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Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between structure and function is still debated. This study aimed to explore the relationship between quantitative measurements of anal sphincter and pelvic floor structures as well as the subjective symptoms and objective assessments of sphincter function regarding anal incontinence. Methods: 50 women with pelvic floor dysfunction were recruited for the study. The severity of anal incontinence was assessed using the CACP score. Ultrasound imaging was employed to measure anal sphincter area, while sphincter pressures were evaluated through manometry. The relationships between variables were analyzed using Pearson's and Spearman's correlation tests. Results: The mean anal sphincter area was 5.51 cm2 at rest and 4.06 cm2 during maximal contraction. Resting anal sphincter pressure had an average of 46.29 mmHg, and contraction pressure averaged 103.25 mmHg. No significant correlation was found between the anal sphincter area and pressure at rest (r = 0.018) or during contraction (r = −0.210). However, a moderate correlation was observed between the change in sphincter pressure and area during contraction (r = 0.312). The CACP score showed no significant correlation with the sphincter area at rest (r = −0.084) but was weakly correlated during contraction (r = −0.270). Conclusions: Conventional diagnostic tools for evaluating anal incontinence can be uncomfortable and are not always readily available. Perineal sonography presents a promising, less invasive alternative for dynamic assessment of the anal sphincter. [ABSTRACT FROM AUTHOR]

Introduction: Digital vaginal examination (DVE) is considered the standard of care for assessing labor progress and cervical dilatation. However, it may be painful and is a subjective method that can increase the risk of chorioamnionitis. Known inter‐ and intra‐observer variability exists in measurements of cervical dilatation obtained digitally. However, little is known about the inter‐ and intra‐observer variability when using intrapartum transperineal ultrasound (TPUS). Our objectives were to investigate the relationship between cervical dilatation as assessed by TPUS and DVE. To assess inter‐ and intra‐observer variability in both single and repeated ultrasound assessments of cervical dilatation during active labor. Material and Methods: This single‐center study was conducted at an inner‐city maternity unit in London, UK. Nulliparous participants at term with a live, singleton fetus in cephalic presentation were recruited between May 2021 and November 2022. During active labor, TPUS was performed subsequent to DVE. Repeat ultrasound assessments were performed where feasible. Participants were in a supine position, with flexed hips and knees and with an empty bladder. The ultrasound transducer was placed transversely on the maternal perineum. The anteroposterior (AP) diameter of the cervix was measured, and two‐dimensional (2D) cine‐loop videos were analyzed to obtain accurate measurements. Data were excluded if the time difference between DVE and TPUS exceeded 60 min. Results: Of the 206 participants who consented to the study, complete data were obtained from 110 participants, yielding 147 paired TPUS and DVE observations. Ninety‐six participants were excluded. The absolute difference between TPUS and DVE assessments was 0 cm in 34% of the observations, 1 cm in 46.3%, and between 2 and 4 cm in 19.7%. The mean difference was −0.9 cm (intraclass correlation coefficient = 0.85; p < 0.001). Data from 30 participants, with 50 cervical dilatation measurements, were used to assess inter‐ and intra‐observer variability. The mean difference for the first ultrasound assessment was 0.07 cm (95% limit of agreement = −0.96 to 1.10, p < 0.001), for inter‐observer variability, and 0.01 cm (95% limit of agreement = −0.29 to 0.30; p < 0.001) for intra‐observer variability. Conclusions: Assessment of the cervix with TPUS during active labor is feasible and shows a strong correlation with DVE measurements. The majority of ultrasound measurements yielded readings within 1 cm of the corresponding DVE values, demonstrating high intraclass correlation and good inter‐ and intra‐observer agreement. [ABSTRACT FROM AUTHOR]

