Comparison of the diagnostic efficiency between the O-RADS US risk stratification system and doctors' subjective judgment.

BACKGROUND: This study aimed to compare the diagnostic efficiency of Ovarian-Adnexal Reporting and Data System (O-RADS) and doctors' subjective judgment in diagnosing the malignancy risk of adnexal masses. METHODS: This was an analysis of 616 adnexal masses between 2017 and 2020. The clinical findings, preoperative ultrasound images, and pathological diagnosis were recorded. Each adnexal mass was evaluated by doctors' subjective judgment and O-RADS by two senior doctors and two junior doctors. A mass with an O-RADS grade of 1 to 3 was a benign tumor, and a mass with an O-RADS grade of 4-5 was a malignant tumor. All outcomes were compared with the pathological diagnosis. RESULTS: Of the 616 adnexal masses, 469 (76.1%) were benign, and 147 (23.9%) were malignant. There was no difference between the area under the curve of O-RADS and the subjective judgment for junior doctors (0.83 (95% CI: 0.79-0.87) vs. 0.79 (95% CI: 0.76-0.83), p = 0.0888). The areas under the curve of O-RADS and subjective judgment were equal for senior doctors (0.86 (95% CI: 0.83-0.89) vs. 0.86 (95% CI: 0.83-0.90), p = 0.8904). O-RADS had much higher sensitivity than the subjective judgment in detecting malignant tumors for junior doctors (84.4% vs. 70.1%) and senior doctors (91.2% vs. 81.0%). In the subgroup analysis for detecting the main benign lesions of the mature cystic teratoma and ovarian endometriosic cyst, the junior doctors' diagnostic accuracy was obviously worse than the senior doctors' on using O-RADS. CONCLUSIONS: O-RADS had excellent performance in predicting malignant adnexal masses. It could compensate for the lack of experience of junior doctors to a certain extent. Better performance in discriminating various benign lesions should be expected with some complement.

Assessing Obstetric Anal Sphincter Injuries: A Comparison of Exoanal and Endoanal Ultrasound.

OBJECTIVES: To explore the differences in assessing obstetric anal sphincter injuries (OASI) between transperineal ultrasound (TPUS) and endoanal ultrasound (EAUS) and test relationships between ultrasound findings and anal incontinence (AI) symptoms. METHODS: A group of 196 women with a history of vaginal delivery was recruited. OASI was detected in a set of 5 slices by EAUS and 8 slices by TPUS. OASI grading was performed on TPUS rules and EAUS rules. A "significant sphincter defect" was diagnosed by TPUS and EAUS using "2/3 rules." Symptoms of AI were determined using the St Mark's Incontinence Score (SMIS). Ultrasound findings were compared between the two methods and correlated with symptoms. RESULTS: Of 196 women, 29 (14.8%) suffered from AI with a mean SMIS of 12.1 ± 4.5, and 70 (35.7%) women with a mean age of 57 years had suspected OASI on imaging. Twenty-one (10.7%) "significant defects" were diagnosed by TPUS and 24 (12.2%) by EAUS. OASI Grades on TPUS had good agreement with EAUS rules (k = 0.70, P < .001). Logistic regression analysis showed that OASI Grade on imaging and "significant sphincter defects" seen on both forms of imaging were associated with AI symptoms. The odds ratio was 46 and 38 for "significant defects" on TPUS and EAUS, and 14 and 7 for OASI 3b+ on TPUS and EAUS in predicting AI, respectively. CONCLUSIONS: "Significant defects" diagnosed by EAUS or TPUS and OASI Grade 3b+ predict AI symptoms. The diagnostic performance of endoanal and exoanal ultrasound (EAUS and TPUS) appear to be very similar.

Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions.

OBJECTIVES: To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions. METHOD: This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap. RESULTS: Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group. CONCLUSION: The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.

Comparison of diagnostic efficiency between IOTA LR2 model and doctors' experiences. / IOTA LR2模型与医师经验诊断效能的比较.

