[Imaging of the pelvic floor (MR defecography) : The surgeon's perspective]. / Bildgebung des Beckenbodens (MR-Defäkographie) : Die Sicht der Chirurgie.

BACKGROUND: Magnetic resonance defecography (MRD) plays a central role in diagnosing pelvic floor functional disorders by visualizing the entire pelvic floor along with pelvic organs and providing functional assessment of the defecation process. A shared understanding between radiology and surgery regarding indications and interpretation of findings is crucial for optimal utilization of MRD. OBJECTIVES: This review aims to explain the indications for MRD from a surgical perspective and elucidate the significance of radiological findings for treatment. It intends to clarify for which symptoms MRD is appropriate and which criteria should be followed for standardized results. This is prerequisite to develop interdisciplinary therapeutic approaches. MATERIALS AND METHODS: A comprehensive literature search was conducted, including current consensus guidelines. RESULTS: MRD can provide relevant findings in the diagnosis of fecal incontinence and obstructed defecation syndrome, particularly in cases of pelvic floor descent, enterocele, intussusception, and pelvic floor dyssynergia. However, rectocele findings in MRD should be interpreted with caution in order to avoid overdiagnosis. CONCLUSION: MRD findings should never be considered in isolation but rather in conjunction with patient history, clinical examination, and symptomatology since morphology and functional complaints may not always correlate, and there is wide variance of normal values. Interdisciplinary interpretation of MRD results involving radiology, surgery, gynecology, and urology, preferably in the context of pelvic floor conferences, is recommended.

Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound.

INTRODUCTION: In the present investigation, a systematic evaluation of the clinical treatment performance of diagnosed with pelvic floor dysfunction is explored. By comparing the 4Dtransperineal pelvic floor ultrasound images with the acupuncture treatment performance of the patients, an evaluation system with various parameters is established to provide critical information to guide the clinical treatment fpostpartum female pelvic floor dysfunction (FPFD). METHODS: Eighty patients diagnosed with FPFD are divided into 2 groups. After the designated treatment to the patients, they are carefully examined using transperineal pelvic floor ultrasound. The shape and activity of bladder neck, cervix and rectum anal canal under resting, anal sphincter and Valsalva movements are observed and recorded. The morphology and continuous shape of levator ani muscle in different states after 4D image reconstruction are obtained. RESULTS: After the acupuncture treatment, the bladder neck descent is decreased by 3.8 cm and the anal levator muscle area is decreased by 3.4 cm2 comparing with the control group. The anal levator muscle hole diameter is decreased by 0.3 cm, while the anterior and posterior diameter is reduced by 0.5 cm. Reduced possibility of cystocele and uterine prolapse is demonstrated by X2 test. These changes upon acupuncture therapy are in line with the improved conditions of the patients, indicating these parameters can help evaluate the therapy performance. CONCLUSION: 4D pelvic floor ultrasound imaging provides objective and quantified information for the clinical diagnosis and treatment of FPFD and the assessment of therapy efficacy, making it a promising novel method in practical applications.

Injury-associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study.

OBJECTIVE: To determine whether all three components of the levator ani muscle (pubovisceral [= pubococcygeal], puborectal and iliococcygeal) and the external anal sphincter are equally affected by oedema associated with muscle injury after vaginal birth. DESIGN: Observational cross-sectional study. SETTING: Michigan Medicine, University of Michigan. POPULATION: Primiparous women classified as high risk for levator ani muscle injury during childbirth. METHOD: MRI scans obtained 6-8 weeks postpartum were analysed. Muscle oedema was assessed on axial and coronal fluid-sensitive magnetic resonance (MRI) scans. Presence of oedema was separately determined in each levator ani muscle component and in the external anal sphincter for all subjects. Descriptive statistics and correlation with obstetric variables were obtained. MAIN OUTCOME MEASURES: Oedema score on fluid-sensitive MRI scans. RESULTS: Of the 78 women included in this cohort, 51.3% (n = 40/78) showed muscle oedema in the pubovisceral (one bilateral avulsion excluded), 5.1% (n = 4/78) in the puborectal and 5.1% (n = 4/78) in the iliococcygeal muscle. No subject showed definite oedema on external anal sphincter. Incidence of oedema on the pubovisceral muscle was seven times higher than on any of the other analysed muscles (all paired comparisons, P < 0.001). CONCLUSIONS: Even in the absence of muscle tearing, the pubovisceral muscle shows by far the highest incidence of injury, establishing that levator components are not equally affected by childbirth. External anal sphincter did not show oedema-even in women with sphincter laceration- suggesting a different injury mechanism. Developing a databased map of injured areas helps understand injury mechanisms that can guide us in honing research on treatment and prevention. TWEETABLE ABSTRACT: Injury-associated levator ani muscle and anal sphincter oedema mapping on MRI reveals vulnerable muscle components after childbirth.

