (16%, P = .012 for both pairwise comparisons). Similarly, there were significant differences in generated vaginal closure forces across the 3 groups, with the prolapse groups generating weaker closure forces than the control group (P = .004), but the differences between the 2 prolapse groups were not significant after controlling for prolapse size (P = .43). Pelvic floor symptoms were more severe for the posterior (mean Pelvic Floor Distress Inventory score, 129) and anterior prolapse groups (score, 128) than the controls (score, 40.2, P < .001 for both comparisons); the difference between the 2 prolapse groups was not significant (P = .83). |
2 |
| 39. Morgan DM, Umek W, Stein T, Hsu Y, Guire K, DeLancey JO. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18(7):773-778. |
Observational-Dx |
137 women with prolapse and 134 women with normal support |
To determine interrater reliability of assessing pubovisceral levator ani muscle defects with magnetic resonance images. |
Among six pairs of examiners, percent agreement and weighted kappa coefficients were calculated to determine agreement between pairs of examiners and among all examiners (i.e., "overall"). For unilateral scoring, exact agreement was found in 83.7%, and differences of one, two, and three grades were found in 14.7, 1.5, and 0.1%, respectively. For bilateral scoring, exact agreement and differences of one, two and three grades were found in 75.4, 15.9, 6.9, and 1.6%, respectively. Thus, exact agreement or a one-point difference was reached in 91.3% of cases. When defect status was categorized as none/normal, minor, and major, the overall weighted kappa coefficient was 0.86 (95% CI 0.83, 0.89). There was variation among examiner pairs with unilateral (p=0.002) and bilateral (p=0.02) scoring, but not when defect status was categorized as none/normal, minor, and major (p=0.59). There was agreement to within one point in 91% of cases when six examiner pairs scored levator ani defects on a seven-point scale. Examiner pairs discriminated injury similarly when defect status was categorized as normal/none, minor, or major. |
3 |
| 40. Lammers K, Futterer JJ, Inthout J, Prokop M, Vierhout ME, Kluivers KB. Correlating signs and symptoms with pubovisceral muscle avulsions on magnetic resonance imaging. American Journal of Obstetrics & Gynecology. 208(2):148.e1-7, 2013 Feb. |
Observational-Dx |
189 women |
To correlate signs and symptoms of pelvic organ prolapse (POP) with pubovisceral muscle avulsions on magnetic resonance imaging (MRI). |
Major pubovisceral avulsions were diagnosed in 83 (44%) women, minor avulsions in 49 (26%) women, while no defects were seen in 57 (30%) women. Women with a history of episiotomy or anterior vaginal wall reconstructive surgery had a higher OR for more severe pubovisceral muscle avulsions (adjusted OR, 3.77 and 3.29, respectively), as did women with symptoms of POP (OR, 1.01, per unit increase) or higher stage POP of the central vaginal compartment based on POP-Q measurement "C" (OR, 1.18). Women with symptoms of obstructive defecation were more likely to have no defect of the pubovisceral muscle on MRI (OR, 0.97, per unit increase). |
3 |
| 41. Beets-Tan RG, Morren GL, Beets GL, et al. Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phased-array MR imaging? A study with healthy volunteers. Radiology. 2001; 220(1):81-89. |
Observational-Dx |
60 patients |
To compare endoanal ultrasonography (US), endoanal magnetic resonance (MR) imaging, and phased-array MR imaging for anal sphincter muscle measurement. |
Both MR methods had good reliability for measurements of all sphincter components, whereas endoanal US was reliable for internal sphincter measurement only. There was little correlation between the techniques, except between the two MR techniques, with a strong correlation for total sphincter and perineal body thickness. The internal sphincter thickened significantly (P =.002) with age at endoanal US and endoanal MR imaging but not at phased-array MR imaging. There were small sex-based differences in sphincter muscle measurements at phased-array MR imaging only. |
1 |
| 42. Huebner M, Margulies RU, DeLancey JO. Pelvic architectural distortion is associated with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19(6):863-867. |
Observational-Dx |
144 cases and 126 controls |
To determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. |
Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1-4.6). |
3 |
| 43. Larson KA, Luo J, Guire KE, Chen L, Ashton-Miller JA, DeLancey JO. 3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects. Int Urogynecol J. 2012; 23(3):285-293. |
Review/Other-Dx |
10 women with anterior predominant prolapse and 10 with normal support |
To assess relative contributions of "midline defects" (widening of the vagina) and "paravaginal defects" (separation of the lateral vagina from the pelvic sidewall). |
The lateral AVW margin was farther from its normal position in cases than controls throughout most of the vaginal length, most pronounced midvagina (effect sizes, 2.2-2.8). Vaginal widths differed in the midvagina with an effect size of 1.0. Strong correlations between apical and paravaginal support were evident in mid- and upper vagina (r = 0.77-0.93). |
4 |
| 44. Lienemann A, Anthuber C, Baron A, Kohz P, Reiser M. Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol. 1997; 7(8):1309-1317. |
Observational-Dx |
5 healthy volunteers and 44 female patients |
To combine dynamic MRI and adequate opacification to better delineate the pelvic-floor anatomy and to visualize the extent of descensus and prolapse. To compare this technique to dynamic fluoroscopy (DF) using the clinical evaluation and the intraoperative results as reference. |
The clinical evaluation and the intraoperative results (30 cases) were used as reference. MR-CCRG and DF were non-diagnostic in 3 cases each. Most patients had a combined type of visceral prolapse, the most frequent combination being a vaginal vault prolapse and a cystocele. The points of reference were sufficiently outlined by DF and MR-CCRG. In comparison with the clinical and intraoperative results, MR-CCRG proved to be especially beneficial in the diagnosis of different types of enteroceles including a uterovaginal prolapse. MR-CCRG showed an equal or higher sensitivity and specificity for all individual sites when compared with DF. Also, predominant herniation obscuring other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolapse in women. |
2 |
| 45. Lakeman MM, Zijta FM, Peringa J, Nederveen AJ, Stoker J, Roovers JP. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. International Urogynecology Journal. 23(11):1547-54, 2012 Nov. |
Observational-Tx |
30 patients |
To assess the interobserver agreement of magnetic resonance imaging (MRI)-based staging of pelvic organ prolapse (POP) and to quantify associations between MRI-based POP staging, findings at pelvic examination, and pelvic floor symptoms. |
The interobserver agreement of MRI-based staging of the anterior and middle compartment was good to excellent. In symptomatic women without prolapse, MRI-based and pelvic-examination-based POP staging were poorly correlated. In none of the women were MRI-based POP Quantification (POP-Q) staging and pelvic floor symptoms strongly associated. |
2 |
| 46. Torricelli P, Pecchi A, Caruso Lombardi A, Vetruccio E, Vetruccio S, Romagnoli R. Magnetic resonance imaging in evaluating functional disorders of female pelvic floor. Radiologia Medica. 103(5-6):488-500, 2002 May-Jun. |
Observational-Tx |
40 patients |
To evaluate the diagnostic capabilities of MRI in the study of functional diseases of the female pelvic floor. |
The MR image quality was adequate in all cases. In the group of symptomatic women MRI diagnosed: urethral hypermobility syndrome: 22 cases; isolated abnormalities of the anterior compartment: 8 cases of cystocele (low grade: 2, middle grade: 2, severe: 4); isolated abnormalities of the middle compartment: 6 cases of hysterocele (low grade: 2, middle grade: 4); isolated abnormalities of the posterior compartment: 5 cases of low-grade rectocele; 2 cases of enterocele (1 low grade, 1 middle grade); multi-compartment abnormalities: 11 cases; joint prolapse of anterior and middle compartment: 5 cases; joint prolapse of posterior and middle compartment: 3 cases; joint prolapse of anterior, middle and posterior compartment: 3 cases. The values of both fixed and mobile landmarks were significantly higher in the symptomatic group compared with the healthy volunteers. MRI confirmed the pelvic examination findings in all cases; in particular MRI findings were in total agreement with the clinical severity of prolapse, as defined by the Baden-Walker classification. In 7 cases MRI detected additional alterations (4 cases of hysterocele and 3 of enterocele) that had been missed at clinical evaluation. |
2 |
| 47. Abdul Jalil SS, Guzman Rojas R, Dietz HP. Does it matter whether levator avulsion is diagnosed pre- or postoperatively?. Ultrasound in Obstetrics & Gynecology. 48(4):516-519, 2016 Oct. |
Observational-Dx |
207 patients |
To determine whether a diagnosis of levator ani muscle avulsion after pelvic floor surgery can be used as a proxy for preoperative diagnosis. |
Mean follow-up after surgery was 1.3 (range, 0.3-5.5) years. Levator avulsion was found preoperatively in 111 (53.6%) patients and postoperatively in 109 (52.7%). The kappa value for the association between pre- and postoperative avulsion was 0.864 (95% CI, 0.796-0.933), signifying high agreement. The odds ratio of prolapse recurrence in women with a preoperative diagnosis of avulsion was 2.5 (95% CI, 1.3-4.5) and in those with a postoperative diagnosis it was 2.3 (95% CI, 1.3-4.2). |