OBJECTIVES: International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and malignant adnexal tumors. This study aims to compare the diagnostic efficiency between the IOTA LR2 model and doctors' subjective assessment on diagnosing benign and malignant adnexal mass. METHODS: The ultrasonographic images of 616 adnexal masses were retrospectively analyzed by the senior doctors' group and the junior doctors' group using the IOTA LR2 model and subjective assessment. The postoperative pathological diagnosis was used as the gold standard to compare the diagnostic efficiency of the 2 methods. RESULTS: The area under the curves of subjective assessment and IOTA LR2 model for diagnosing malignant adnexal masses were 0.86 and 0.90 for the senior doctors' group and 0.79 and 0.88 for the junior doctors' group, respectively. The sensitivity and specificity of subjective assessment for diagnosing the malignant adnexal masses were 81.0% and 91.3% for the senior doctors' group and 70.1% and 88.7% for the junior doctors' group, respectively. The sensitivity and specificity of the IOTA LR2 model for diagnosing the malignant adnexal masses were 79.6% and 88.1% for the senior doctors' group, and 79.6% and 81.7% for the junior doctors' group, respectively.There were no significant difference in the sensitivities between the senior doctors' group and junior doctors' group using the IOTA LR2 model and the senior doctors' group using subjective assessment (both P>0.05). CONCLUSIONS: The diagnostic efficiency of the IOTA LR2 model is equal to the senior doctors' experiences. This model can help junior doctors to reduce the missed diagnosis of malignant adnexal masses.

A comparison of the diagnostic performance of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems by senior and junior doctors.

PURPOSE: This study compared the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the Risk of Malignancy Index 4 (RMI4), the International Ovarian of Tumor Analysis Logistic Regression Model 2 (IOTA LR2), and the IOTA Simple Rules (IOTA SR) in predicting the malignancy of adnexal masses (AMs). METHODS: This retrospective study included 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (group I) and two junior doctors (group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. A receiver operating characteristic curve was used to test the diagnostic performance. The interrater agreement between the two groups was tested using kappa values. RESULTS: Of all 592 AMs, 447 (75.5%) were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68, and 0.77 for the O-RADS, RMI4, IOTA LR2, and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems were 0.90, 0.89, 0.90, and 0.86 for group I and 0.89, 0.87, 0.88, and 0.84 for group II, respectively. The O-RADS had the highest sensitivity (91.0% in group I and 84.8% in group II). CONCLUSION: The four diagnostic systems could compensate for junior doctors' inexperience in predicting malignant adnexal lesions. The O-RADS performed best and showed the highest sensitivity.

The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence.

OBJECTIVES: To investigate the association of hiatal area (HA), bladder neck mobility, and urethral mobility during the cough stress test (CST) with stress urinary incontinence (SUI). METHODS: This was a prospective study of 110 continent and 190 incontinent women using transperineal ultrasound. HA, bladder neck mobility, and the mobility of six points along the urethra (Vectors 1-6) were measured. The cohort was randomly divided at a ratio of 2:1 into a training cohort and a validation cohort. The correlations of HA with bladder neck mobility, urethral mobility, and SUI were tested. The predictive model was yielded by fisher linear discriminant analysis and receiver operating characteristics to assess the parameters' ability to predict SUI. RESULTS: Valid data were collected from 177 incontinent women and 105 continent women. Significant differences were identified in HA, body mass index (BMI), funneling, bladder neck mobility, and Vectors 1-6 between them. HA was positively correlated to bladder neck mobility. In the training cohort, bladder neck position on Valsalva, Vectors 3, and BMI had the area under curves of 0.74, 0.69, and 0.66 (all P < 0.001); Funneling and Vector 3 had odds ratios of 18.96 and 3.65 (all P < 0.001), for predicting SUI. The predictive model incorporating funneling, Vectors 3, and BMI provided the best performance in predicting SUI in both cohorts. CONCLUSION: The larger the HA was, the higher the bladder neck mobility. However, it was mid-urethral mobility rather than bladder neck mobility that performed best at predicting SUI.

Urethral configuration and mobility during urine leaking described using real-time transperineal ultrasonography.

PURPOSE: The aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and standing positions between women with and without stress urinary incontinence (SUI). METHODS: This prospective study included 100 control women and 100 incontinent women who had a CST with transperineal ultrasonography. The bladder neck configuration and urethral mobility were described in terms of urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility at six points along the urethra (vectors 1 to 6). The two groups' ultrasound findings in the two positions were compared. RESULTS: Valid data were collected from 78 control women and 90 women with SUI. Significant differences were found in age and body mass index between the two groups (P<0.01). Urethral funneling was found in 33 women (36.7%) with SUI and five continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA significantly increased (160° to 179°, P<0.001) in the SUI group; The mean vector of points 1 to 6 significantly increased in the control group (all P<0.001). The RVA, BND, and vectors 1 to 4 were significantly greater (all P≤0.01) in women with SUI than without, in both positions. CONCLUSION: Urethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper- and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs of SUI.