Objective : To investigate the application of transperineal ultrasound for assessing pelvic floor muscle (PFM) function in male patients with constipation and to evaluate its clinical value. Methods: The study included 32 male patients with constipation and 32 healthy controls, all of whom underwent transperineal ultrasound examinations. Measured parameters included the anorectal angle (ARA), levator plate angle (LPA), excursions of the ARA and LPA, and displacements of the bulb of the penis (BP), mid-urethra (MU), urethra-vesical junction (UVJ), and anorectal junction (ARJ) at rest, during maximal voluntary contraction (MVC), and during maximal Valsalva maneuver. Reliability was evaluated in 20 healthy controls using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Results: (1) The ICCs for each parameter measured by both the same and different observers were above 0.84, indicating high repeatability. At least 90% of the measurements by the same and different observers fell within the 95% confidence interval (CI). (2) At rest, the ARA in patients with constipation was significantly larger than in healthy men (P < 0.05). During MVC, LPA, the ARA excursion, LPA excursion, BP displacement, UVJ displacement, and ARJ displacement in constipation patients were also significantly larger than in healthy men (P < 0.05). Furthermore, BP displacement, UVJ displacement, and ARA excursion during maximal Valsalva maneuver in constipation patients were significantly larger than in healthy men (P < 0.05). (3) Receiver operating characteristic curve analysis revealed that the following indicators demonstrated area under the curve (AUC) values exceeding 0.75: ARA excursion of MVC, ARA excursion of maximal Valsalva maneuver, resting ARA, and ARJ displacement of MVC, with AUC values of 0.782, 0.778, 0.770, and 0.765, respectively. No significant differences in diagnostic performance were found among these indicators (P > 0.05). Conclusion: Transperineal ultrasound is a reliable and practical technique for assessing the morphology and function of male PFMs. Parameters such as ARA excursion during MVC, ARA excursion during maximal Valsalva maneuver, resting ARA, and ARJ displacement during MVC are valuable for diagnosing PFM dysfunction in constipated patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: To investigate the utility of transperineal ultrasound in detecting stress urinary incontinence (SUI) and identify optimal anatomical and functional parameters. Methods: Thirty-four women presenting with SUI with or without pelvic organ prolapse between 2012 and 2016 were studied. The control group included patients without SUI who underwent surgery for mild gynecologic disorders or pelvic organ prolapse. The relationship between selected ultrasound parameters and SUI was determined. Results: Among the 20 variables measured in ultrasonography using 4 angles and the bladder–symphysis distance (BSD) values, we found that the difference in the BSD obtained at rest and during the Valsalva maneuver (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.27, p = 0.004), the mean urethral diameter (UD; OR: 4.29, 95% CI: 2.07–8.83, p = 0.0001), and the occurrence of the funneling sign during the Valsalva maneuver (OR: 21; 95% CI: 6.1–71.9, p < 0.0001) were associated with urinary incontinence in the logistic regression analysis. The optimal cut-off point for BSD was >8 mm (area under the curve (AUC), 0.71; sensitivity, 91.2%; specificity, 56.8%; p = 0.001) and that for UD was >6 mm (AUC, 0.84; sensitivity, 82.1%; specificity, 73%; p < 0.001). Conclusions: Transperineal ultrasonography is a useful tool for detecting SUI. Our findings highlighted the utility of several sonographic parameters, mainly the urethral diameter, in the diagnosis of urinary incontinence. [ABSTRACT FROM AUTHOR]

The pelvic floor responds to changes in trunk pressure, elevating during low‐pressure exhale and descending during high‐pressure exhale. Voicing occurs during exhalation, spanning low‐to‐high trunk‐pressure, yet it is unknown how voicing affects the pelvic floor. The aim of this study was to quantify pelvic floor response to voicing and identify if there are differences for women with stress urinary incontinence. We hypothesized that shouting would cause pelvic floor descent, with greater magnitude for incontinent women. Sixty women (38 incontinent, 22 continent) performed four voicing tasks (counting to "4" in speaking/shouting/low‐pitch/high‐pitch voice) while transperineal ultrasound measured changes in pelvic floor morphology. ANOVA compared variance of responses to voicing and t‐tests compared groups. Bladder neck height shortened, levator plate length increased and levator plate angle decreased more during shouting compared to speaking; consistent with pelvic floor straining. There were no differences for high versus low pitch‐voicing and small group differences based on continence status. Voicing causes pelvic floor muscles to strain, with greater strain during shouting. Changing vocal pitch does not affect pelvic floor morphology and incontinent women had slight differences from continent women. Voicing may be a safe way to lengthen the pelvic floor without provoking incontinence. [ABSTRACT FROM AUTHOR]