2 |
| 48. Albrich SB, Welker K, Wolpert B, et al. How common is ballooning? Hiatal area on 3D transperineal ultrasound in urogynecological patients and its association with lower urinary tract symptoms. Archives of Gynecology & Obstetrics. 295(1):103-109, 2017 Jan. |
Observational-Dx |
246 patients |
To measure hiatal area on Valsalva in a cohort of urogynecological patients; and to correlate hiatal area with urogynecological symptoms, levator integrity and evaluate cut-off values for pelvic organ prolapse. |
Median age of our study population was 66 (range 29-94) years, median parity was 2.1 (range 0-9) with 17 (6.9 %) nulliparous women. Symptoms of overactive bladder in 71.1 % were most common, followed by 54.5 % symptoms of stress incontinence and 32.1 % symptoms of prolapse. On examination 49.2 % showed signs of prolapse. Levator avulsions on 3D ultrasound were detected in 20.7 %. Hiatal area was normally distributed with a median of 28.7 cm2 (range 10.4-50.0 cm2). Patients with levator avulsion had a significantly larger hiatal area (p < 0.001). Also patients with signs of prolapse had a significantly larger hiatal area (p < 0.001). There was no correlation between hiatal area and symptoms of overactive bladder (p = 0.374). Although not reaching statistical significance there was evidence of a smaller hiatal area for patients with stress incontinence (p = 0.016). In our cohort there were 33.7 % (83) women without ballooning, 27.2 % (67) showed mild, 18.3 % (45) moderate, 12.3 % (30) marked and 8.5 % (21) severe ballooning. The ROC curve analysis for hiatal area on patients with prolapse yielded an AUC of 0.755 [95 % CI (0.696-0.814)]. Using the Youden-Index we obtained 27.53 cm2 as a cut-off with a sensitivity of 0.70 and a specificity of 0.69. |
3 |
| 49. Notten KJB, Vergeldt TFM, van Kuijk SMJ, Weemhoff M, Roovers JWR. Diagnostic Accuracy and Clinical Implications of Translabial Ultrasound for the Assessment of Levator Ani Defects and Levator Ani Biometry in Women With Pelvic Organ Prolapse: A Systematic Review. [Review]. Female Pelvic Medicine & Reconstructive Surgery. 23(6):420-428, 2017 Nov/Dec. |
Meta-analysis |
31 articles |
To assess the diagnostic accuracy and clinical implications of translabial 3-dimensional (3D) ultrasound for the assessment of levator ani defects and biometry in women with pelvic organ prolapse (POP). |
Thirty-one articles were selected in accordance with parts of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that can be applied to studies of diagnostic accuracy. Twenty-two articles (71%) are coauthored by 1 expert in this field. Detecting levator ani defects with translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to good agreement, whereas measuring hiatal biometry on translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to very good agreement.The interobserver agreement for diagnosing levator ani defects and measuring the levator hiatal area showed a moderate to very good agreement. Furthermore, levator ani defects increase the risk of cystocele and uterine prolapse, and levator ani defects are associated with recurrent POP.Finally, a larger hiatus was associated with POP and recurrent POP. |
Good |
| 50. Dietz HP. Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 2010; 202(4):321-334. |
Review/Other-Dx |
N/A |
To give an overview of sonography and its main current uses in clinical assessment and research. |
No results stated in abstract. |
4 |
| 51. Perniola G, Shek C, Chong CC, Chew S, Cartmill J, Dietz HP. Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol. 31(5):567-71, 2008 May. |
Observational-Dx |
31 women |
A comparative clinical study to determine agreement between defecation proctography and translabial ultrasound. |
Six women did not attend defecation proctography, leaving 31 cases for comparison. The mean age was 53 years. Patients rated discomfort at a median of 1 (range 0-10) for ultrasound and 7 (range 0-10) for defecation proctography (P < 0.001). Defecation proctography suggested rectocele and rectal intussusception/prolapse more frequently than did ultrasound. While the positive predictive value of ultrasound (considering defecation proctography to be the definitive test) was 0.82 for rectocele and 0.88 for intussusception/prolapse, negative predictive values were only 0.43 and 0.27, respectively. Cohen's kappa values were 0.26 and 0.09, respectively. There was poor agreement between ultrasound and defecation proctography measurements of anorectal angle and rectocele depth. |
2 |
| 52. Steensma AB, Oom DM, Burger CW, Schouten WR. Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis. 2010; 12(6):533-539. |
Observational-Dx |
75 patients |
To compare EP with 3DTPUS in diagnosing posterior compartment prolapse. |
Between 2005 and 2007, 75 patients were included with a median age of 59 years (range 22-83). The Cohen's Kappa Index for enterocole was 0.65 (good) and for rectocele it was 0.55 (moderate). The level of correlation for intussusception was fair (kappa = 0.21). |
2 |
| 53. Beer-Gabel M, Assoulin Y, Amitai M, Bardan E. A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. International Journal of Colorectal Disease. 23(5):513-9, 2008 May. |
Observational-Dx |
62 patients |
To compare dynamic evacuation proctography (DEP) with dynamic transperineal ultrasonography (DTP-US) for the diagnosis of cul-de-sac hernias in those patients presenting with evacuatory dysfunction. |
Both the DEP and the DTP-US techniques show concordance for the diagnosis of cul-de-sac hernias in an unselected patient cohort. Patients in both groups have the same duration of constipation with a greater likelihood of prior hysterectomy in those with cul-de-sac hernias. The diagnosis was established separately by DEP in 88% and in 82% of the cases by DTP-US. Transperineal sonography is discordant with DEP in 45% of cases once the diagnosis of cul-de-sac hernia is made, over the contents of the hernia and over the degree of transvaginal enterocele descent, where DTP-US tends to upgrade enterocele severity. Both techniques confirm the high incidence of concomitant pelvic floor compartment pathology. |
3 |
| 54. Dietz HP, Kamisan Atan I, Salita A. Association between ICS POP-Q coordinates and translabial ultrasound findings: implications for definition of 'normal pelvic organ support'. Ultrasound Obstet Gynecol. 47(3):363-8, 2016 Mar. |
Observational-Dx |
825 women |
To compare clinical examination and imaging findings, especially regarding cut-offs for the distinction between normal pelvic organ support and prolapse |
Full datasets were available for 825 women. On clinical examination, 646 (78.3%) were found to have prolapse of at least POP-Q Stage 2. All coordinates on clinical examination were strongly associated with the ultrasound measurements of pelvic organ descent (P?<?0.001). These relationships were almost linear, especially for the anterior compartment. |
2 |
| 55. Lone FW, Thakar R, Sultan AH, Stankiewicz A. Accuracy of assessing Pelvic Organ Prolapse Quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse. International Urogynecology Journal. 23(11):1555-60, 2012 Nov. |
Observational-Dx |
97 women |
To determine the relationship between clinical assessment of female pelvic organ prolapse (POP) using the validated Pelvic Organ Prolapse Quantification (POP-Q) and dynamic 2D transperineal ultrasound (TPUS). |
One hundred and fifty-eight women had a POP-Q and TPUS; 20 scans (12.6 %) were not analysable, and 41 women had prolapse beyond the hymen. Ninety-seven women were thus analysed. The correlation between 2D TPUS (with/without the addition of the offset) and POP-Q was statistically significant (p value <0.0001) for all three compartments. The proportion of correct predictions was 59.6 %, 61.5 % and 32.6 % for bladder, bowel and middle-compartment prolapse, respectively. |
3 |
| 56. Dietz HP, Steensma AB. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol. 2005; 26(1):73-77. |
Review/Other-Dx |
198 women |
To determine the prevalence of these conditions in a urogynecological population. |
Clinically, a rectocele was diagnosed in 112 (56%) cases. Rectovaginal septal defects were observed sonographically in 78 (39%) women. There was a highly significant relationship between ultrasound and clinical grading (P < 0.001). Of 112 clinical rectoceles, 63 (56%) cases showed a fascial defect, eight (7%) showed perineal hypermobility without fascial defect, and in three (3%) cases there was an isolated enterocele. In 38 (34%) cases, no sonographic abnormality was detected. Neither position of the ampulla nor presence, width or depth of defects correlated with vaginal parity. In contrast, age showed a weak association with rectal descent (r = -0.212, P = 0.003), the presence of fascial defects (P = 0.002) and their depth (P = 0.02). |
4 |
| 57. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourology & Urodynamics. 21(2):167-78, 2002. |
Review/Other-Dx |
N/A |
To present definitions of the symptoms, signs, urodynamic observations and conditions associated with lower urinary tract dysfunction (LUTD) and urodynamic stu-dies (UDS), for use in all patient groups from children to the elderly. |
No abstract available. |
4 |
| 58. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary Incontinence in Women: A Review. [Review]. JAMA. 318(16):1592-1604, 2017 Oct 24. |
Review/Other-Dx |
N/A |
To summarize the evaluation and therapeutic options for women affected by urinary incontinence |
No results stated in abstract. |
4 |
| 59. Cassado Garriga J, Pessarrodona Isern A, Rodriguez Carballeira M, et al. Three-dimensional translabial ultrasound assessment of urethral supports and the urethral sphincter complex in stress urinary incontinence. Neurourology & Urodynamics. 36(7):1839-1845, 2017 Sep. |