The Visualized Urethral Mobility Profile in Stress Urinary Incontinence Described by Four-Dimensional Transperineal Ultrasound.

OBJECTIVES: To describe the urethral mobility during urine leaking in stress urinary incontinence (SUI) by transperineal ultrasound (TPUS) with urethral mobility profile (UMP) analysis. METHODS: This was a prospective study of 380 women who had a cough stress test (CST) with TPUS. UMP software automatically placed six equidistant points from the bladder neck (Point 1) to the external urethral meatus (Point 6) and determined their x and y coordinates relative to the symphysis pubis. Urethral mobility vector of Points 1-6 (Vectors 1-6) and the distance between the six points and the symphysis (Dist. 1-6) were calculated and compared between the two groups. The visualized UMP was created by reproducing the positions of the six points at rest and on Valsalva. RESULTS: Valid data of 188 women with SUI and 174 continent women were analyzed. The mean age of all 362 women was 49.3 years. Mean body mass index in the SUI group was significantly increased (23.8 vs 22.2 kg/m2 , P < .001). During CST, Vectors 1-6 and Dist. 2-6 were significantly increased (all P < .005) in the SUI group. The UMP showed the mid-urethral rotated down around the symphysis pubis. The upper urethral profile in the two groups was similar. But the gap between the mid-urethra and the symphysis was wider in the SUI group. CONCLUSIONS: The visualized UMP illustrated the mid-urethral hypermobility in SUI by showing a wider gap due to the unstable connection between the mid-urethra and the symphysis pubis.

Ultrasound Findings and O-RADS Malignancy Risk Stratification of Ovarian Collision Tumors.

OBJECTIVES: To describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O-RADS system. METHODS: This was a retrospective analysis of 25 ovarian collision tumors from 8739 patients between May 2010 and January 2020. All clinical characteristics, ultrasound images, and histological findings were collected and analyzed. Using the O-RADS lexicon descriptors, the O-RADS score was determined by two senior doctors. Lesions with O-RADS scores of 1 to 3 were classified as benign tumors, and lesions with O-RADS scores of 4 to 5 were classified as malignant tumors. RESULTS: The mean age of the 25 patients was 30.4 years. Histological findings showed that all tumors were a combination of mature cystic teratomas and cystadenomas/cystadenocarcinomas. There were 11 benign tumors of O-RADS 2 or 3, including 3 uniocular cysts, 3 dermoid cysts, and 5 dermoid cysts with an anechoic fluid cavity. There were 12 benign tumors of O-RADS 4, including 3 uniocular-multilocular cysts with solid components, 2 multilocular cysts with irregular walls, and 8 multilocular cysts with dermoid sacs. One borderline tumor of O-RADS 4 was a multilocular cyst with irregular septation. One malignant tumor of O-RADS 5 was a multilocular cystic tumor with solid components and ascites. CONCLUSIONS: The most common ovarian collision tumor was the coexistence of a mature cystic teratoma and a cystadenoma. The O-RADS system was able to sensitively detect malignant tumors in this series. A typical dermoid cyst with an anechoic cavity or a multilocular cyst with a dermoid sac may signify a benign collision tumor.

The learning curve and difficult points of the O-RADS ultrasound risk stratification system in 54 trainees.

PURPOSE: This study aimed to evaluate the learning curve and explore the difficult points of the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification system. METHODS: One hundred adnexal masses (AMs) were randomly selected for five tests as training data. Two experienced trainers had an inter-rater agreement of 0.95 for the O-RADS scores. Fifty-four trainees (26 level I practitioners [group 1], 17 level II practitioners [group 2], and 11 experienced level II practitioners [group 3]) attended the training. Every trainee received assessment and feedback after 20 scored cases. The outcomes of the five tests were compared among the three groups using repeated-measurements analysis of variance. RESULTS: Of the 100 AMs, 52 were pathologically benign and 48 were malignant; the O-RADS scores were 2, 3, 4, and 5 in 22, 11, 48, and 19 AMs, respectively. The between-subjects effects test showed no significant differences between groups 1, 2, and 3 for the five tests (P=0.501). For each group, the differences among the five tests were significant (P<0.001, P=0.006, and P=0.044 for groups 1, 2, and 3, respectively). Test 2 was the worst. In 23 cases, more than 40% of trainees gave incorrect answers, which mainly related to classic benign lesions, the color flow score, and solid-appearing masses. CONCLUSION: After training, junior doctors at different levels can reach a coincident O-RADS ultrasound risk stratification. The difficulties primarily related to subjective judgments of classic benign lesions, the color flow score, and solid-appearing masses. More experience is needed to improve the applicability of the system.

