Relationship Involving Sexual Function, Distress Symptoms of Pelvic Floor Dysfunction, and Female Genital Self-Image / Relação entre função sexual, incômodo dos sintomas de disfunção do assoalho pélvico e autoimagem genital feminina

Abstract Objective To assess the relationship involving sexual function (SF), the distress symptoms caused by pelvic floor dysfunction (PFD), and female genital self-image (GSI). Materials and Methods We assessed the GSI, SF and PFD distress symptoms by the Female Genital Self-Image Scale (FGSIS), the Female Sexual Function Index (FSFI), and the Pelvic Floor Distress Inventory (PFDI-20) respectively. Data were analyzed by multiple linear regression. Results Among the 216 women (age: 50.92 ± 16.31 years) who participated in the study, 114 were sexually active in the previous 4 weeks. In the total sample (p < 0.001; adjusted R2 = 0.097) and among sexually active women (p = 0.010; adjusted R2 = 0.162), the distress symptoms caused by pelvic organ prolapse (POP) were related to the GSI. Among sexually active women, sexual desire also was related to the GSI (p < 0.001; adjusted R2 = 0.126). Conclusion The findings of the present study provide additional knowledge about female GSI and suggest that SF and POP distress symptoms should be investigated together with the GSI in the clinical practice.

Resumo Objetivo Avaliar a relação entre a função sexual (FS), o incômodo provocado pelos sintomas de disfunção do assoalho pélvico (DAP) e a autoimagem genital (AIG) feminina. Materiais e Métodos A AIG, a FS e incômodo causado pelos sintomas de DAP foram avaliados pela Genital Self-Image Scale (FGSIS), pelo Female Sexual Function Index (FSFI) e pelo Pelvic Floor Distress Inventory (PFDI-20), respectivamente. Os dados foram analisados por regressão linear múltipla. Resultados Das 216 mulheres (idade: 50,92 ± 16,31 anos) que participaram do estudo, 114 eram sexualmente ativas nas últimas 4 semanas. Na amostra total (p < 0,001; R2 ajustado = 0,097) e entre as mulheres sexualmente ativas (p = 0,010; R2 ajustado = 0,162), o incômodo provocado pelos sintomas de prolapso de órgãos pélvicos (POP) relacionou-se à AIG. Entre as mulheres sexualmente ativas, o desejo sexual também se relacionou à AIG (p < 0,001; R2 ajustado = 0,126). Conclusão Os achados deste estudo fornecem conhecimento adicional sobre a AIG feminina e sugerem que a FS e o incômodo causado pelos sintomas de POP devem ser investigados juntamente com a AIG na prática clínica.

Pelvic floor rehabilitation domestic and abroad in the last decade: a visualized analysis / 中国康复理论与实践

ObjectiveTo perform a visualized analysis on the relevant literature about rehabilitation in pelvic floor dysfunction (PFD) domestic and abroad, and summarize the current hot spots and frontiers in this field. MethodsThe literature related to PFD rehabilitation from January, 2012 to June, 2022 was searched and screened from the databases of CNKI and Web of Science, and the CiteSpace software was used to analyze the trends of publications, authors, institutions and key words. ResultsA total of 2 448 articles were included. Relatively few high-quality domestic researches were published. In terms of research hotspots, both domestic and international researches focused on causes, mechanisms, rehabilitation techniques and evaluation indicators of PFD, but domestic researches had not paid enough attention to evaluation indicators and prevention of PFD. The key words constantly appeared in 2022 were mechanisms of PFD due to pregnancy, treatment of postoperative complications in prostate cancer patients, the role of pelvic floor muscle training, and quality of life studies in women. ConclusionResearch related to the field of PFD rehabilitation is increasing. There is still a large gap for future development in China.

Ultrasound evaluation of the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus after vaginal delivery / 中华超声影像学杂志