Observational-Tx |
173 patients |
To evaluate the role of 3D-4D ultrasound in the assessment of the fascial supports of the urethra and the urethral sphincter complex (USC) for diagnosing stress urinary incontinence. |
A total of 173 women were examined, 78 continent and 95 incontinent. There was a significant difference in urethral mobility between continent and incontinent women (12.82?mm vs. 21.85?mm, P?<?0.001), but there was no significant difference in the percentage of supports affected (43.27% vs. 35.94%, P?<?0.070). The length of the USC at rest was significantly shorter (P?<?0.001) ??in incontinent patients. |
2 |
| 60. Walsh LP, Zimmern PE, Pope N, Shariat SF, Urinary Incontinence Treatment Network. Comparison of the Q-tip test and voiding cystourethrogram to assess urethral hypermobility among women enrolled in a randomized clinical trial of surgery for stress urinary incontinence. Journal of Urology. 176(2):646-9; discussion 650, 2006 Aug. |
Observational-Dx |
43 patients |
To compare 2 measures of urethral hypermobility, the Q-tip test and voiding cystourethrogram, preoperatively in women recruited in 1 center participating in a multicenter randomized clinical trial comparing Burch colposuspension with autologous rectus fascia sling. |
In 43 patients the mean urethral angle at rest and UAS were 20 degrees +/- 12 and 51 degrees +/- 20, by voiding cystourethrogram compared to 16 degrees +/- 9 and 58 degrees +/- 10 by Q-tip test, respectively. The mean angle difference (urethral angle with straining minus urethral angle at rest) was greater for the Q-tip test (42 degrees +/- 9) than that for the voiding cystourethrogram test (32 degrees +/- 17; p < 0.05). Fewer patients (14% by Q-tip, 28% by voiding cystourethrogram) had urethral hypermobility using the definition of urethral angle at rest greater than 30, while almost all patients (91% by voiding cystourethrogram, 100% by Q-tip) had urethral hypermobility using the definition of urethral angle with straining greater than 30. However, using the definition of urethral angle with straining minus urethral angle at rest greater than 30, only 58% of patients had urethral hypermobility by voiding cystourethrogram compared to 98% by Q-tip. |
3 |
| 61. Dumoulin C, Tang A, Pontbriand-Drolet S, Madill SJ, Morin M. Pelvic floor morphometry: a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence. International Urogynecology Journal. 28(8):1233-1239, 2017 Aug. |
Observational-Dx |
40 patients |
To determine if pelvic floor muscle (PFM) morphometry at baseline, as measured by MRI, can predict response to PFM training in women with stress or mixed urinary incontinence (UI). |
The urethro-vesical junction height at rest, as measured by MRI before treatment, was associated with response to PFM training both on univariate (p?=?0.005) and multivariate analyses (p?=?0.007). The area under the ROC curve was 0.82 (95% confidence interval [CI]: 0.67-0.96). Using a cut-off point of 11.4 mm, participants' response to PFM training was predicted with a sensitivity of 77% and a specificity of 83%. Incontinent women with a urethro-vesical junction height above this threshold were 35% more likely to respond to PFM training (OR 1.35; 95% CI: 1.08-1.67). |
3 |
| 62. Pontbriand-Drolet S, Tang A, Madill SJ, et al. Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study. Neurourology & Urodynamics. 35(4):515-21, 2016 Apr. |
Observational-Dx |
66 women |
To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence. |
Women with MUI symptoms had a lower PFM resting position (M-Line P?=?0.010 and PC/H-line angle P?=?0.026) and lower pelvic organ support (urethrovesical junction height P?=?0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P?=?0.026 and P?=?0.008, respectively). There were no significant differences between groups on PFM MVC or straining. |
3 |
| 63. Morgan DM, Umek W, Guire K, Morgan HK, Garabrant A, DeLancey JO. Urethral sphincter morphology and function with and without stress incontinence. J Urol. 2009; 182(1):203-209. |
Observational-Dx |
103 women with stress incontinence and 108 asymptomatic continent controls |
To analyze the relationship between urethral sphincter anatomy, urethral function and pelvic floor function using magnetic resonance images. |
The striated urogenital sphincter in women with stress incontinence was 12.5% smaller than that in asymptomatic continent women (mean +/- SD length-area index 766.4 +/- 294.3 vs 876.2 +/- 407.3 mm(3), p = 0.04). The groups did not differ significantly in striated urogenital sphincter length (13.2 +/- 3.4 vs 13.7 +/- 3.9 mm, p = 0.40), thickness (2.83 +/- 0.8 vs 3.11 +/- 1.4 mm, p = 0.09) or area (59.1 +/- 18.4 vs 62.9 +/- 24.7 mm(2), p = 0.24). Striated urogenital sphincter length and area, and the length-area index were associated during voluntary pelvic muscle contraction with more urethral axis elevation and increased vaginal closure force augmentation. |
3 |
| 64. Tasali N, Cubuk R, Sinanoglu O, Sahin K, Saydam B. MRI in stress urinary incontinence: endovaginal MRI with an intracavitary coil and dynamic pelvic MRI. Urol J. 2012; 9(1):397-404. |
Observational-Dx |
25 women with SUI and 8 controls |
To evaluate both morphology of the urethra and its supporting structures using endovaginal magnetic resonance imaging (EV-MRI) and the grade of the bladder neck prolapsus using dynamic pelvic MRI (DP-MRI) in women with stress urinary incontinence (SUI). |
Significant differences were found in the thickness of each three layers of the urethra between the two groups (P < .05). There was a significantly higher pubourethral ligament distortion (P = .024) and larger vesicourethral angle (P = .000) in women with SUI. In women with SUI, there was no significant relationship between the number of deliveries and the degree of the bladder neck prolapsus (P > .05). |
2 |
| 65. Tunn R, Goldammer K, Neymeyer J, Gauruder-Burmester A, Hamm B, Beyersdorff D. MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2006; 126(2):239-245. |
Observational-Dx |
54 women |
To evaluate pathomorphologic changes of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence (SUI) by MRI. |
The urethral sphincter muscle showed a reduced thickness of its posterior portion (37%), an omega shape (13%) or higher signal intensity (50%); its abnormal configuration was associated with an increased signal intensity in 70% (p=0.001). The levator ani muscle comprised an unilateral loss of substance in 30%, a higher signal intensity in 28%, and altered origin in 19%. Central defects of the endopelvic fascia were present in 39% (n=21), lateral defects in 46%. There was a significant association between loss of the symphyseal concavity of the anterior vaginal wall and lateral fascial defects (p=0.001) and levator ani changes (p=0.016). |
3 |
| 66. Dietz HP.. Pelvic floor ultrasound in incontinence: what's in it for the surgeon?. [Review]. International Urogynecology Journal. 22(9):1085-97, 2011 Sep. |
Review/Other-Dx |
N/A |
To focus on clinical utility in the work-up of the incontinent patient, both in the context of preoperative investigations, and in the diagnostic work-up, and in the context of dealing with treatment failure and postoperative complications. |
No results stated in abstract. |
4 |
| 67. Tunn R, Petri E. Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. [Review] [54 refs]. Ultrasound Obstet Gynecol. 22(2):205-13, 2003 Aug. |
Review/Other-Dx |
N/A |
To review the different applications of ultrasound in benign urogynecological diseases. |
No results stated in abstract. |
4 |
| 68. Wlazlak E, Surkont G, Shek KL, Dietz HP. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data?. Eur J Obstet Gynecol Reprod Biol. 193:114-7, 2015 Oct. |
Observational-Dx |
341 women |
To replicate the claim that urethral hypermobility and resting urethral pressure can largely explain stress incontinence in women in an unselected cohort of women seen for urodynamic testing, including as many potential confounders as possible. |
On binary logistic regression, the following parameters were statistically significant in predicting urodynamic stress incontinence: age (P=0.03), significant rectocele (P=0.02), max. abdominal pressure reached (negatively, P<0.0001), midurethral mobility (P=0.0004) and MUP (negatively, P<0.0001). On multivariate analysis, accounting for multiple interdependencies, the following predictors remained significant: max. abdominal pressure reached (negatively, P<0.0001), cough pressure (P=0.006), midurethral mobility (P=0.003) and MUP (negatively, P<0.0001), giving an R(2) of 0.24. |
4 |
| 69. Torella M, De Franciscis P, Russo C, et al. Stress urinary incontinence: usefulness of perineal ultrasound. Radiologia Medica. 119(3):189-94, 2014 Mar. |
Observational-Dx |
51 patients |
To evaluate whether the degree of urethral mobility can be a determinant of success of a minimally invasive prosthetic procedure. |
We recorded a difference in the average pubo-urethral distance of 3 mm ± 1.2 at rest and 2.7 mm ± 1.2 under stress and a difference in the average pubo-urethral angle of 13° ± 6.3° at rest and 8° ± 6.3° under stress between the two groups. |
4 |
| 70. Bergman A, Vermesh M, Ballard CA, Platt LD. Role of ultrasound in urinary incontinence evaluation. Urology. 33(5):443-4, 1989 May. |
Observational-Dx |
20 Patients |
To assess anatomic support of the urethrovesical junction (UVJ) in continent and stress incontinent women using transrectal ultrasound. |
