ObjectiveTo study the value of transperineal three-dimensional ultrasound imaging in the diagnosis of pelvic organ prolapse (POP). MethodsFifty-two female patients undergoing transperineal three-dimensional ultrasound imaging between December 2011 and May 2013 were chosen for our study. Thirty-two of them with POP were designated into the observation group, and the other 20 patients with common gynecological diseases were regarded as the control group. Both the two groups of patients underwent transperineal three-dimensional ultrasound imaging in their resting state, action state (Valsalva deep inspiration followed by breath holding), and under levator ani muscle shrinking condition. These three kinds of state images clearly showed pelvic floor levator hiatus area and sagittal levator hiatus lengths change in the patients. ResultsPelvic floor was more relaxed in the observation group than that in the control group. The levator hiatus area and sagittal levator hiatus lengths were larger in the observation group than those in the control group, and the differences were significant (P<0.05). ConclusionTransperineal three-dimensional ultrasound imaging can better display pelvic anatomic structure, improve the effectiveness and accuracy of the diagnosis of pelvic organ prolapse, which is worthy of clinical application.
ObjectiveTo evaluate the feasibility and efficacy of laparoscopic paravaginal repair (LPVR) for anterior vaginal prolapse in women of child-bearing age. MethodsTotally, 21 patients with anterior vaginal prolapse underwent laparoscopic extraperitoneal vaginal vault suspension between January 2012 and May 2013. Among the 21 patients, 5 were in grade Ⅲ, 15 in grade Ⅱ, and 1 in grade Ⅰ. Under laparoscope, the bilateral white lines and ischial spines were exposed, and then the angle of vaginal fornix was sutured to the ipsilateral ischial spine and the vaginal wall was sutured to the ipsilateral white line. Laparoscopic sacrocolpopexy or Burch or posterior vaginal wall repair was performed as well if necessary. The patients without any subjective symptom were defined as subjective cure and those whose pelvic organ prolapse quantification of anterior vaginal was zero degree were defined as objective cure. ResultsLaparoscopic sacrocolpopexy was performed in 5 patients, Burch in 3, and posterior vaginal wall repair alone in 6. The operation time ranged from 110 to 225 minutes with an average of 155 minutes, and the intraoperative blood loss ranged from 30 to 100 mL with an average of 60 mL. No intraoperative complication occurred. The marking point of pelvic organ prolapse quantitation Aa before and after operation was (1.0±0.4) cm and (-3.0±0.8) cm, and Ba was (1.5±0.4) cm and (-3.0±0.5) cm, and there were significant differences (P<0.01). The patients were discharged from hospital within 5 to 10 days averaging 7 days. The cost of hospitalization was 7 000 to 11 000 yuan, with an average of 8 500 yuan. One patient who felt obstruction of urethra and diffcult urination was improved by keeping indwelling urinary catheter for 7 days. Follow-up was achieved in 21 patients for 10 to 18 months with a mean of 15 months, and 19 of them had subjective cure and 20 of them objective cure. ConclusionLPVR can be successfully completed in anterior vaginal prolapse patients with paravaginal defect with less injury and shorter recovery time.
Female pelvic floor dysfunction (PFD) is a common disease affecting women's quality of life, especially in older women. The establishment and application of multimodal evaluation system is the key to the accurate diagnosis and effective treatment of PFD. The purpose of this expert consensus is to provide a comprehensive, multi-layered assessment framework that includes clinical examinations, imaging examinations, biomechanical tests, and questionnaires to comprehensively assess pelvic floor function in women. By integrating different assessment methods, we aim to improve the early identification and diagnostic accuracy of PFD, so that personalized treatment can be developed to improve patient outcomes. The consensus also discusses the advantages and disadvantages of various assessment techniques and suggests directions for future research and clinical applications.