Long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China.

Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.

Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound.

INTRODUCTION AND HYPOTHESIS: The objective was to describe the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound (TPUS). METHOD: We carried out prospective data collection and a retrospective data analysis of 102 women with stress urinary incontinence (SUI) who had a positive CST with TPUS in the supine and/or standing position. On TPUS, the behaviour of the bladder neck and proximal urethra was described by the urethral length, urethral funnelling, bladder neck descent (BND), retrovesical angle (RVA) and urethral rotation angle (URA). Differences between the ultrasound findings in the two positions were evaluated. RESULTS: In the 102 women, the mean age was 48 years and mean BMI was 23.8 kg/m2. On TPUS, urine leakage was detected in the supine or standing position in 102 women and in both positions in 81. Between the two positions, significant differences were found in the URA and RVA. In the standing position, the median RVA of 166° was significantly larger than that of 133° in the supine position (p < 0.001), and the median URA of 35° was significantly smaller than that of 64° in the supine position (p < 0.001). CONCLUSIONS: TPUS in both positions can be used to detect the real-time behaviour of the bladder neck and urethra in the CST. In the standing position, less rotation and more straightening of the bladder neck and proximal urethra occurred during urine leakage.

A Preliminary Study on Quantitative Quality Measurements of the Urethral Rhabdosphincter Muscle by Supersonic Shear Wave Imaging in Women With Stress Urinary Incontinence.

OBJECTIVES: To quantitatively assess the quality of the urethral rhabdosphincter muscle by measuring its shear wave velocity (Vs ) and calculating the Young modulus (E) with supersonic shear wave imaging (SSI). METHODS: This was a prospective study of 43 women with SUI and 52 female control participants who underwent a transperineal US examination with SSI. Supersonic shear wave imaging was performed at rest with a linear transducer and a specialized-preset procedure. The stability and validity of the shear waves were automatically assessed by the SSI procedure. The SSI images were visualized in a color-coded elastographic image. In the postprocessing analysis, the ventral part of the urethral rhabdosphincter muscle was manually outlined. The mean Vs and the mean E of the muscle were measured by the SSI procedure. The relationship between the mean Vs , mean E, and SUI was evaluated. RESULTS: The SSI examination was successfully performed in 40 patients with SUI (93.0%) and 40 female control participants (76.9%). No significant differences between the groups in age, body mass index, and parity were identified. For the SUI and control groups, the mean Vs values were 2.54 and 2.73 m/s, respectively, and the mean E values were was 19.7 and 22.7kPa. Significant correlations were found between SUI and the mean Vs as well as the mean E (Spearman correlation coefficients, -0.41 and -0.43; P < .05). CONCLUSIONS: The mechanical properties of the urethral sphincter can be quantitatively assessed by SSI. The stiffness of the urethral rhabdosphincter muscle was significantly lower in women with SUI.

The use of tomographic ultrasound imaging on three-dimensional translabial ultrasound: a diagnostic sign for urethral diverticulum.

INTRODUCTION AND HYPOTHESIS: The objective was to apply tomographic ultrasound imaging (TUI) to diagnose urethral diverticulum (UD) and summarize the specific imaging findings. METHODS: This was a retrospective analysis of 42 women with a paraurethral cyst. All women underwent a clinical interview, three-dimensional pelvic floor ultrasound and a transvaginal cystectomy between May 2016 and March 2019. UD was defined on TUI if a tract connecting the paraurethral cyst to the urethral lumen was shown in the urethral rhabdosphincter circular muscle in the pelvic floor axial plane. All patients' demographics, history, clinical evaluation and surgical outcomes were reviewed. RESULTS: On surgical findings, 33 women had a UD and 9 had a Gartner duct cyst. Characteristics of paraurethral cysts described by TUI were consistent with surgical findings in 40 patients (95%). Good agreement was shown by κ test (κ = 0.88, p < 0.001). Of 33 UD patients, the mean age was 45 years and the mean duration of symptoms was 6.5 months. The most common presenting symptom was recurrent urinary tract infection (17, 52%), followed by stress urinary incontinence and a vaginal lump (15, 46%). The mean maximum diameter of 33 UDs was 26 mm (range 8-45 mm). On TUI, one tract, connecting the paraurethral cyst to the urethral lumen, was identified as a gap in the hyperechoic rhabdosphincter muscle circle in the pelvic floor axial plane in 23 UDs (70%); there were two or more tracts in 8 (24%). CONCLUSIONS: The diagnostic sign to identify urethral diverticulum is a gap in the hyperechoic urethral rhabdosphincter circle formed between the cyst and urethral lumen in the axial plane.