Objective:To observe the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus (GDM) after vaginal delivery.Methods:This study included 192 pregnant patients from Henan Provincial People′s Hospital who met the conditions between Jan.2020 and Aug.2021. All participants were screened for GDM by oral glucose tolerance test (OGTT) or fasting blood glucose at 24-28 weeks of pregnancy, and were divided into GDM group (34 cases) and non-GDM group (158 cases) based on the presence or absence of GDM. All participants underwent pelvic floor ultrasonography at the first trimester (6-8 gestational weeks), 3 days postpartum, 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Area of urogenital hiatus (AUH), transversal diameter of urogenital hiatus (TDUH) and anteroposterior diameter of urogenital hiatus (APDUH) were measured using Smart Pelvic. The Logistic regression model was used to calculate and match the propensity score between the GDM group and the non-GDM group.Results:In the non-GDM group, TDUH during rest maneuver at 6 weeks postpartum( P=0.319), the indicators during rest and contract maneuver at 6 months postpartum( P=0.586, 0.877, 0.164, 0.226, 0.465, 0.097), and TDUH during tension maneuver at 1 year postpartum( P=0.643) returned to the level of early pregnancy. In the GDM group, the indicators during rest maneuver and TDUH during contract maneuver at 6 months postpartum recovered to the level of early pregnancy ( P=0.647, 0.584, 0.376, 0.440), while APDUH and AUH during contract maneuver ( F=7.784, 9.785; P=0.005, <0.001) and the indicators during tension maneuver at 1 year postpartum( F=15.343, 11.974, 17.981; P<0.001) did not recover to the level of early pregnancy. After propensity score matching, APDUH and AUH during tension maneuver at 1 year postpartum in the GDM group were significantly greater than those in the non-GDM group( t=2.810, 2.926; P=0.006, 0.004). Conclusions:The pelvic floor muscles of GDM patients after vaginal delivery are more severely damaged, and the recovery speed is slower. Pelvic floor muscle exercise during pregnancy and enhanced postpartum follow-up are needed to prevent, diagnose and treat pelvic floor dysfunction early.

To promote the development of standardized diagnosis and treatment of lower urinary tract and pelvic floor dysfunction diseases in China / 中华泌尿外科杂志

With the progress of the aging population in China and driven by the needs of patients and the disciplines construction, the standardization of the diagnosis and treatment of lower urinary tract and pelvic floor dysfunction diseases is extremely urgent. We need to make scientific plans and bold breakthroughs to promote the development of urinary continence discipline in China, including introducing concepts such as whole-course disease management and multi-disciplinary treatment, strengthening clinical and scientific research, promoting the development of basic-level medical, and strengthening the talent cultivation in the field of lower urinary tract and pelvic floor dysfunction diseases.

Aging and pelvic floor dysfunction / 中华物理医学与康复杂志

Objective:To investigate the pelvic floor muscle functioning of persons with pelvic floor dysfunction (PFD) at different ages in order to provide a reference for clinical treatment.Methods:A total of 580 PFD patients were divided into group A ( n=163, ≤29 years old), Group B ( n=161, 30-39), Group C ( n=114, 40-49), Group D ( n=128, 50-59) and Group E ( n=14, ≥60 years old). All were given a surface electromyography (sEMG) examination of their pelvic floor muscles. Average sEMG amplitude and its variability were recorded in the pre-resting and post-resting stages. The maximum sEMG amplitude and its rise time and recovery time during rapid contraction of pelvic floor muscles were recorded. Average sEMG amplitude and variability were also recorded during slow muscle contraction. The observations were correlated with the age. Results:Significant differences among the 5 groups were found in all of the measurements. Spearman correlation analysis showed that age was positively correlated with the variation in the sEMG amplitudes in the pre-resting stage, with the rise time and with the recovery time. Age also correlated with the maximum sEMG amplitude in the rapid stage, the variation of the EMG amplitude in the slow-muscle stage, and the EMG amplitude in the post-resting stage. But it was negatively correlated with the average sEMG amplitude during pelvic floor contraction.Conclusions:The stability and coordination of the pelvic floor muscles gradually deteriorates with age. The rate of activation and recovery become slower, with prolonged recruitment, slower response and poor excitability.

Effects of Pelvic Biomechanical Changes on Female Pelvic Floor Dysfunction / 医用生物力学

Pelvic floor dysfunction disease has a high incidence in women after pregnancy. During this special physiological period of women pregnancy, posture of woman pelvis will change, and the pelvic biomechanics will change as well. Such mechanical changes will bring corresponding diseases. The relationship between dynamic changes and occurrence of functional disorders were discussed, the influences of changes in abdominal pelvic mechanics on the pelvic floor after pregnancy were summarized, and the high risk factors of pelvic floor dysfunction （PFD） were investigated, so as to provide the optimal treatment plans and method for pelvic floor rehabilitation treatment.

Comparison of pelvic floor dysfunction in primiparous and nulliparous women and its relation to pelvic floor muscle strength

Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery.