There was no measurable change in the Q-tip angle and angle change on strain with the introduction of the ultrasonic rectal probe. All patients with stress urinary incontinence had urethrovesical junction (UVJ) prolapse on straining of more than 1 cm (mean change 1.6, range 1.2-2.4 cm) (Fig. 1). All patients with no stress incontinence had minimal, or no UVJ prolapse on strain (mean change 0.2 cm, range O-O.5 cm) (Fig. 2) (P 5 0.05, Student t test). All patients had an easily identifiable UVJ (with Qtip in place). The mean time of the ultrasonic evaluation was three minutes with a range from two to four minutes. |
3 |
| 71. Bergman A, McKenzie CJ, Richmond J, Ballard CA, Platt LD. Transrectal ultrasound versus cystography in the evaluation of anatomical stress urinary incontinence. British Journal of Urology. 62(3):228-34, 1988 Sep. |
Observational-Dx |
85 patients |
To compare transrectal ultrasound versus cystography in the evaluation of anatomical stress urinary incontinence. |
Cystographic and ultrasonographic tests for the position of the urethrovesical junction at the most dependent position in the bladder during straining were very sensitive in women with stress urinary incontinence (94 and 87% respectively) but much less specific (45 and 48% respectively). When evaluating anatomical support to the urethrovesical junction and its descent on straining, these tests were both highly sensitive (97 and 94% respectively) and specific (76 and 96% respectively) in women with genuine stress urinary incontinence. |
4 |
| 72. Richmond DH, Sutherst JR. Burch colposuspension or sling for stress incontinence? A prospective study using transrectal ultrasound. British Journal of Urology. 64(6):600-3, 1989 Dec. |
Experimental-Tx |
29 women |
To discuss procedure and success rate of Burch colposuspension versus sling for stress incontinence. |
No results stated in abstract. |
4 |
| 73. Richmond DH, Sutherst JR. Clinical application of transrectal ultrasound for the investigation of the incontinent patient. British Journal of Urology. 63(6):605-9, 1989 Jun. |
Review/Other-Dx |
84 patients |
To describe a transrectal ultrasound technique for imaging the bladder neck and urethra. |
No results stated in abstract. |
4 |
| 74. Kuhn A, Genoud S, Robinson D, et al. Sonographic transvaginal bladder wall thickness: does the measurement discriminate between urodynamic diagnoses?. Neurourology & Urodynamics. 30(3):325-8, 2011 Mar. |
Observational-Dx |
123 patients |
To determine if vaginally measured bladder wall thickness (BWT) correlates with urodynamic diagnoses in a female population. |
123 patients were included in the study with a median age of 69 years (range 40-93), median parity of 2 (range 0-3) and a median body mass index of 29.5 kg/m(2) (range 23-38). Urodynamic stress incontinence was diagnosed in 59 patients, DO in 40 and obstruction in 24 cases. Bladder wall thickness was significantly higher in DO patients and in obstruction than in urodynamic stress incontinence. Detrusor pressure at maximum flow rate (pdet/Q(max) ) correlated significantly with BWT. |
4 |
| 75. Zacharakis D, Grigoriadis T, Pitsouni E, Domali E, Protopapas A, Athanasiou S. Ultrasonographic Evaluation of the Urethral Rhabdosphincter Morphology in Female Patients With Urodynamic Stress Incontinence. Female Pelvic Medicine & Reconstructive Surgery. 23(4):267-271, 2017 Jul/Aug. |
Observational-Tx |
142 patients |
To evaluate the feasibility of a simple sonographic technique for the assessment of the urethral rhabdosphincter morphology by using a 2-dimensional (2D) transvaginal transducer and to evaluate any associations between the sonographic parameters of rhabdosphincter morphology with the presence of urodynamic stress incontinence (USI). |
Statistical analysis showed that women with a rhabdosphincter area of less than 0.65 cm, mean thickness of less than 0.24 cm, and differential perimeter of less than 1.08 cm had 3.98, 5.67, and 5.41 times greater odds for USI, respectively. Receiver operating characteristic curve analysis results showed that the optimal cutoff values for the prediction of USI from rhabdosphincter thickness, differential perimeter. and surface area were 0.24 cm (79.6% sensitivity, 63.4% specificity), 1.08 cm (70.8% sensitivity and 69.1% specificity), and 0.65 cm (71.9% sensitivity, 57.1% specificity), respectively. |
2 |
| 76. Digesu GA, Robinson D, Cardozo L, Khullar V. Three-dimensional ultrasound of the urethral sphincter predicts continence surgery outcome. Neurourology & Urodynamics. 28(1):90-4, 2009. |
Experimental-Dx |
91 women |
To assess the predictive value of three-dimensional (3D) ultrasound volumes of the urethral sphincter in women undergoing continence surgery. |
Ninety-one women were studied. Women who failed continence surgery had significantly smaller preoperative urethral sphincter volumes than those who had an objective cure (P < 0.001). UPP parameters were not found to be predictive of surgical outcome (P = 0.5). |
3 |
| 77. Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006; 130(5):1510-1518. |
Review/Other-Dx |
N/A |
To define criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). |
Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include proctalgia fugax (fleeting pain) and chronic proctalgia; chronic proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with > or =2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation). |
4 |
| 78. Bharucha AE, Wald AM. Anorectal disorders. Am J Gastroenterol. 2010; 105(4):786-794. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 79. Rao SS, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol. 2005; 100(7):1605-1615. |
Review/Other-Dx |
N/A |
To perform a systematic review of diagnostic tests commonly used in constipation. |
No studies assessed the routine use of blood tests or abdominal x-ray. One retrospective endoscopic study showed that cancer and polyp detection rate was comparable to historical controls. Two studies of barium enema were unhelpful in diagnosis of constipation. Physiological studies showed differences in study population, methodology, and interpretation, and there was no gold standard. Ten colonic transit studies showed prevalence of 38-80% in support of slow transit constipation. Nine anorectal manometry studies showed prevalence of 20-75% for detecting dyssynergia. Nine studies of balloon expulsion showed impaired expulsion of 23-67%. Among 10 defecography studies, abnormalities were reported in 25-90% and dyssynergia in 13-37%. |
4 |
| 80. Videlock EJ, Lembo A, Cremonini F. Diagnostic testing for dyssynergic defecation in chronic constipation: meta-analysis. Neurogastroenterol Motil. 25(6):509-20, 2013 Jun. |
Meta-analysis |
79 studies on 7581 patients |
To estimate the prevalence of abnormal findings associated with DD across testing modalities in patients referred for physiological testing for CC. |
A total of 79 studies on 7581 CC patients were included. The median prevalence of any single abnormal finding associated with DD was 37.2%, ranging from 14.9% (95% CI 7.9-26.3) for absent opening of the anorectal angle (ARA) on defecography to 52.9% (95% CI 44.3-61.3) for a dyssynergic pattern on ultrasound. The prevalence of a dyssynergic pattern on manometry was 47.7% (95% CI 39.5-56.1). The prevalence of DD was similar across specialty and geographic area as well as when restricting to studies using Rome criteria to define constipation. |
M |
| 81. Agachan F, Pfeifer J, Wexner SD. Defecography and proctography. Results of 744 patients. Dis Colon Rectum. 1996; 39(8):899-905. |
Review/Other-Dx |
744 patients |
To assess the incidence and clinical significance of defecographic findings in patients with possible evacuation disorders. |
Between July 1988 and July 1995, 744 patients (566 females and 178 males) with a mean age of 63.5 (range, 12-95) years had defecographic and proctographic examination. Four hundred forty-six (60 percent) patients were diagnosed who complained of constipation, 123 (16.5 percent) of fecal incontinence, 42 (5.6 percent) of rectal prolapse, 82 (11 percent) of rectal pain, and 51 (6.9 percent) had a combination of more than one of these diagnoses. Although 93 (12.5 percent) of these evaluations were considered normal, 61 (8 percent) revealed rectal prolapse, 191 (25.7 percent) rectocele, 82 (11 percent) sigmoidocele, and 94 (12.6 percent) intussusception; in 223 (30 percent) patients, a combination of these findings was noted. Patients with paradoxical puborectalis contraction had an extremely high frequency of constipation compared with other symptoms (P < 0.0001). |
4 |
| 82. Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS. Four-contrast defecography: pelvic "floor-oscopy". Dis Colon Rectum. 1995; 38(7):695-699. |
Observational-Dx |
62 women |
To determine the accuracy of physical examination (as judged by four-contrast defecography) for women with pelvic floor relaxation disorders. |
Four-contrast defecography changed the diagnosis in 46 patients (75 percent); 26 percent of presumed cystoceles, 36 percent of enteroceles, and 25 percent of rectoceles were not present on defecography. Defecography also revealed unsuspected coexisting defects in addition to known abnormalities detected on physical examination. In contrast, when physical examination was negative for these defects, 63 percent of patients were found to have cystoceles, 46 percent to have enteroceles, and 73 percent to have rectoceles on four-contrast defecography. The discovery of Grade 2 or 3 unsuspected abnormalities was significant, especially so for enteroceles. For posterior vaginal eversions extending to or past the introitus, physical examination was accurate in only 61 percent. Physical examination of large anterior defects was more accurate, with 74 percent of patients being correctly diagnosed. |
3 |
| 83. Harvey CJ, Halligan S, Bartram CI, Hollings N, Sahdev A, Kingston K. Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology. 1999; 211(1):223-227. |