Detection of Concealed Uterine Prolapse in the Volume-Rendering Mode of 4-Dimensional Translabial Ultrasound: A Retrospective Observational Study.

OBJECTIVES: To assess the association between a widened vaginal canal on volume-rendered ultrasound (US) imaging with concealed uterine prolapse. METHODS: This work was a retrospective study of 253 women who had an International Continence Society Pelvic Organ Prolapse Quantification System examination and translabial US examination. The anteroposterior diameter of the vaginal canal was measured in the rendered axial plane for all women. The widened vaginal canal was defined as an anteroposterior diameter above the 95th centile in women with normal uterine descent. The performance of the widened vaginal canal for prediction of clinical uterine prolapse was tested. RESULTS: Valid data from 233 women were analyzed. A mean anteroposterior diameter of 5.6 mm (range, 2.3-10.5 mm; 95th percentile, 10 mm) was seen in 119 women with normal uterine descent. An eye-shaped vaginal canal with a mean anteroposterior diameter of 17.8 mm (range, 10.7-26.8 mm) was seen in 69 women with uterine prolapse. A widened vaginal canal was defined as an anteroposterior diameter of greater than 10 mm. Of 45 concealed uterine descents, 32 had a widened vaginal canal (ie, anteroposterior diameter > 10 mm), and 27 had clinical uterine prolapse. The κ test showed good agreement between physical and US findings (κ = 0.76; P < .001). Ultrasound findings had excellent predictive value (odds ratio, 82.3) for the diagnosis of clinical uterine prolapse. CONCLUSIONS: An eye-shaped vaginal canal with an anteroposterior diameter of greater than 10 mm in the rendered axial plane was a sign of uterine prolapse. This sign may be helpful for detecting concealed uterine prolapse in complex pelvic organ prolapse.

Concordance of tomographic ultrasound and multiplanar ultrasound in detecting levator ani muscle injury in patients with pelvic organ prolapse.

AIM: To compare the evaluations of evaluate levator ani muscle injury (LAMI) by tomographic ultrasound imaging (TUI) and multiplanar (MP) ultrasound in patients with pelvic organ prolapse (POP). METHOD: This retrospective analysis studied women who underwent International Continence Society POP quantification examination between October 2015 and June 2016. LAMI was assessed by both TUI and MP ultrasounds. Concordance of these two testing results was analyzed. Their correlations with clinical symptoms were also studied. RESULTS: A total of 135 women were included. All the patients with POP had a minimal LAMI depth ≥ 7 mm. Two examinations, TUI and MP, had satisfactory concordance (k = 0.71, P < 0.01). Depth of LAMI in the coronal plane demonstrated good agreement with TUI scores (r = 0.84; P < 0.01). After controlling for age, BMI, and parity, to have clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19-1.44) and 1.25 (95% CI 1.14-1.36), and for TUI scores were 1.72 (95% CI 1.37-2.17) and 1.63 (95% CI 1.31-2.03). Receiver operating characteristic curve analyses showed a cutoff depth of 7 mm of LAMI yielded a sensitivity of 62% and specificity of 80% for POP symptoms. CONCLUSIONS: TUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP.

Evaluating Z Scores to Quantify Levator Hiatal Distensibility by 3-Dimensional Ultrasonography in Nulliparas and Women With Pelvic Organ Prolapse.