Added value of dynamic magnetic resonance images in pelvic floor dysfunction / Valor agregado das imagens de ressonância magnética dinâmica na disfunção do assoalho pélvico

ABSTRACT Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p < 0.001). Physical examination found a single pathology in 80.8 % of cases. Anterior rectocele (AR) was the most frequent isolated diagnosis on physical examination (68 %). On the Dynamic and Multiplanar Evaluation of the Pelvic Floor, anterior rectocele was diagnosed as an isolated condition in 10.9 %. In 231 cases, anterior rectocele was associated with up to 5 other pelvic floor disorders. The number of individuals with associated pathologies of the posterior and anterior compartments tripled. It modified physical examination findings in 17 % of individuals and, in 63.5 %, allowed the identification of additional pelvic floor pathologies that were missed by physical examination. The Dynamic and Multiplanar Evaluation of the Pelvic Floor had greater added value in patients with anterior rectocele (59.6 % vs. 20.9 %; p < 0.001). Female gender was also associated with a greater diagnostic yield (p < 0.001). Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic floor dislocations, allowing a comprehensive therapeutic planning.

RESUMO Objetivo A disfunção do assoalho pélvico tem alta prevalência na população adulta. A avaliação dinâmica e multiplanar do assoalho pélvico (DMRIPF) representa uma ferramenta ideal para o gerenciamento multidisciplinar. O objetivo desta análise é avaliar o valor agregado da avaliação dinâmica e multiplanar do assoalho pélvico em pacientes com suspeita de distúrbios do assoalho pélvico. Métodos Análise retrospectiva de uma série consecutiva de pacientes submetidos à avaliação dinâmica e multiplanar do assoalho pélvico por suspeita de distúrbios do assoalho pélvico entre Abril de 2005 e Julho de 2019. Resultados 359 pacientes foram incluídos. O número médio de diagnósticos alcançados pelo exame físico foi de 1,2vs. 2,5 pela avaliação dinâmica e multiplanar do assoalho pélvico p < 0,001. O exame físico encontrou uma única patologia em 80.8 % dos casos. A retocele anterior (RA) foi o diagnóstico isolado mais frequente no exame físico (68 %). Na avaliação dinâmica e multiplanar do assoalho pélvico, a retocele anterior foi diagnosticada como uma condição isolada em 10.9 %. Em 231 casos, a retocele anterior foi associada a até 5 outros distúrbios do assoalho pélvico. O número de indivíduos com patologias associadas dos compartimentos posterior e anterior triplicou. Modificou os achados do exame físico em 17 % dos indivíduos e em 63.5 %; permitiu a identificação de outras patologias do assoalho pélvico que foram esquecidas pelo exame físico. A avaliação dinâmica e multiplanar do assoalho pélvico teve maior valor agregado em pacientes com retocele anterior (59.6 % vs.20.9 %; p < 0,001. O sexo feminino também foi associado a um maior rendimento diagnóstico p < 0,001. Conclusão A avaliação dinâmica e multiplanar do assoalho pélvico permite a detecção de defeitos multicompartimentários que, de outra forma, poderiam não ser detectados, ou mesmo alterar o diagnóstico clínico inicial, representando uma ferramenta ideal para a abordagem multidisciplinar das luxações do assoalho pélvico, permitindo um planejamento terapêutico abrangente.

Progress of application of tactile imaging to pelvic floor dysfunction / 上海交通大学学报（医学版）

Elastic imaging is a technique for converting the elastic modulus of soft tissues to real-time computer images. As one of the branches of elastic imaging, tactile imaging is distinguished by the feature of pressing directly against the surface of soft tissues. It is a mature option to diagnose diseases in urology, general surgery, gynecology and obstetrics. In recent years, tactile imaging, especially vaginal tactile imaging, has been used to evaluate female pelvic floor dysfunction diseases. This review is about tactile imaging and its application to the field of pelvic floor dysfunction.

Factors associated with sexual activity for women with pelvic floor dysfunction - a cross-sectional study / Fatores associados à atividade sexual de mulheres com distúrbios do assoalho pélvico - um estudo transversal

Abstract Objective To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). Methods We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. Results The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. Conclusion Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.

