Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
Ultraschall Med. 2021 Aug;42(4):e31-e41. doi: 10.1055/a-1109-2493. Epub 2020 May 4.
Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele.
The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317 women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound.
The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P < 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88-42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P < 0.001, OR 0.16, 95 % CI 0.06-0.43) than those without postoperative cystocele postoperatively.
4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.
针对女性盆底的超声研究很少采用阴道内超声。本研究旨在探讨四维（4D）阴道内超声在经阴道修补术后评估膀胱膨出女性盆底肌肉（PFM）功能中的作用。
对 20 名女性进行了超声测量的可靠性和一致性的研究，使用 95%置信区间的组内相关系数（ICC）和 Bland-Altman 分析。通过将挤压超声测量值与改良牛津量表（MOS）相关联，评估了超声参数的有效性，共评估了 317 名女性。回顾性分析了 241 名女性在术后 12 个月评估时的阴道内超声资料，其中 29 名女性有（n=29）和无（n=212）术后膀胱膨出。使用断层超声成像诊断提肌撕裂。通过阴道内超声在咳嗽和挤压时膀胱颈和生殖器裂孔的动态变化来探索无意识和自愿的 PFM 功能。
所有测试超声参数的可靠性 ICC 均为良好至非常好。从静息到挤压时大多数超声测量值的变化和变化率与 MOS 相当相关。术后膀胱膨出的女性更常发生完全性提肌撕裂[41.3%比 4.7%，P<0.001，优势比（OR）14.26，95%置信区间（CI）4.88-42.42]，术后能自愿进行 PFM 收缩的女性比例更低[65.5%比 92.5%，P<0.001，OR 0.16，95%CI 0.06-0.43]。
4D 阴道内超声可用于评估经阴道修补术后膀胱膨出女性的 PFM 功能。