Development of a core data set for pelvic floor disorder patients registry.

OBJECTIVES: Pelvic floor disorders (PFDs) are important public health concerns due to their increasing prevalence. Hence, there is an increasing need for developing systematically collected quality data to assist appropriate clinical decision-making. This study aimed to develop a core data set for patients with PFDs based on the PFDs registry. METHODS: A descriptive cross-sectional study was conducted in 2019. Data were retrieved from electronic databases including PubMed, Embase and Google scholar. Available documents and data systems in clinical centers were also assessed. The Delphi technique was applied to reach a consensus about the data elements using a questionnaire. A panel of experts evaluated the content validity of the questionnaire. RESULTS: We developed a dataset for PFDs that included two classes of data (65 data items) identified from the related literature. In the Delphi survey, 74 data elements were determined by the experts and final data were divided into two demographic and clinical categories that included 12 and 62 data elements, respectively. CONCLUSIONS: This dataset has the potential for standardizing the data by providing accurate, consistent, complete and uniform data elements. Furthermore, it can provide valuable research facilities for clinicians and researchers in the healthcare system resulting in improvement of the quality of care and containment of costs.

Sport and pelvic floor dysfunction in male and female athletes: A scoping review.

AIMS: The aims of the present scoping review were to systematically map and summarize findings to identify any study that reported epidemiological data on pelvic floor dysfunction (PFD) among male and female athletes. METHODS: Six medical databases were searched up to March 2020. No language, study design, and publication type restrictions were applied. Additional studies were identified through gray literature and the reference lists of articles were screened. The results were presented numerically and thematically. RESULTS: A total of 4358 records were identified with an initial search. A hundred studies met the criteria for inclusion. The number of studies published annually increased over the years. Cross-sectional studies (n = 62), urinary incontinence (n = 64), multiple sports (n = 58), and female athletes (n = 83) are the most investigated study design, condition, sport, and population, respectively. Only 12 studies explored PFD in the male population. Authors focused selectively on elite athletes in 21 studies. CONCLUSIONS: This is the first scoping review to provide a comprehensive overview of the topic. The major gaps in the literature include studies focused on male participants, other PFD (e.g., anal incontinence, pelvic organ prolapse, and pelvic pain), with appropriate study design. This review may be useful to raise awareness of the issue among clinicians and stakeholders in sport and it may represent a starting point for future research.

Adaptación y validación de las escalas de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico en mujeres con cáncer ginecológico / Adaptation and validation in Spanish of self-efficacy and outcomes expectation scales for practice of pelvic floor exercises scale in women with gynecological cancer

ANTECEDENTES: La autoeficacia y expectativa de resultados son constructos teóricos que explican muchos cambios de conductas en salud, como la práctica de ejercicios de suelo pélvico (ESP) y son predictores de adherencia. Las mujeres en tratamiento por cáncer ginecológico presentan distintos grados de disfunción de suelo pélvico que pueden prevenirse con la práctica de ejercicios. El éxito de este tipo de intervenciones depende de la adherencia a ellos. Hay escasez de instrumentos de autoeficacia en idioma español desarrollados en el contexto de intervenciones preventivas. OBJETIVO: Adaptar y validar en Chile la Escala de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico (EAPEAP) desarrollada en Brasil. Pacientes y método: Estudio observacional, longitudinal prospectivo y de validación, incluyó traducción-traducción inversa y revisión por pares expertos. Se evaluaron las propiedades psicométricas del instrumento - consistencia interna y capacidad predictiva, aplicado a 53 mujeres chilenas derivadas a tratamiento de radioterapia por cáncer ginecológico. Para los análisis se consideró un p < 0,05. RESULTADOS: La escala presenta buena consistencia interna, siendo el alfa de Cronbach de 0,932 para la Escala de Autoeficacia para ESP y alfa de 0,748, para la Escala de Expectativa de Resultados. Respecto de la validez predictiva, la escala de autoeficacia fue capaz de discriminar entre adherentes y no adherentes a tratamiento (p = 0,034), no así la escala de expectativa de resultados. CONCLUSIÓN: La escala de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico es lingüísticamente apropiada y psicométricamente válida para ser aplicada en Chile