Observational-Dx |
50 patients |
To determine the diagnostic and therapeutic effects of evacuation proctography. |
Diagnostic confidence rose significantly after evacuation proctography (mean, 7.0 before evacuation proctography vs 8.4 after evacuation proctography; P < .001). Lead diagnosis changed in nine (18%) patients. Intended surgical management became nonsurgical after evacuation proctography in seven (14%) patients, and intended nonsurgical therapy became surgical in two (4%). Surgery remained likely in 15 patients, but its nature changed in five (10%). Five (10%) clinicians stated that evacuation proctographic findings resolved diagnostic conflict, and nine (18%) found that evacuation proctographic findings revealed unsuspected diagnoses. Clinicians found evacuation proctography of major benefit in 20 (40%) cases studied and of moderate benefit in 20 (40%). In general, 20 (43%) clinicians found evacuation proctography very useful and 24 (51%) found it moderately useful. |
3 |
| 84. Halligan S, Malouf A, Bartram CI, Marshall M, Hollings N, Kamm MA. Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR. 2001; 177(3):633-636. |
Observational-Dx |
31 patients |
To determine the positive predictive value of impaired evacuation during evacuation proctography for the subsequent diagnosis of anismus. |
Twenty-eight (90%) of the 31 patients with impaired proctographic evacuation were found to have anismus at subsequent physiologic testing. Among the 28 were all 10 patients who evacuated no contrast medium and all 11 patients with inadequate pelvic floor descent, giving evacuation proctography a positive predictive value of 90% for the diagnosis of anismus. A prominent puborectal impression was seen in only three subjects during proctography, one of whom subsequently showed no physiologic sign of anismus. |
3 |
| 85. Piloni V, Fioravanti P, Spazzafumo L, Rossi B. Measurement of the anorectal angle by defecography for the diagnosis of fecal incontinence. International Journal of Colorectal Disease. 14(2):131-5, 1999 Apr. |
Observational-Dx |
674 patients |
To evaluate the intraobserver reproducibility of anorectal angles (ARAs) measured by defecography at rest, squeezing, and straining in a large series ofpatients affected by various types of evacuation dysfunctions and (b) to compare data from continent and incontinent subjects to determine which set of ARA measurements, if any, provide better discrimination between the two groups, regardless of the underlying abnormality at defecography. |
The two groups were homogeneous with regard to sex distribution (48.6% vs. 51.4% men and 44.7% vs. 55.3% women, n.s.) and age (56.5 +/- 10.2 vs. 59.3 +/- 9.7 years, n.s.). The incidence of rectal prolapse was the same in the two groups (40 each). The intraobserver agreement index from two independent measurements (Pearson's correlation coefficient), age, and gender interaction [T2 Hotelling test in multivariate analysis of variance (ANOVA)] and the most discriminating category of ARA measurement (Fisher's F test in ANOVA) were calculated. In addition, the relationship between ARA and severity of incontinence was assessed by the eta coefficient. Pearson's correlation coefficient was between 0.78 and 0.98 (P < 0.01). The mean ARA differed significantly between the continent and incontinent subjects (104.5 +/- 10.3 degrees vs. 116.2 +/- 23.6 degrees at rest, 84.5 +/- 14.2 degrees vs. 95.1 +/- 20.1 degrees on squeezing, and 133.7 +/- 21.7 degrees vs. 141.7 +/- 25.9 degrees on straining; T2 0.066, P < 0.05 in multivariate ANOVA). No interaction was noted between groups and gender (T2 = 0.023; F = 1.11, n.s.). Resting ARA was shown by ANOVA to be the most discriminating index (F = 9.4 P < 0.01) between the two groups. Overall, ARA measurement was correlated with the severity of fecal incontinence (eta coefficient: 0.894 at rest; 0.811 on squeezing; 0.695 on straining); its accuracy was 79%, the false-positive rate was 15.3% and the false-negative rate 26.5%. |
3 |
| 86. Reiner CS, Tutuian R, Solopova AE, Pohl D, Marincek B, Weishaupt D. MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value. Br J Radiol. 84(998):136-44, 2011 Feb. |
Observational-Dx |
48 patients |
To describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation. |
The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic defecation of 100% (95% confidence interval (CI) 97-100%), but a specificity of only 23% (95% CI 7-40%). A lower sensitivity (50%; 95% CI 24-76%) and a high specificity (97%; 95% CI 89-100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63-100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81-100%) of the patients with dyssynergic defecation. |
2 |
| 87. Elshazly WG, El Nekady Ael A, Hassan H. Role of dynamic magnetic resonance imaging in management of obstructed defecation case series. Int J Surg. 2010; 8(4):274-282. |
Observational-Dx |
40 consecutive patients |
To evaluate the role dynamic magnetic resonance imaging defecography, and to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients in order to minimize failures. |
The dynamic MRI of the pelvic floor showed 23 patients with descending perineum, 32 rectoceles (28 females), 12 cystoceles (10 females), 6 enteroceles (4 females), 18 intussusceptions (14 females), and 7 dyskinetic puborectalis muscle (3 females). The diagnosis of combined pelvic floor disorders with dynamic MRI defecography was consistent with clinical results in 70% and there were additional diagnostic parameters in 30% of patients. Dynamic MRI findings changed treatment decision in 8 patients 20% with surgical treatment performed in 25 patients (8 stappled trans-anal rectal resection, 11 trans-anal Delorme's, 6 trans-abdominal combined repair), and conservative treatment in 15 patients. |
2 |
| 88. Ratz V, Wech T, Schindele A, et al. Dynamic 3D MR-Defecography. Rofo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 188(9):859-63, 2016 Sep. |
Review/Other-Dx |
6 patients |
To propose a 3?D MR-defecography setup that uses an extended radial bSSFP stack-of-stars imaging sequence for data acquisition and a modified “Fast Iterative Shrinkage Threshold Algorithm – FISTA” compressed sensing algorithm for data reconstruction. We applied this setup to 6 female patients in order to optimize the imaging protocol with respect to the sampling strategy as well as the spatial and temporal resolution. |
No results stated in abstract. |
4 |
| 89. Foti PV, Farina R, Riva G, et al. Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol Med (Torino). 118(1):23-39, 2013 Feb. |
Review/Other-Dx |
19 patients |
To prospectively compare the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome. |
Comparison between CD and MR with evacuation phase (MRWEP) showed no significant differences in sphincter hypotonia, dyssynergia, rectocele or rectal prolapse and significant differences in descending perineum. Comparison between CD and MR without evacuation phase (MRWOEP) showed no significant differences in sphincter hypotonia, dyssynergia or enterocele but significant differences in rectocele, rectal prolapse and descending perineum. Comparison between MRWEP and MRWOEP showed no significant differences in sphincter hypotonia, dyssynergia, enterocele or descending perineum but significant differences in rectocele, rectal prolapse, peritoneocele, cervical cystoptosis and hysteroptosis. |
4 |
| 90. Hetzer FH, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D. MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 2006; 240(2):449-457. |
Observational-Dx |
50 patients |
To retrospectively evaluate magnetic resonance (MR) defecography findings in patients with fecal incontinence who were evaluated for surgical treatment and to assess the influence of MR defecography on surgical therapy. |
MR defecography revealed rectal descent of more than 6 cm (relative to the pubococcygeal line) in 47 (94%) of 50 patients. A bladder descent of more than 3 cm was present in 20 (40%) of 50 patients, and a vaginal vault descent of more than 3 cm was present in 19 (43%) of 44 women. Moreover, 17 (34%) anterior proctoceles, 16 (32%) enteroceles, and 10 (20%) rectal prolapses were noted. Interobserver agreement was good to excellent (kappa = 0.6-0.91) for image analysis results. MR defecography findings led to changes in the surgical approach in 22 (67%) of 33 patients who underwent surgery. |
3 |
| 91. Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007; 22(7):783-790. |
Observational-Dx |
312 patients |
To examine if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonography. |
Absent, decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean (+/-SD) manometric findings: mean resting pressure 41.3 (+/-20), 43.8 (+/-20) and 61.6 (+/-23) Hg (p<0.001); incremental squeeze pressure 20.6 (+/-20), 38.4 (+/-31) and 62.4 (+/-34) Hg (p<0.001). External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects <90 degrees in 36% (37/103); for defects between 90-150 degrees in 61% (20/33); for defects between 150-270 degrees in 100% (6/6). Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures (p=0.04); patients with a gaping anus had lower resting pressures (p=0.013) at anorectal manometry. All other findings were not related to any anorectal function test or endoanal ultrasonography. |
3 |
| 92. Lam TJ, Mulder CJ, Felt-Bersma RJ. Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment. Int J Colorectal Dis. 2012; 27(7):931-937. |
Observational-Dx |
218 patients |
To establish the additive value of performing anorectal function tests in these patients in selecting them for surgery. |
