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Introduction: and hypothesis. We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy. Methods: We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits. Results: In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling. Conclusion: LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS. Clinical Trial Registration: Clinical trial ID: NCT03772691. [ABSTRACT FROM AUTHOR]

Introduction: There is evolving literature on the superiority of transperineal ultrasound (TPU) in predicting the mode of delivery either before induction or during the course of labour. An ultrasound score (USG score) similar to a Bishop score or an ultrasound scoring method based on independent predictors before the onset of labour at term gestation would serve as a baseline objective record over which further progress of labour could be evaluated. Objective: 1. To sonographically examine the clinical parameters evaluated during a digital examination. 2. To derive an USG score using TPU parameters, similar to a Bishop score, and determine its performance in predicting pregnancy outcomes. 3. To identify which are the independent predictors of caesarean section among all the studied ultrasound (USG) parameters. Materials and methods: In this prospective study, all the eligible women who came for routine antenatal care at term gestation and who were due for pelvic assessment were recruited. They underwent transabdominal ultrasound (TAS) for evaluating head position and head circumference, and TPU for evaluating head station with and without applying fundal pressure, various cervical parameters, sub pubic angle. Equivalent five USG parameters were scored along similar lines as the Bishop score. These women underwent vaginal examination for Bishop score and pelvic adequacy by an obstetrician who was blinded about USG parameters. While spontaneous onset of labour (SOL) was awaited in some of these women, some were induced as and when indicated. After delivery, the Bishop scores, pregnancy outcome in terms of SOL or induction of labour (IOL), mode of delivery and duration of labour were noted retrospectively from case records. Independent predictors of caesarean were obtained by univariate and multivariate analysis. Results: All the parameters were assessed for predictive ability of caesarean section by univariate analysis. The cervical length, angle of progression (AOP) at rest, head perineal distance (HPD) at rest and with pressure, Bishop score and USG score were found significant. On multivariate analysis, cervix length and USG score were found to be statistically significant. At a USG score of ≤ 5, the sensitivity and specificity to predict caesarean section were 84% and 68%, respectively. The relative risk (RR) was 4.9 (95% CI 2.3–12). The USG score could predict SOL. The p value was 0.001. The area under the curve (AUC) for the ultrasound score was 0.74. Conclusions: USG examination by USG score at term gestation before the onset of labour can predict mode of delivery by caesarean section. It can predict spontaneous onset of labour. However, among all the individual parameters, cervix length has best predictive ability for caesarean section. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction. Methods: Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3–8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis. Results: The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05). Conclusion: This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The clitoris has a critical pivotal role in female orgasm and arousal. The aim of this cross-sectional study was to evaluate topographic measurements of the clitoris, as well as to explore potential relationships between the clitoral complex and the orgasm domain of female sexual function, combining transperineal ultrasound with morphometric measurements. Methods: In sexually active, heterosexual, premenopausal women, three-dimensional transperineal ultrasound imaging was used to measure the subpubic angle, the anterior triangle area (ATA) of the genital hiatus, the levator urethra gap, and the anteroposterior and transverse diameters of the genital hiatus. Mons pubis thickness, clitoris–urethra distance (CUD), clitoris–fourchette distance, and fourchette–perineal body distance were measured using a caliper. Comparison of measurements and correlation with orgasm score were performed. Results: Among the 108 sexually active women, 30 (27.7 %) reported a low orgasm domain score. There were statistically significant differences between the low orgasm group and the control group in the ATA (4.05 vs 3.64 cm2 respectively; p = 0.03), CUD (21 mm; p = 0.04 vs 16.1 mm; p = 0.04), and volume of the glans clitoris (947.7 mm3 vs 1081 mm3; p = 0.02). There was a moderate and inverse correlation between clitoris–urethra distance and orgasm (r = −0.53, p < 0.001), and arousal (r = −0.42 p < 0.001). Broader ATA (OR = 0.47; 95 % CI = 0.23–0.99; p = 0.04) and longer CUD (OR = 0.57; 95 % CI = 0.44–0.73; p < 0.001) were identified as the only independent predictors of orgasm problems. Conclusions: Longer glans clitoris–urethra distance and broad space for the deep structures of the clitoris is related to difficulty in reaching orgasm and arousal problems. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Rectoceles are common among parous women and they are believed to be due to disruption or distension of the rectovaginal septum as a result of childbirth. However, the etiology of rectocele is likely to be more complex since posterior compartment prolapse does occur in nulliparous women. This study was designed to determine the role of childbearing as an etiological factor in true radiological rectocele. Methods: This was a secondary analysis of the data from 657 primiparous women recruited as part of a previously reported study and another ongoing prospective study. Women were invited for antenatal and postnatal appointments comprising an interview, clinical examination and translabial ultrasonography. The presence and depth of any rectocele were determined on maximum Valsalva maneuver, as was descent of the rectal ampulla. Potential demographic and obstetric factors as predictors of rectocele development were evaluated using either multiple regression or logistic regression analysis as appropriate. Results: A true rectocele was identified in 4 % of women antenatally and in 16 % after childbirth ( P < 0.001). Mean rectocele depth was 13.5 mm (10 - 23.2 mm). The mean antepartum position of the rectal ampulla on Valsalva maneuver was 4.39 mm above and it was 1.64 mm below the symphysis pubis postpartum ( P < 0.0001). De novo appearance of true rectocele was significantly associated with a history of previous <20 weeks pregnancy and fetal birth weight. Body mass index and length of the second stage were associated with rectocele depth increase. Conclusions: Childbirth seems to play a distinct role in the pathogenesis of rectocele. Both maternal and fetal factors seem to contribute. [ABSTRACT FROM AUTHOR]

Background: The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination. We report our experience with preoperative ultrasound evaluation of four cases of anal endometriosis. Methods: Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography. Results: In 3 of 4 women, the lesions involved old episiotomy scars. Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized. The lesions either involved the anal sphincter ( n = 2, one within the rectovaginal septum) or were localized superficially in the ischiorectal space ( n = 2). Surgery and pathologic exam confirmed the ultrasonographic findings. Conclusions: Ultrasonographic findings of anal endometriosis are characteristics and may allow accurate preoperative staging of the disease. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the reliability of transperineal ultrasonography (TPUS) in the pre-operative identification of the internal opening of anal fistulas compared to conventional proctological examination and operative findings. Forty-three patients with anal fistula were assessed by TPUS with and without the use of hydrogen-peroxide injection (E-TPUS) in an attempt to identify the internal opening. Results were compared to preoperative conventional examination and operative findings. Operative assessment showed an anterior internal opening in 29 patients (67.4%) and a posterior opening in 14 (32.6%). Compared to the operative findings, the agreement rate for the identification of the internal opening was 74.4% for physical examination alone, 93.0% for TPUS and 90.7% for E-TPUS. Physical examination was less accurate in detecting the internal opening than both TPUS ( p=0.014) and E-TPUS ( p=0.026). TPUS and E-TPUS are superior to physical examination in the identification of internal openings in anal fistulas. Hydrogen peroxide injection does not provide additional advantages. [ABSTRACT FROM AUTHOR]