OBJECTIVES: To use Z scores to quantify hiatal distensibility and to test the performance of Z scores for levator hiatal areas in predicting substantial pelvic organ prolapse (POP). METHODS: We undertook a retrospective study of the data from 145 nulliparas and 166 patients with POP who had a clinical POP examination with 3-dimensional translabial ultrasonography. Z scores were used to normalize levator hiatal areas of nulliparas. The Z score model for the hiatal area was built by the formula Z score = (measured value - predicted mean value)/predicted standard deviation and was used to evaluate hiatal ballooning in women with POP. RESULTS: Valid data were gathered from 134 nulliparas and 159 patients with POP. POP stage 1 was found in 46 women, stage 2 in 62, stage 3 in 43, and stage 4 in 8. We built the Z score model as follows: Z-Av = (measured value - 17.15)/3.11, where Av represented the minimal levator hiatal area on the maximum Valsalva maneuver. The levator hiatal area was strongly related to the POP stage (P < .001). On a receiver operating characteristic curve analysis, the cutoff of Z-Av was 1 for POP stage 2 or higher (sensitivity, 77%; specificity, 60%) and substantial POP on ultrasonography (sensitivity, 84%; specificity, 75%). CONCLUSIONS: Hiatal distensibility can be exactly evaluated by Z-Av. A Z-Av value of less than 1.0 was defined as a "normal hiatal expansion," 1 to 3 as "mild ballooning," 3 to 5 as "moderate ballooning," 5 to 7 as "marked ballooning," and 7 or greater as "severe ballooning."

Correlations between Sonographic and Urodynamic Findings after Mid Urethral Sling Surgery.

PURPOSE: We studied correlations between sonographic and urodynamic findings after suburethral sling surgery. MATERIALS AND METHODS: This retrospective study was done in 141 women who underwent multichannel urodynamic testing and translabial 4-dimensional ultrasound after suburethral sling surgery between 2006 and 2016. We determined the sling-pubis gap, ie the distance between the sling and the inferior posterior margin of the pubic symphysis, during the Valsalva maneuver and the urethral motion profile. The latter was assessed by calculating the mobility vectors of 6 equidistant points along the length of the urethra from the bladder neck to the external urethral meatus against the dorsocaudal margin of the pubic symphysis during the Valsalva maneuver. Correlations were determined between the sling-pubis gap and the mobility vectors, and between these measures and urodynamic data. RESULTS: Median followup in the 126 women with complete data was 36 months. Significant correlations were found between the sling-pubis gap and the mid urethral mobility vectors (all p <0.02). The sling-pubis gap and the mid urethral mobility vectors negatively correlated with detrusor pressure at maximum flow (p = 0.037 and 0.004, respectively). Urodynamic stress incontinence was more likely in women with a greater sling-pubis gap (p = 0.003). CONCLUSIONS: The tighter the sling on ultrasound, the less likely is urodynamic stress incontinence and the higher the detrusor pressure during voiding.

Can We Evaluate Hiatal Ballooning by Measuring the Anteroposterior Diameter With 2-Dimensional Translabial Ultrasonography?

OBJECTIVES: To analyze the association between the anteroposterior hiatal diameter and pelvic organ prolapse and to determine whether 2-dimensional translabial ultrasonography can evaluate hiatal ballooning by measuring the anteroposterior diameter. METHODS: This study was a retrospective analysis of 312 women seen for lower urinary tract symptoms or pelvic organ prolapse between December 2014 and July 2016. All women had an International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) system examination and 4-dimensional translabial ultrasonography. The anteroposterior hiatal diameter was measured in the midsagittal plane, and the hiatal area was measured in the minimal axial plane during the maximal Valsalva maneuver. RESULTS: Valid data from 294 patients were analyzed. International Continence Society POP-Q stage 0 was found in 121 women, stage 1 in 49, stage 2 in 78, stage 3 in 42, and stage 4 in 4. The anteroposterior diameter had an excellent linear correlation (r = 0.814; P < .001) with the hiatal area during the Valsalva maneuver and was strongly related to ICS POP-Q stages (P < .01). A receiver operating characteristic curve analysis proposed a cutoff of 6.0 cm for the anteroposterior diameter against ICS POP-Q stage 2 and higher (sensitivity, 73%; specificity, 52%) and prolapse symptoms (sensitivity, 74%; specificity, 64%). CONCLUSIONS: The anteroposterior hiatal diameter, which represents hiatal distensibility in the midsagittal plane, can be used to evaluate hiatal ballooning. "Mild" ballooning was defined as an anteroposterior diameter measurement of 6.0 to less than 6.5 cm, "moderate" ballooning as 6.5 to less than 7.0 cm, and "marked" ballooning as 7.0 cm or greater.