In total, 218 patients were evaluated. Of these, 107 (49%) patients had no sphincter defects, 71 (33%) had small defects and 40 (18%) had large defects. Anorectal manometry could not differentiate between patients with and without sphincter defects. Patients with sphincter defects were only found to have a significantly shorter sphincter length and reduced rectal capacity compared to patients without sphincter defects. Forty-three patients (20%) had a normal anal pressures >/= 40 mmHg. Seventeen patients (8%) had also a dyssynergic pelvic floor both on clinical examination and anorectal manometry. Fifteen patients (7%) had a reduced rectal capacity between 65 and 100 ml. There was no difference in anal pressures or the presence of sphincter defects in these patients compared to patients with a rectal capacity >150 ml. There was no correlation between anorectal manometry, endosonography and faecal incontinence severity scores. |
3 |
| 93. Murad-Regadas SM, Karbage SA, Bezerra LS, et al. Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?. Techniques in Coloproctology. 21(7):555-565, 2017 Jul. |
Observational-Dx |
42 women |
To evaluate the role of dynamic translabial ultrasound (TLUS) in the assessment of pelvic floor dysfunction and compare the results with echodefecography (EDF) combined with the endovaginal approach. |
A total of 42 women were included. Four sphincter defects were identified with both techniques, and EDF clearly showed if the defect was partial or total and additionally identified the pubovisceral muscle defect. There was substantial concordance regarding normal relaxation and anismus. Perfect concordance was found with rectocele and cystocele. The rectocele depth was measured with TLUS and quantified according to the EDF classification. Fair concordance was found for intussusception. There was no correlation between the displacement of the puborectal muscle at maximum straining on EDF with the displacement of the anorectal junction (ARJ), compared at rest with maximal straining on TLUS to determine perineal descent (PD). The mean ARJ displacement was similar in patients with normal and those with excessive PD on TLUS. |
2 |
| 94. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994; 81(3):463-465. |
Observational-Dx |
12 patients |
To validate the interpretation of ultrasonographic images of external sphincter defects using histology as a 'gold standard'. In addition the accuracy of clinical examination, manometry, EMG mapping and anal endosonography in the diagnosis of sphincter defects were compared prospectively. |
Combined operative and histological examination identified an external sphincter defect in nine of the 12 patients. Anal endosonography correctly identified all nine defects and the three normal sphincters. The accuracy of clinical examination was 50 per cent and that of both EMG and anal manometry 75 per cent. |
3 |
| 95. Gold DM, Halligan S, Kmiot WA, Bartram CI. Intraobserver and interobserver agreement in anal endosonography. Br J Surg. 1999; 86(3):371-375. |
Observational-Dx |
51 patients |
To determine intraobserver and interobserver agreement for sonographic measurements of anal canal structures using anal endosonography (AES), and to determine interobserver agreement for the diagnosis of anal sphincter disruption |
Intraobserver agreement was better than interobserver agreement for measurements of anal canal structures. Interobserver limits of agreement for external sphincter measurements spanned 5 mm, whereas those for the internal sphincter spanned 1.5 mm. Interobserver agreement for diagnosis of sphincter disruption and internal sphincter echogenicity was very good (kappa = 0.80 and 0.74 respectively). |
3 |
| 96. Santoro GA, Wieczorek AP, Dietz HP, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011; 37(4):381-396. |
Review/Other-Dx |
N/A |
To present the different ultrasound techniques (transvaginal sonography (TVS), endoanal ultrasound (EAUS) and transperineal ultrasound (TPUS)) for pelvic floor imaging, and to discuss how these modalities may be combined to achieve a complete anatomical evaluation of this region. |
No results stated in abstract. |
4 |
| 97. Cazemier M, Terra MP, Stoker J, et al. Atrophy and defects detection of the external anal sphincter: comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum. 2006; 49(1):20-27. |
Observational-Dx |
18 patients |
To compare prospectively three-dimensional anal endosonography to magnetic resonance imaging in the detection of atrophy and defects of the external anal sphincter in patients with fecal incontinence. In addition, to compare both techniques for anal sphincter thickness and length measurements. |
Eighteen patients were included (median age, 58 years; range, 27-80; 15 women). Three-dimensional anal endosonography and magnetic resonance imaging did not significantly differ for the detection of external anal sphincter atrophy (P = 0.25) and defects (P = 0.38). Three-dimensional anal endosonography demonstrated atrophy in 16 patients, magnetic resonance imaging detected atrophy in 13 patients. Three-dimensional anal endosonography agreed with magnetic resonance imaging in 15 of 18 patients for the detection of external anal sphincter atrophy. Using the grading system, 8 of the 18 patients scored the same grade. Three-dimensional anal endosonography detected seven external anal sphincter defects and magnetic resonance imaging detected ten. Three-dimensional anal endosonography and magnetic resonance imaging agreed on the detection of external anal sphincter defects in 13 of 18 patients. Comparison between three-dimensional anal endosonography and magnetic resonance imaging for sphincter thickness and length measurements showed no statistically significant concordance and had no correlation with external anal sphincter atrophy. |
3 |
| 98. West RL, Dwarkasing S, Briel JW, et al. Can three-dimensional endoanal ultrasonography detect external anal sphincter atrophy? A comparison with endoanal magnetic resonance imaging. Int J Colorectal Dis. 2005; 20(4):328-333. |
Observational-Dx |
18 women |
To establish whether 3D EUS measurements can be used to detect EAS atrophy. For this purpose 3D EUS measurements were compared with endoanal MRI measurements. |
Eighteen parous women (median age 56 years, range 32-80) with symptoms of faecal incontinence were included. Agreement between 3D EUS and endoanal MRI was 61% for IAS defects and 88% for EAS defects. EAS atrophy was seen in all patients on endoanal MRI. Correlation between the two methods for EAS thickness, length and area was poor. In addition, correlation was also poor for EAS volume determined on 3D EUS, and EAS thickness and area measured on endoanal MRI. |
2 |
| 99. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012; 85(1015):865-875. |
Review/Other-Dx |
N/A |
To conduct a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. |
No results stated in abstract. |
4 |
| 100. Rousset P, Deval B, Chaillot PF, Amara N, Buy JN, Hoeffel C. MRI and CT of sacrocolpopexy. AJR. 2013; 200(4):W383-394. |
Review/Other-Dx |
N/A |
To describe the surgical procedure of sacrocolpopexy as well as the normal postoperative features and complications on cross-sectional imaging, with an emphasis on MRI. |
Sacrocolpopexy with mesh insertion is a commonly performed operation to treat pelvic organ prolapse. MDCT and MRI are used not only to evaluate for potential complications of the procedure but also to evaluate for functional disorders and recurrent prolapse. |
4 |
| 101. Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011; 22(7):789-798. |
Meta-analysis |
110 studies |
To describe the incidence, risk factors, and treatments of graft erosion, wound granulation, and dyspareunia as adverse events following vaginal repair of pelvic organ prolapse with non-absorbable synthetic and biologic graft materials. |
One hundred ten studies reported on erosions with an overall rate, by meta-analysis, of 10.3%, (95% CI, 9.7 - 10.9%; range, 0 - 29.7%; synthetic, 10.3%; biological, 10.1%). Sixteen studies reported on wound granulation for a rate of 7.8%, (95% CI, 6.4 - 9.5%; range, 0 - 19.1%; synthetic, 6.8%; biological, 9.1%). Dyspareunia was described in 70 studies for a rate of 9.1%, (95% CI, 8.2 - 10.0%; range, 0 - 66.7%; synthetic, 8.9%; biological, 9.6%). |
M |
| 102. Haylen BT, Freeman RM, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery. Int Urogynecol J. 2012; 23(5):515-526. |
Review/Other-Dx |
N/A |
A report on the terminology and standardized classification for those complications related to native tissue female pelvic floor surgery by combining the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. |
A terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids ( www.icsoffice.org/ntcomplication ). |
4 |
| 103. Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J. 2011; 22(1):3-15. |
Review/Other-Dx |
N/A |
A report on the terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery by combining the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. |
A terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids ( www.icsoffice.org/complication ). |
4 |
| 104. van Geelen JM, Dwyer PL. Where to for pelvic organ prolapse treatment after the FDA pronouncements? : A systematic review of the recent literature. Int Urogynecol J. 2013; 24(5):707-718. |
Review/Other-Tx |
N/A |
To review recent studies of good quality on POP to assess the safety and effectiveness of treatment options and determine their place in management. |
