Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

Revista Brasileira de Ginecologia e Obstetrícia

Sthela Maria Murad-regadas²  Leonardo Robson Pinheiro Sobreira Bezerra¹  Claudio Regis Sampaio Silveira¹  Jacyara De Jesus Rosa Pereira²  Graziela Olivia Da Silva Fernandes²  José Ananias Vasconcelos Neto¹  Iris Daiana Dealcanfreitas² 

[1] ,Universidade Federal do Ceará Hospital das Clínicas Anorectal Physiology and Pelvic Floor UnitFortaleza CE ,Brazil

关键词: Pelvic floor;    Cervix uteri;    Reproducibility of results;    Observer variations;    Diafragma pélvico;    Colo do útero;    Reprodutibilidade dos testes;    Variações dependentes do observador;   

DOI  :  10.1590/S0100-72032013000300006

来源: SciELO

【 摘 要 】

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

【 授权许可】

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