BACKGROUND: Self-efficacy and outcomes expectation are theoretical constructs that explain many changes in health behaviors, such as the practice of pelvic floor exercises (PFE), and they are predictors of adherence. Women undergoing treatment for gynaecological cancer have different degrees of pelvic floor dysfunction that can be prevented with PFE. The success of these kinds of procedures are dependent on adherence to them. There is a lack of self-efficacy instruments in Spanish related to preventive approaches. OBJECTIVE: to adapt and validate the Scale of Self-efficacy and Outcomes Expectation for the Practice of Pelvic Floor Exercises (EAPEAP) developed in Brazil. PATIENTS AND METHOD: Observational, prospective longitudinal and validation study that included translation- back translation and expert peer review. The psychometric properties of the instrument (internal consistency and predictive capacity) were evaluated, applied to 53 Chilean women referred for radiotherapy treatment for gynaecological cancer. RESULTS: The scale shows good internal consistency, with a Cronbach's alpha of 0.932 for the self-efficacy scale for PFE; and alpha of 0.748 for the outcomes expectation scale for PFE. Regarding predictive validity, the self-efficacy scale was able to discriminate between adherence and non-adherence to treatment (p = 0.034), but not the outcomes expectation scale. For all the analyses, a p < 0.05 was considered. CONCLUSION: the scale of self-efficacy and outcomes expectation for the practice of PFE is linguistically appropriate and psychometrically valid to be applied in Chile

Cómo la pandemia por COVID-19 ha cambiado la forma de atender a las pacientes en una unidad de uroginecología / How did COVID-19 pandemic change the way we attend the patients in an urogynaecological unit

La actual pandemia ocasionada por el SARS-coronavirus tipo 2 ha generado, en pocas semanas, cambios importantes en el funcionamiento del sistema sanitario y la forma en cómo se realiza la atención a las pacientes. La patología uroginecológica afecta a la calidad de vida, pero sin riesgo vital en la mayoría de casos, por lo que suele ser demorable. Además, afecta a un alto porcentaje de mujeres > 65 años (población de riesgo ante la infección por COVID-19). En este manuscrito se resume la evidencia que existe sobre la efectividad de la telemedicina aplicada en las disfunciones de suelo pélvico, así como recomendaciones de las sociedades científicas uroginecológicas durante el estado de alarma. Describimos el abordaje de las disfunciones de suelo pélvico durante la pandemia por COVID-19 y una propuesta de cómo organizar las agendas para el diagnóstico (visitas y pruebas diagnósticas) y tratamiento (conservador, farmacológico y la cirugía) en el período interpandemia y en el futuro

The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future

Laparoscopic Mesh Repair for Perineal Hernia after En Bloc Resection of an Aggressive Angiomyxoma Using a Modified Sacral Colpopexy Technique.

STUDY OBJECTIVE: To demonstrate laparoscopic mesh repair of perineal hernia (PH) by a modified sacral colpopexy technique. DESIGN: Step-by-step demonstration of the technique used for the surgical repair of PH after gynecologic surgery. SETTING: PH is defined as a pelvic floor defect through which the intra-abdominal viscera may protrude [1]. The reported incidence of PH ranges from 0.6% to 3%, and it generally occurs after rectal or prostate surgery [2]. Owing to its low incidence, there is no standard procedure to treat PH [3]. Herein, we demonstrate a successful case of PH treatment with a composite mesh (Dual Mesh; W. L. Gore & Associates, Newark, DE) after gynecologic surgery by a modified laparoscopic sacral colpopexy technique, which was approved by our institutional review board. INTERVENTIONS: The patient had undergone extralevator abdominoperineal excision for an aggressive angiomyxoma and developed a sigmoid colon-protrudent PH after the surgery [4]. The patient suffered from defecatory dysfunction and dysmenorrhea. A total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and mesh repair of the PH were performed at 2 years after the primary surgery, and they were successful without any intra- or postoperative complications. Because the pelvic floor defect was too large to secure the mesh by a simple placement, we applied the modified sacral colpopexy technique using 2-0 proline (ETHICON, Tokyo, Japan) to cover and support this defect. At 12 months after the second surgery, there was no sign of recurrence of PH and aggressive angiomyxoma, and the preoperative symptoms had diminished. CONCLUSION: Laparoscopic mesh repair by the modified sacral colpopexy technique is safe and effective to manage PH.