Resumo Objetivo Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). Métodos Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP emFortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. Resultados A análise de 659 mulheres comDAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR]= 1,07; intervalo de confiança [IC] 95%: 1,03-1,12) e status pós-menopausa (OR= 2,28; IC 95% 1,08-4,8) foram negativamente associados à atividade sexual. O casamento (OR= 0,43; IC 95% 0,21-0,88) foi associado à AS. Por outro lado, POP (OR= 1,16; IC 95% 0,81-1,68) e IU (OR= 0,17; IC 95% 0,08-0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p< 0,001), foram fatores significativamente associados. Os dados do Prolapse Qualityof- life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. Conclusão O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.

Clinical value of three-dimensional ultrasound in the diagnosis of female pelvic floor dysfunction disease / 中国基层医药

Objective To analyze the clinical value of three-dimensional ultrasound in the diagnosis of pelvic floor dysfunction disease.Methods From June 2016 to December 2017,95 cases of female pelvic floor dysfunction disease in the People's Hospital of Dongyang were selected as observation group.And 90 healthy women received physical examination during the same period were selected as control group.Both two groups were subjected to three-dimensional ultrasonography,and the results were analyzed.Results In the observation group,the anteroposterior diameter and area in resting period,anteroposterior diameter and area in tension period,anteroposterior diameter and area in anus period of the anal pelvic diaphragmatic hiatus were (65.58 ± 6.38)cm,(20.01 ± 3.98) cm2,(68.40 ± 5.54) cm,(22.50 ± 3.12) cm2,(60.17 ± 5.55) cm and (19.28 ± 2.52) cm2,respectively,which were significantly higher than those in the control group [(51.84 ± 3.46) cm,(13.93 ± 2.09) cm2,(53.65 ± 4.23) cm,(14.60 ± 2.95) cm2,(48.95 ± 3.48) cm,(13.45 ± 1.76) cm2] (t =18.066,12.903,20.272,13.200,16.369,18.150,P =0.000,0.000,0.000,0.000,0.000,and 0.000).But the pubic rectal muscle thickness of resting period,tension period,anal contraction period in the observation group were (10.28 ± 1.96) cm,(10.63 ± 1.57) cm,and (10.01 ± 1.13) cm,respectively,which were lower than those in the control group [(10.28 ± 1.96)cm,(10.63 ±1.57)cm,(10.35 ±1.49)cm] (t =1.015,1.940,1.741,P =0.311,0.053,0.083).The observation group was asymmetrical,asymmetrical on both sides and interrupted continuously.In the control group,the echo was uniform,bilateral symmetry,without interruption.Conclusion The use of three-dimensional ultrasound in the diagnosis of female pelvic floor dysfunction disease has good clinical value.

Construction of "integrated management system" for pelvic floor dysfunction / 中国实用护理杂志

Objective@#To establish an "integrated management system" for pelvic floor dysfunction and explore its effects on clinical practice.@*Methods@#A pelvic floor nursing team was set up to connect the outpatient management system, the ward perioperative management system and the home follow-up management nursing system, and to build an integrated management system for pelvic floor dysfunction diseases.@*Results@#After five years of practice, the qualified rate of residual urine in pelvic floor dysfunction patients increased from 58.2%(191/330) to 93.6%(309/328), the difference was statistically significant(χ2=113.008, P<0.01). The compliance of pelvic floor muscle exercise at home increased from 63.6%(210/330) to 83.8%(275/328). The difference was statistically significant(χ2=36.654, P<0.01).@*Conclusions@#The three level prevention of pelvic floor dysfunction disease has been formed through "the integrated management system", which can play a significant role in the development of disease management and specialized nursing.

Construction of"integrated management system"for peLvic fLoor dysfunction / 中国实用护理杂志

Objective To establish an "integrated management system" for pelvic floor dysfunction and explore its effects on clinical practice. Methods A pelvic floor nursing team was set up to connect the outpatient management system, the ward perioperative management system and the home follow-up management nursing system, and to build an integrated management system for pelvic floor dysfunction diseases. ResuLts After five years of practice, the qualified rate of residual urine in pelvic floor dysfunction patients increased from 58.2% (191/330) to 93.6% (309/328), the difference was statistically significant( χ2=113.008, P<0.01). The compliance of pelvic floor muscle exercise at home increased from 63.6%(210/330) to 83.8%(275/328). The difference was statistically significant( χ2=36.654, P<0.01). ConcLusions The three level prevention of pelvic floor dysfunction disease has been formed through "the integrated management system", which can play a significant role in the development of disease management and specialized nursing.