Prospective comparative studies show that vaginal pessaries constitute an effective and safe treatment for POP and should be offered as first treatment of choice in women with symptomatic POP. However, a pessary will have to be used for the patient's lifetime. Abdominal sacral colpopexy is effective in treating apical prolapse with an acceptable benefit-risk ratio. This procedure should be balanced against the low but non-negligible risk of serious complications. The results of native tissue vaginal POP repair are better than previously thought with high patient satisfaction and acceptable reoperation rates. The insertion of mesh at the time of anterior vaginal wall repair reduces the awareness of prolapse as well as the risk of recurrent anterior prolapse. There is no difference in anatomic and subjective outcome when native tissue vaginal repairs are compared with multicompartment vaginal mesh. Mesh exposure is still a significant problem requiring surgical excision in approximately >/=10 % of cases. The ideal mesh has not yet been found necessitating more basic research into mesh properties and host response. Several studies indicate that greater surgical experience is correlated with fewer mesh complications. In women with uterovaginal prolapse uterine preservation is a feasible option which women should be offered. Randomized studies with long-term follow-up are advisable to establish the place of uterine preservation in POP surgery. |
4 |
| 105. Alvarez J, Cvach K, Dwyer P. Complications in pelvic floor surgery. Minerva Ginecol. 2013; 65(1):53-67. |
Review/Other-Tx |
N/A |
To review the complications of treatment of pelvic organ prolapse and urinary incontinence. |
Long-term complications such as pelvic pain and dyspareunia may be as high as 25%. Prolapse surgery associated with mesh may result in better anatomical outcomes but this is offset by the high complication rate, particularly that of mesh exposure which has been reported to be between 3-15%. Minimally invasive anti-incontinence procedures are associated with less morbidity than their abdominal predecessors but they are not free of complications. Complications of mid-urethral slings include those of mesh exposure (0.3%), voiding dysfunction (7%) and de novo urgency (25%). The risk and severity of complications varies depending on the procedure performed and on patient characteristics and, therefore, patients need to be informed of these risks or clinicians will be held responsible. This has never been more true than now with the debate regarding the value of transvaginal mesh and laparoscopic procedures for prolapse, their risks and potential benefits, and the associated medico-legal sequelae. |
4 |
| 106. Chermansky CJ, Winters JC. Complications of vaginal mesh surgery. Curr Opin Urol. 2012; 22(4):287-291. |
Review/Other-Tx |
N/A |
To review the current literature on complications seen with the use of vaginal mesh for both stress urinary incontinence and POP. |
The use of mesh in midurethral slings results in similar efficacy but less morbidity compared with nonmesh sling techniques. The use of mesh in abdominal sacrocolpopexy may result in lower rates of mesh complications compared with transvaginal mesh prolapse repairs. In 2011, the Food and Drug Administration issued an updated safety communication stating that serious complications associated with transvaginal mesh for POP repair are not rare. Yet, certain patients do benefit from the use of transvaginal mesh for POP repair. |
4 |
| 107. Khatri G, Carmel ME, Bailey AA, et al. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction. [Review]. Radiographics. 36(4):1233-56, 2016 Jul-Aug. |
Review/Other-Dx |
N/A |
To describe some of the many available treatment options for pelvic floor disorders, discuss pertinent imaging techniques, and illustrate the utility of imaging in postoperative patients. |
No results stated in abstract. |
4 |
| 108. Macura KJ, Genadry RR, Bluemke DA. MR imaging of the female urethra and supporting ligaments in assessment of urinary incontinence: spectrum of abnormalities. [Review] [26 refs]. Radiographics. 26(4):1135-49, 2006 Jul-Aug. |
Review/Other-Dx |
N/A |
To review the spectrum of abnormalities detected at MR imaging in women with stress urinary incontinence. |
The spectrum of abnormalities detected at MR imaging in women with stress urinary incontinence are classified as (a) findings related to the urethral sphincter deficiency and (b) defects of the urethral support ligaments and urethral hypermobility. These abnormalities include a small urethral sphincter, funneling at the bladder neck, distortion of the urethral support ligaments, cystocele, an asymmetric pubococcygeus muscle, abnormal shape of the vagina, enlargement of the retropubic space, and an increased vesicourethral angle. |
4 |
| 109. Carr LK, Herschorn S, Leonhardt C. Magnetic resonance imaging after intraurethral collagen injected for stress urinary incontinence. J Urol. 1996; 155(4):1253-1255. |
Observational-Dx |
32 women |
Magnetic resonance imaging (MRI) was performed to evaluate the results of intraurethral collagen injected stress urinary incontinence. |
Intraurethral collagen was easily imaged by MRI and appeared as a hyperintense focus within the wall of the urethra. Neither volume nor position of retained intraurethral collagen was predictive of clinical outcome (p= 0.80 and p= 0.32, respectively). The volume of injected intraurethral collagen strongly correlated with the retained volume in clinically successful and failed cases (Pearson's r= 0.64 and r= 0.90, respectively). No evidence of local or remote pathological conditions resulting from intraurethral collagen injection was identified. |
3 |
| 110. Schuettoff S, Beyersdorff D, Gauruder-Burmester A, Tunn R. Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo. Ultrasound Obstet Gynecol. 2006; 27(6):687-692. |
Observational-Dx |
20 women |
To determine whether introital sonography and magnetic resonance imaging (MRI) after TVT (tension-free vaginal tape) insertion can depict the polypropylene tape, and thus be used for patient follow-up. |
In the phantom, the polypropylene tape was depicted with a low signal intensity by MRI and as a highly echogenic structure by ultrasound. In the clinical study, introital ultrasound in a mediosagittal orientation depicted the vaginal tape in all patients: it was located under either the midurethra (n = 16) or the lower urethra (n = 4), and in either the muscular coat of the urethra (n = 8) or in the urethrovaginal space (n = 12), the tape was either flat (n = 6) or curled up (n = 14), and there was no retropubic visualization of the tape. Overall, depiction by MRI was limited, and was poorer in comparison with ultrasound, especially when the tape had a sub- or paraurethral location. Retropubically, however, MRI identified the tape near the periosteum of the pubic bone (55% of cases), in the retropubic space (37.5% of cases), or near the bladder wall (7.5% of cases). |
3 |
| 111. Schofield ML, Higgs P, Hawnaur JM. MRI findings following laparoscopic sacrocolpopexy. Clin Radiol. 2005; 60(3):333-339. |
Review/Other-Dx |
N/A |
A pictorial review to describe the operation, show examples of normal meshes with a good result, and detail some complications which have been demonstrated on MRI. |
Sacrocolpopexy is not an uncommon procedure. Open sacrocolpopexy is considered the ‘gold standard’; the laparoscopic technique is less usual because of the degree of technical difficulty, but the appropriateness of MRI is the same. An MR request following a sacrocolpopexy is relatively infrequent, but there is evidently a useful role for postoperative MRI. |
4 |
| 112. Staack A, Vitale J, Ragavendra N, Rodriguez LV. Translabial ultrasonography for evaluation of synthetic mesh in the vagina. Urology. 83(1):68-74, 2014 Jan. |
Observational-Dx |
51 patients |
To compare the clinical and surgical findings using translabial ultrasonography (US) in the evaluation of symptoms after transvaginal synthetic mesh placement. |
A total of 51 consecutive patients (mean age 59 years) were evaluated by history and physical examination, translabial US, and intraoperative findings. Using intraoperative findings as the reference standard, translabial US was able to predict the location of the sling in relationship to the urethra (6 distal, 25 mid-urethral, and 20 at the bladder neck), to differentiate between transobturator (n = 21) and retropubic (n = 30) slings, and to detect all anterior (n = 21) and posterior (n = 15) placed mesh. Translabial US was superior to physical examination in identifying mesh erosion into the periurethral fascia or sphincteric unit. US was inferior to physical examination in diagnosing vaginal extrusion but was superior for locating the mesh. |
4 |
| 113. Graf CM, Kupec T, Stickeler E, Goecke TW, Meinhold-Heerlein I, Najjari L. Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence. BioMed Research International. 2016:6495858, 2016. |
Experimental-Dx |
32 patients |
To evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. |
Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. |
3 |
| 114. Eisenberg VH, Steinberg M, Weiner Z, et al. Three-dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy. Ultrasound Obstet Gynecol. 43(4):459-65, 2014 Apr. |
Review/Other-Dx |
62 women |
To characterize, using three-dimensional (3D) transperineal ultrasound, the appearance, position and dimensions of mesh implants following minimally invasive abdominal sacrocolpopexy. |
Overall, 62 women, mean age 58.4 (range, 42-79) years were evaluated at a median of 9 (range, 1-26) months following surgery. The anterior arm of the mesh was caudal to the lowermost point of descent of the anterior compartment in 56 (90.3%) women, was equally positioned in five (8.1%) and was cranial in one. The posterior arm was caudal in 44 (71%) women, was equally positioned in 16 (25.8%) and was cranial in two (3.2%). The Y connection and the sacral arm of the mesh could not be adequately seen because of physical limitations of ultrasound (lower resolution at greater depth), large recurrent rectoceles, echogenic stools or folding of mesh remnants. Folding of the mesh was seen in 46 (74.2%) women, folding of the anterior arm in five (8.1%) and folding of the posterior arm in 23 (37.1%). Folding occurred caudally in 26 (41.9%) women, proximally in 11 (17.7%) and in both areas in nine (14.5%). There were no erosions. |