Age-associated changes in the mechanical properties of human cadaveric pelvic floor muscles.

Proper function of the female pelvic floor requires intact pelvic floor muscles (PFMs). The prevalence of pelvic floor disorders (PFDs) increases substantially with age, in part due to clinically identified deterioration of PFM function with age. However, the etiology of this decline remains largely unknown. We previously demonstrated that PFMs undergo age-related fibrotic changes. This study sought to determine whether aging also impacts PFMs' passive mechanical properties that are largely determined by the intramuscular extracellular matrix. Biopsies from younger (≤52y) and older (>52y) female cadaveric donors were procured from PFMs, specifically coccygeus (C) and two portions of the levator ani - iliococcygeus (IC) and pubovisceralis (PV), and the appendicular muscles - obturator internus (OI) and vastus lateralis (VL). Muscle bundles were subjected to a passive loading protocol, and stress-sarcomere length (Ls) relationships calculated. Muscle stiffness was compared between groups using 2-way ANOVA and Sidak pairwise comparisons, α < 0.05. The mean age was 43.4 ±â€¯11.6y and 74.9 ±â€¯11.9y in younger (N = 5) and older (N = 10) donors, respectively. In all PFMs, the quadratic coefficient of parabolic regression of the stress-Ls curve, a measure of stiffness, was lower in the younger versus older group: C: 33.7 ±â€¯13.9 vs 87.2 ±â€¯10.7, P = 0.02; IC: 38.3 ±â€¯12.7 vs 84.5 ±â€¯13.9, P = 0.04; PV: 24.7 ±â€¯8.8 vs 74.6 ±â€¯9.6, P = 0.04. In contrast, non-PFM stiffness was not affected by aging: OI: 14.5 ±â€¯4.7 vs 32.9 ±â€¯6.2, P = 0.8 and VL: 13.6 ±â€¯5.7 vs 30.1 ±â€¯5.3, P = 0.9. Age-associated increase in PFM stiffness is predicted to negatively impact PFM function by diminishing muscle load-bearing, excursional, contractile, and regenerative capacity, thus predisposing older women to PFDs.

Prevalence and risk factors for pelvic floor disorders during early and late pregnancy in a cohort of Austrian women.

PURPOSE: To investigate the prevalence of pelvic floor disorders (PFDs) in a cohort of Austrian women either during their early or late pregnancy and to search for clinical risk factors which correlate with pelvic floor symptoms during pregnancy. METHODS: A prospective study was conducted and 200 pregnant women answered the validated German pelvic floor questionnaire during their first or third trimenon of gestation. Furthermore, a multivariate logistic regression model was used to determine independent risk factors for PFDs after adjusting for confounders. RESULTS: 96/200 (48%) women reported psychological strain in at least 1 of the 4 pelvic floor domains while the remaining 104 women (52%) were asymptomatic. Affected women showed a significant higher BMI, a more frequent positive family history and a higher rate of multiple pregnancies was noted compared to asymptomatic women (p < 0.05). Furthermore, a statistically significant positive correlation could be observed between BMI, smoking and mean bladder score as well as mean prolapse score, signifying more symptom bother from bladder and prolapse in smokers with high BMI. A significant positive correlation was also detected between mean bowel score and parity. In the multivariate model, high BMI (CI 1.013-1.143), positive family history (CI 0.044-0.260) and multiple pregnancies (CI 0.011-0.244) remained independently associated with pelvic floor symptoms (p < 0.05). CONCLUSION: Our results demonstrate that pelvic floor-related quality of life during pregnancy is a prevalent condition which is strongly affected by the expectant mother's weight as well as her family history. In addition, women with multiple pregnancies seem to be at increased risk.

A fiber-optic sensor-based device for the measurement of vaginal integrity in women.

AIMS: Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra-abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. METHODS: An intravaginal probe was fabricated with 18 independent fiber-optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. RESULTS: The probe reliably detected variations in the composition of sub-surface material in the vaginal phantom. During in-vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. CONCLUSIONS: Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.

Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor.