Clinical study of curative effects of partial sigmoidectomy and pelvic floor repair for treatment of pelvic floor dysfunction with dolichasigmoid / 中国实用妇科与产科杂志

OBJECTIVE: To explore the curative effects of the combined therapy of laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair for the treatment of severe pelvic floor dysfunction(PFD).METHODS: The clinical data of 14 severe PDF patients(uterine prolapse in stage Ⅲ-Ⅳ）with dolichasigmoid were studied retrospectively from May 2017 to August 2018 in Shanghai Traditional Chinese Medical University. The surgical way was laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair. The objective effects were assessed by comparing the position of each indication points of the preoperative and postoperative pelvic organs' prolapse(in POP-Q scale).Subjective effects were also assessed by comparing Clevel score of constipation,pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire short form(PFIQ-7)between preoperation and 6 months and 1 year after operation.RESULTS: All 14 patients were successfully operated on without any intra-operative and post-operative complications. The comparion of positions of the POP-Q indication points(AA,Ba,C,D,AP,BP)between preoperation and 1 year after operation showed the difference was statistically significant(P<0.01). PFDI-20,PFIQ-7 and Clevel constipation scores were also significantly different respectively(P<0.01).CONCLUSION: Laparoscopic partial sigmoidectomy combined with pelvic floor repair is an optional method in the treatment for pelvic floor dysfunction, which could effectively improve the constipation caused by dolichasigmoid and pelvic floor defect. It is also with low postoperative morbidity.

Application of natural orifice transluminal endoscopic surgery in pelvic floor dysfunction / 中国实用妇科与产科杂志

In recent years,due to the coming of aging society,pelvic floor dysfunction(PFD)has gradually become one of the research hotspots in the field of obstetrics and gynecology worldwide.At present,surgery is the preferred treatment for moderate to severe PFD patients. With the development of minimally invasive surgery technology and the renewal of minimally invasive concept,PFD treatment options have been improved continuously. Natural orifice transluminal endoscopic surgery has been applied to gynecological surgery because of its fast recovery,slight pain and being without abdominal incision. Although the development of minimally invasive surgery provides more surgical options,different surgical methods have their advantages and disadvantages,and they should be controlled.Therefore,the age,symptoms,signs,medical history and general condition of the patients should be comprehensively evaluated to achieve the best therapeutic effect.

Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study

PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.

Analysis of psychological resilience level and its influencing factors inpatients of postpartum pelvic floor dysfunction / 中国实用护理杂志

Objective To analyze the patients′ psychological resilience level of postpartum pelvic floor dysfunction and to explore the influencing factors, in order to provide the scientific basis for patients′psychological intervention. Methods A cross-sectional survey was conducted on 208 patients of postpartum pelvic floor dysfunction by using the Connor-Davidson Resilience scale(CD-RISC), Positive and Negative Affective scales(PANAS) and Medical Coping Modes questionnaire(MCMQ, which includes "confrontation","acceptance-resignation"and"avoidance"). Results The score of psychological resilience of 208 patients was (53.64 ± 12.29)points, differences in age, family monthly income, living locations, delivery methods and delivery times reached a statistically significant level(F=15.287,5.731,t=-2.571,-15.911,-2.922,all P<0.05). Patients′psychological resilience level had significant positive correlation with positive emotions(P<0.01)and"confrontation",and it had negative correlation with"acceptance-resignation"(P<0.01).Age,living locations, delivery methods, positive emotions and "acceptance- resignation" are the forecast factors of psychological resilience, which can explain 69.6% of total variation. Conclusions Patients of postpartum pelvic floor dysfunction have low levels of psychological resilience, which associated with positive emotions and medical coping modes. Therefore, nursing staffs should pay attentions to the patients′ psychological status, develop individualized psychological guidelines,implement psychological intervention and health education,in order to improve the level of patients′resilience and improve their living quality.