4 |
| 115. Hegde A, Nogueiras M, Aguilar VC, Davila GW. Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery?. International Urogynecology Journal. 28(6):857-864, 2017 Jun. |
Experimental-Tx |
100 patients |
To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery. |
When compared with group B, group A had a significantly greater number of patients in whom the sling deformed at Valsalva (flat at rest, curving into a c-shape at Valsalva), the urethral movement was concordant with the sling and the sling had a midurethral location (p?<?0.0001). In all 17 patients in group B in whom the urethra moved in a concordant manner with the sling (34%), the sling did not deform on Valsalva maneuver and was located proximally. In all 15 patients in group A in whom the sling remained either flat or curved (30%), the urethra moved concordant with the sling and the sling was in midurethral location. |
2 |
| 116. Larson K, Scott L, Cunningham TD, Zhao Y, Abuhamad A, Takacs P. Two-Dimensional and Three-Dimensional Transperineal Ultrasound Findings in Women With High-Pressure Voiding After Midurethral Sling Placement. Female Pelvic Medicine & Reconstructive Surgery. 23(2):141-145, 2017 Mar/Apr. |
Observational-Dx |
42 patients |
To evaluate dynamic two-dimensional (2D) and 3D transperineal pelvic ultrasound findings with urodynamic studies in women with lower urinary tract symptoms after midurethral sling placement. |
Univariate analyses to examine the relationships between high-pressure voiding, and each variable revealed that Valsalva sling angle, G3 versus G1+2, and sling position as percentage of the urethral length yielded significant findings (odds ratio, 95% confidence interval, P value for each, respectively: 1.037, 1.001-1.074, 0.04; 11.67, 2.116-64.31, 0.004; and 0.952, 0.911-0.994, 0.02). When including G3 versus G1+2, Valsalva sling angle, and percentage into the regression model, we concluded that there was only statistically significant association between groups and high-pressure voiding (odds ratio, 6.85; 95% confidence interval, 1.12-42.04; P = 0.03). |
3 |
| 117. Takacs P, Larson K, Scott L, Cunningham TD, DeShields SC, Abuhamad A. Transperineal Sonography and Urodynamic Findings in Women With Lower Urinary Tract Symptoms After Sling Placement. Journal of Ultrasound in Medicine. 36(2):295-300, 2017 Feb. |
Observational-Dx |
77 women |
To evaluate dynamic 2-dimensional (2D) transperineal pelvic sonographic findings and urodynamic studies in women with lower urinary tract symptoms after midurethral sling placement. |
Seventy-seven women were enrolled. The detrusor pressure at the maximum flow rate was significantly higher in group 3 than groups 1 and 2 (mean?±?SD, 36?±?16 versus 19?±?11 mm H2 O; P?<?.001). The odds of high detrusor pressure (>20 mm H2 O) in group 3 was approximately 12 times the odds of those in groups 1 and 2. After adjusting for other variables using a multiple logistic regression analysis, a statistically significant association between group 3 and high detrusor pressure persisted (odds ratio, 29.7; 95% confidence interval, 2.949-299.6; P?=?.0040) persisted. |
3 |
| 118. Wen L, Shek KL, Dietz HP. Changes in urethral mobility and configuration after prolapse repair. Ultrasound in Obstetrics & Gynecology. 53(1):124-128, 2019 Jan. |
Observational-Dx |
92 patients |
To evaluate changes in urethral mobility and configuration after prolapse repair. |
Mean age was 58?years and mean follow-up was 5.8?months. Prolapse symptoms had resolved in 85% of patients. Highly significant reductions in urethral mobility and urethral kinking were seen after surgery (all P?=?0.001). Similar changes were observed after anterior vaginal repair with or without apical repair, without concomitant posterior repair (n?=?23; all P?<?0.05). |
4 |
| 119. Manonai J, Rostaminia G, Denson L, Shobeiri SA. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications. Neurourology & Urodynamics. 35(3):407-11, 2016 Mar. |
Observational-Dx |
79 patients |
To investigate the clinical and ultrasonographic findings of women who had three-dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications. |
Seventy-nine patients presented to our center because of their, or their physicians' concern regarding mesh complications. Forty-one (51.9%) had vaginal/pelvic pain, and 51/62 (82.2%) of sexually active women experienced dyspareunia. According to ultrasonographic findings, mesh or sling was not demonstrated in six patients who believed they have had mesh/sling implantation. The positive predictive value for vaginal examination was 94.5% (95% CI: 84.9%-98.8%), negative predictive value was 12.5% (95% CI: 2.8%-32.4%), sensitivity was 72.2% (95% CI: 59.4%-81.2%), and specificity was 50.0% (95% CI: 12.4%-87.6%). Fifty-four patients were indicated for surgical treatment. Median postoperative review was 12 (range, 3-18) months and 38/53 (71.7%) patients were satisfied. |
4 |
| 120. Hegde A, Smith AL, Aguilar VC, Davila GW. Three-dimensional endovaginal ultrasound examination following injection of Macroplastique for stress urinary incontinence: outcomes based on location and periurethral distribution of the bulking agent. International Urogynecology Journal. 24(7):1151-9, 2013 Jul. |
Observational-Tx |
100 patients |
To use three-dimensional enodovaginal ultrasound (3D EVUS) to identify sonographic parameters that are associated with successful outcomes following injection of Macroplastique. |
Group A had a greater proportion of women with Macroplastique located in the proximal urethra, while midurethral location was found to be significantly more frequent in group B (p = 0.036). The odds of a circumferential periurethral distribution in group A were 13.62 times the odds in group B (95% CI: 5.12-56.95). When the location of the injection and the type of periurethral distribution were considered together, it was found that when the site of injection was proximal, the odds of circumferential distribution in group A was significantly greater than those in group B (odds ratio [95% CI]: 22 [3.05-203.49]; p < 0.001). |
2 |
| 121. Yang JM, Yang SH, Huang WC, Tzeng CR. Matched-pair analyses of resting and dynamic morphology between Monarc and TVT-O procedures by ultrasound. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 169(2):402-7, 2013 Jul. |
Observational-Dx |
128 women |
To determine morphologic differences between Monarc and TVT-O procedures in axial and coronal planes by three- and four-dimensional (3D and 4D) ultrasound. |
At rest, women subjected to Monarc procedures had a significantly wider aTA at one-fourth of the tape and a wider cTA at one-, two-, and three-fourths of the tape than did those subjected to TVT-O procedures. There were no significant differences in other resting ultrasound parameters between these two procedures. Additionally, after both procedures women had comparable straining and coughing ultrasound manifestations as well as respective dynamic changes. |
3 |
| 122. Rautenberg O, Kociszewski J, Welter J, Kuszka A, Eberhard J, Viereck V. Ultrasound and early tape mobilization--a practical solution for treating postoperative voiding dysfunction. Neurourology & Urodynamics. 33(7):1147-51, 2014 Sep. |
Observational-Dx |
61 patients |
To assess the effectiveness of ultrasound in determining tape distance to urethra and the impact of early tape mobilization on outcomes in women with postoperative voiding dysfunction resulting from a too tightly positioned tension-free vaginal tape (TVT). |
Seventy-one postoperative TVT mobilization procedures were conducted on 61 women, which was 4.1% (61/1501) of all suburethral tape procedures performed. Early tape mobilization restored normal micturition in 59 (96.7%) of the women at the time of discharge. Significant differences were found in residual volumes (P?<?0.001) and tape-LSM distances (P?<?0.001) pre- and post-mobilization. At 6-month follow-up visits, 58 (95.1%) women were cured of SUI, three were incontinent, and no additional voiding dysfunction occurred. |
3 |
| 123. Javadian P, Quiroz LH, Shobeiri SA. In Vivo Ultrasound Characteristics of Vaginal Mesh Kit Complications. Female Pelvic Medicine & Reconstructive Surgery. 23(2):162-167, 2017 Mar/Apr.Female pelvic med. reconstr. surg.. 23(2):162-167, 2017 Mar/Apr. |
Observational-Dx |
46 women |
To investigate the ultrasound characteristics of vaginal mesh in women with vaginal mesh complications. |
Forty-six women with vaginal mesh complications and good image quality were included. When comparing mesh length between posterior and anterior compartments, the posterior meshes were significantly longer than the anterior meshes (42.1 [SD, 11.9] mm vs 25.8 [SD, 9] mm; P < 0.0001) and more often associated with pain. In the posterior compartment, the mean mesh length seen on EVUS was significantly longer in women with pain than in women without pain (46.5 [SD, 9] mm vs 31.8 [SD, 12.1] mm; P = 0.0001). There was also a higher proportion of a "flat" mesh pattern, 14 (58.3%) of 25, in the posterior compartment associated with the presence of pain (P = 0.013). In the posterior compartment, a smaller distance between the distal edge of the mesh and the anal sphincter was significantly associated with the presence of pain (8 mm [0-37] vs 21 mm [8-35], P = 0.024). In both compartments, the EVUS had 100% sensitivity for detection of mesh extrusions. |
4 |
| 124. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