PURPOSE: Pregnancy and labor are known risk factors for pelvic floor dysfunction (PFD). Yet not much is known regarding recovery from PFD. We hypothesized that the recovery from PFD during the postpartum period would be associated with the duration of the second stage of labor (SSL). METHODS: We conducted a case-control study of patients who gave birth at the Soroka University Medical Center, Beer-Sheva, Israel. Those who consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), a questionnaire developed to measure the extent of injury to the pelvic floor, after delivery and 3-month postpartum. The difference between the scores was calculated, representing recovery of symptoms. The duration of the SSL, and clinical and obstetrical characteristics were retrieved from the patients' medical records. Wilcoxon rank test was used, assessing the significance of the recovery. The association between the degree of the recovery and the duration of SSL was tested using Mann-Whitney ranking. RESULTS: A total of 92 patients completed the PFDI-20 after delivery and 3-month postpartum. We found a significant difference between PFD symptoms during pregnancy and 3-month postpartum (P < 0.001). This difference remained consistent in all components of the PFDI-20. In addition, a more profound recovery of colorectal and anal dysfunction (CRAD) symptoms was associated with a shorter duration of the SSL (P = 0.03). CONCLUSIONS: There is a statistically significant recovery of PFD symptoms in the postpartum period. Furthermore, greater recovery from CRAD symptoms is associated with a shorter duration of the SSL.

Can Narrowband Imaging Improve the Laparoscopic Identification of Superficial Endometriosis? A Prospective Cohort Trial.

STUDY OBJECTIVE: To assess the usefulness of narrowband imaging (NBI) to detect additional areas of endometriosis not identified by standard white light in patients undergoing laparoscopy for the investigation of pelvic pain. DESIGN: A prospective cohort trial (Canadian Task Force classification II). Evidence obtained from a well-designed cohort study. SETTING: A tertiary laparoscopic subspecialty unit in Melbourne, Australia. PATIENTS: Fifty-seven patients undergoing laparoscopy for the investigation of pelvic pain were recruited. Fifty-three patients were eligible for analysis. INTERVENTIONS: Patients underwent standard white-light laparoscopy of the pelvis followed by NBI survey to assess for any additional areas suspicious for endometriosis. MEASUREMENTS AND MAIN RESULTS: All identified areas of possible endometriosis were resected and sent for blinded histopathological analysis. The additional predictive value of NBI was 0% if the preceding white-light survey was negative and 86% if the preceding white-light survey was positive. CONCLUSION: The use of NBI at laparoscopy for the investigation of pelvic pain is beneficial in finding additional areas of endometriosis if endometriosis is already suspected after white-light survey in a tertiary laparoscopic unit. Further research in nonspecialized units may show additional benefit and requires further research. NBI may also be useful as a diagnostic aid for trainees.

Effects of pelvic endometriosis and adenomyosis on ciliary beat frequency and muscular contractions in the human fallopian tube.

BACKGROUND: Pelvic endometriosis (EM) and adenomyosis (AM) have different effects on the fallopian tube. This study aimed to assess the transport capability of the fallopian tube in women with pelvic EM or AM. METHODS: Twenty women with uterine leiomyoma (control group), 20 with adenomyosis without pelvic EM (AM group) and 35 with pelvic EM without AM (EM group) were included. EM cases were further divided into the tubal EM and non-tubal EM subgroups. Ciliary beat frequency (CBF), percentage of ciliated cells, and smooth muscle contraction were measured. RESULTS: CBFs of the ampulla in EM cases were significantly lower than those of control and AM cases; CBFs of the ampulla and isthmus in tubal EM cases were significantly lower than those of the control group and non-tubal EM subgroup. In both the ampulla and isthmus segment, percentages of ciliated cells in EM patients were significantly lower than those of AM and control patients; the tubal EM subgroup showed significantly lower values than the control group and non-tubal EM subgroup. Amplitude-to-weight ratios of longitudinal muscular contractility in EM cases were significantly lower than control values; tubal EM cases showed significantly lower values than controls and the non-tubal EM subgroup. Contraction frequencies in EM cases were significantly lower than those of control and AM cases, in both longitudinal and circular muscles; tubal EM cases showed significantly lower values than controls and the non-tubal EM subgroup. CONCLUSION: EM with tubal EM damaged transport function of the fallopian tube, to varying degrees, whereas tubal function in EM without tubal EM and in AM is not altered.

Surgical Treatment of Recurrent Rectal Prolapse in an Adult Female Black-crested Mangabey (Lophocebus aterrimus) by Colopexy.

A 13-y-old, multiparous female black-crested mangabey (Lophocebus aterrimus) underwent surgical treatment for chronically recurring rectal prolapse by laparotomy and subsequent colopexy. Initially, a laparoscopic approach was attempted but was converted to an open approach after intraabdominal adhesions were noted. The colopexy was performed through a ventral midline incision, with no complications intraoperatively or postoperatively. The predisposing factors responsible for the development of this condition likely were related to pelvic floor weakness due to multiple past pregnancies. Transport-associated stressors likely contributed to the acute worsening of this patient's condition. Rectal prolapse is a common condition in laboratory-housed NHP. This case report describes an effective surgical treatment for recurring or otherwise nonreducible rectal prolapse in these species.