Effect of modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrical stimulation on early stage postpartum pelvic floor dysfunction / 中国中药杂志

To investigate the curative effect of modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrostimulation on early postpartum pelvic floor dysfunction disease (PFD) and its effect on the expression of transforming growth factor (TGF-β1), matrix metalloprotein (MMP-2), and tissue inhibitor of metalloproteinase (TIMP-2). A total of 186 PFD patients admitted to our hospital from March 2014 to December 2016 were selected in the study and were randomly divided into test group (=93) and control group (=93). The control group received pelvic floor muscle exercises-biofeedback-electrostimulation, while the test group was additionally treated with modified Buzhong Yiqi decoction based on the treatment in control group. Then the clinical efficacy was compared between two groups. The results showed that vaginal contractile electromyography (EMG), duration of vaginal constriction, dynamic vaginal pressure and pelvic floor myoelectric activity in the test group at 1, 3 and 6 months after treatment were significantly higher than those before treatment and the control group (<0.05). The effective rate for urinary incontinence was 97.14% in test group, significantly higher than 75.68% in the control group (<0.05). The effective rate for improvement of sexual life quality was 96.43% in test group, significantly higher than 74.07% in control group (<0.05). 1, 3 and 6 months after treatment, the uterine prolapse, posterior wall prolapse and anterior wall prolapse grade in test group was slightly lower than that in the control group, but the difference was not statistically significant. After treatment, the levels of TGF-β1 and TIMP-2 in the test group were higher than those in the control group, while the levels of MMP-2 were lower than those in the control group (<0.05). The results showed that modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrostimulation can effectively relieve the clinical symptoms, promote the body recovery and improve the quality of sexual life in PFD patients, with remarkable advantages, so it is worthy of popularizing.

The preliminary study on biomechanical properties of four synthetic implants for reconstructive surgery of pelvic floor dysfunction / 生物医学工程学杂志

This study aimed to investigate biomechanical properties of synthetic implants for reconstructive surgery of pelvic floor dysfunction. In this dissertation, we chose four synthetic implants, i.e. total pelvic floor repair system (PROLIFT), gynecone TVT obtutator system (TVT-O), intra-vaginal sling placement device (IVS) and acellular dermal matrix (Renov), for tensile test respectively. The biomechanical properties of four synthetic implants were measured and analyzed using a material testing machine (Instron 4302 versatile material testing machine). The biomechanical parameters included ultimate stress strength, modulus of elasticity, maximum load and maximum elongation. The results showed that the maximum load of the four symthetic implants was TVT-O > IVS > PROLIFT > Renov, and the maximum load of TVT-O was significantly higher than PROLIFT and Renov ( < 0.05). The ultimate stress strength was TVT-O > IVS > PROLIFT > Renov, with no significant differences among them ( > 0.05). The maximum elongation of the four implants was TVT-O > PROLIFT > IVS > Renov, and the maximum elongation of TVT-O and PROLIFT were both significantly higher than Renov ( < 0.05). The modulus of elasticity was IVS > Renov > TVT-O > PROLIFT, with no significant differences among them ( > 0.05). Taken together, the present study demonstrates that the modulus of elasticity of IVS was the highest in the four synthetic implants; TVT-O had the highest mechanical strength; The maximum load, ultimate stress strength and maximum elongation of Renov were all the lowest; The mechanical properties of PROLIFT was the most stable, and its modulus of elasticity was the lowest in the four synthetic implants, which had good extensibility and elasticity. Therefore, it is necessary to pay attention to the biomechanical properties of new pelvic reconstructive materials for the clinical pelvic reconstructive surgery.

Nursing for the different postoperative residual urine of patient with pelvic floor dysfunction / 现代临床护理

Objective To discuss the nursing for the different postoperative residual urine of patient with pelvic floor dysfunction.Method To evaluate the nursing for the postoperative residual urine of patient with pelvic floor dysfunction and the time of urinary catheters inserted,We completed a retrospective review of 138 adult patients.Results ①Toally 138 participants were categorized into 3 groups:74 (53.6％) patients carried a residual volume ＜ 100ml,53 (38.4％) patient did 100～300ml,11 (8.0％)did ＞300ml.②About11 patients who were able to void but carried a residual volume ＞300ml required indwelling catheterization.In these cases,100％ carried a residual volume ＜ 100ml after indwelling urinary catheter extraction (IUCE) after 4～5 days.③About 53 patients who were able to void but carried a residual volume between 100ml to 300ml received urine nursing,phychological nursing and bladder function exercise.Two days after IUCE 41 (77.4％) patients' residual volume was ＜100ml;three days after IUCE 11 (20.7％) patients' residul volume was ＜100ml;five days 1 patiens' residul volum was ＜100ml.Conclusion When a postvoid residual＞300ml,the patient should be performed catheterization,When a postvoid residual between 100ml to 300ml,the nurse should give the patient mental easing and teach them to perform pelvic floor muscle exercise.This can reduce the suffering of patients.