Pelvic floor evaluation with transperineal ultrasound: a new approach.

The increased life expectancy, the importance of the prevention in younger age and the role of the pelvic floor dysfunction not only in the disease of the third age, but also in the childbearing age, as the influence on the type of delivery, underline the importance of the evaluation of the pelvic floor. The evaluation of pelvic floor is generally clinical, but in the last 2 decades, the use of ultrasound has become a mainstream diagnostic tool in the investigation of female pelvic organ prolapse, urinary and fecal incontinence and defecation disorders, providing an immediate objective confirmation of findings obtained on clinical examination and filling some of the gaps of the urogynecological exam. The use of transabdominal ultrasound was the first developed, while the use of translabial, transrectal and transvaginal techniques started later. This review will focus on the use of transperineal ultrasound, including two-dimensional (2D), three-dimensional (3D) and 4D imaging, as a valuable and objective method in the urogynecological evaluation, allowing the assessment of the pelvic floor anatomy and its functions and dysfunctions, the choice of the right type of treatment and the analysis of the changes after surgical treatment and its complications. The ultrasound approach has become an important instrument for the prevention, but also for the analysis of the disease, and to understand the importance of the pelvic floor function in different period of life of a woman.

Oocyte oxidative DNA damage may be involved in minimal/mild endometriosis-related infertility.

Early endometriosis is associated with infertility, and oxidative stress may play a role in the pathogenesis of disease-related infertility. This prospective case-control study aimed to compare the presence of oxidative stress markers in the follicular microenvironment and systemic circulation of infertile women with minimal/mild endometriosis (EI/II) versus individuals undergoing controlled ovarian stimulation for intracytoplasmic sperm injection (ICSI). Seventy-one blood samples (27 from infertile women with EI/II and 44 controls with tubal and/or male infertility factor) and 51 follicular fluid samples (19 EI/II and 32 controls) were obtained on the day of oocyte retrieval. Total hydroperoxides (FOX1 ), reduced glutathione, vitamin E, Superoxide dismutase, total antioxidant capacity, malondialdehyde, advanced oxidation protein products, and 8-hydroxy-2'-deoxyguanosine (8OHdG) concentrations were measured in both fluids. Women with EI/II showed higher FOX1 (8.48 ± 1.72 vs. 7.69 ± 1.71 µmol/g protein) and lower total antioxidant capacity (0.38 ± 0.18 vs. 0.46 ± 0.15 mEq Trolox/L) concentrations in serum, and higher 8OHdG concentrations (24.21 ± 8.56 vs. 17.22 ± 5.6 ng/ml) in follicular fluid compared with controls. These data implicate both systemic and follicular oxidative stress may in infertile women with EI/II undergoing controlled ovarian stimulation for ICSI. Furthermore, the elevated 8OHdG concentrations in follicular fluid of women with EI/II may be related to compromised oocyte quality.

Combination of tomographic ultrasound imaging and three-dimensional magnetic resonance imaging-based model to diagnose postpartum levator avulsion.

Vaginal delivery may cause levator avulsion, which may increase the risk of pelvic floor dysfunction (PFD). To explore the morphological changes of the levator ani muscle (including the puborectalis and iliococcygeus) and levator avulsion after vaginal delivery, translabial tomographic ultrasound imaging (TUI) was used to examine 80 women 45-60 days after their vaginal delivery. Subsequently, magnetic resonance imaging (MRI) was performed if at least one-sided puborectalis avulsion was found on TUI. The incidence of puborectalis avulsion in these postpartum women was 13.75% in this study. Both MRI and TUI can detect puborectalis avulsion well, and their results have good consistency. Iliococcygeus muscle injury is difficult to detect using TUI. However, MRI is a good way to observe the morphological changes of the iliococcygeus, which may also be damaged during vaginal delivery. Interestingly, our study reveals that iliococcygeus muscle injury is often associated with severe puborectalis muscle tear.

Pelvic tuberculosis mimicking deep endometriosis.

Pelvic tuberculosis is most frequently observed in developing countries and often leads to the misdiagnosis of pelvic malignancy. We report the first case of pelvic tuberculosis mimicking deep endometriosis.