Abstract To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P

Accurate assessment of fetal head station (FHS) is crucial during labor management to reduce the risk of complications and plan the mode of delivery. Although digital vaginal examination (DVE) has been associated with inaccuracies in FHS assessment, ultrasound (US) evaluation remains dependent on sonographer expertise. This study aimed at investigating the reliability and accuracy of an automatic approach to assess the FHS during labor with transperineal US (TPU). In this prospective observational study, 27 pregnant women in the second stage of labor, with fetuses in cephalic presentation, underwent conventional labor management with additional TPU examination. A total of 45 2D B-mode TPU acquisitions were performed at different FHS, before performing DVE. The FHS was assessed by the algorithm (FHS aut) on TPU images and by DVE (FHS dig). The sonographic assessment of FHS by expert sonographer (FHS exp) on the same TPU acquisition used for the automatic measurement served as gold standard. The performance and accuracy were assessed through Spearman's ρ , the coefficient of determination (R 2), root mean square error (RMSE), and Bland–Altman analysis. A strong correlation between FHS aut and FHS exp (ρ = 0.97, p < 0.001) and a high coefficient of determination (R 2 = 0.95) were found. A lower correlation with FHS exp (ρ = 0.66, p < 0.001) and coefficient of determination (R 2 = 0.52) was found for DVE. Moreover, the RMSE reported higher accuracy of FHS aut (RMSE = 0.32 cm) compared to FHS dig (RMSE = 0.97 cm). Bland–Altman analysis showed that the algorithm performed with smaller bias and narrower limits of agreement compared to DVE. The proposed algorithm can evaluate FHS with high accuracy and low RMSE. This approach could facilitate the use of US in labor, supporting the clinical staff in labor management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Material and Methods: Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Results: Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound. [ABSTRACT FROM AUTHOR]

Objectives: Well‐established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head–perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women's pain during such examinations. Methods: Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed‐effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery. Results: A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1–3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0–2), with no significant difference between vaginal‐ or Cesarean‐delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0–1) and for VE it was 3 (IQR, 0–6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD. Conclusions: Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To assess the evolution of levator ani muscle (LAM) avulsion from 1 year to 8 years after first delivery in women with and those without subsequent vaginal delivery. In addition, to assess whether women with full or partial avulsion 8 years after first delivery have larger LAM hiatal area and more symptoms of pelvic organ prolapse compared to women with normal LAM insertion. Methods: In this single‐center longitudinal study, 195 women who were primiparous at the start of the study were included and underwent transperineal ultrasound examination 1 year and 8 years after first delivery. Muscle insertion was assessed by tomographic ultrasound imaging in the axial plane. Full LAM avulsion was defined as abnormal muscle insertion in all three central slices. Partial LAM avulsion was defined as abnormal muscle insertion in one or two central slices. Eight years after the first delivery, LAM hiatal area was assessed at rest, during maximum pelvic floor muscle contraction and on maximum Valsalva maneuver. To assess symptoms of pelvic organ prolapse, the vaginal symptoms module of the International Consultation on Incontinence Questionnaire was used. Results: At 1‐year follow‐up, 25 (12.8%) women showed signs of LAM avulsion, of whom 20 fulfilled the sonographic criteria of full avulsion and five of partial avulsion. Eight years after the first delivery, 35 (17.9%) women were diagnosed with avulsion, of whom 25 were diagnosed with full avulsion and 10 with partial avulsion. No woman with partial or full avulsion at 1 year had improved avulsion status at 8‐year follow‐up. Of the 150 women who had subsequent vaginal delivery, 21 (14.0%) women were diagnosed with partial or full LAM avulsion 1 year after first delivery, and 31 (20.7%) women were diagnosed with partial or full avulsion 8 years after first delivery. Of the 45 women without subsequent vaginal delivery, one woman with partial avulsion 1 year after first delivery was diagnosed with full avulsion at 8‐year follow‐up. All women with full avulsion at 1‐year follow‐up were diagnosed with full avulsion at 8‐year follow‐up regardless of whether they had subsequent vaginal delivery. At 8‐year follow‐up, women with full avulsion had statistically significantly larger LAM hiatal area compared to women with normal muscle insertion. Mean ± SD vaginal symptom scores ranged between 5.5 ± 5.7 and 6.0 ± 4.0 and vaginal symptom quality of life scores ranged between 0.9 ± 1.4 and 1.5 ± 2.2 and did not differ significantly between women with normal muscle insertion and women with partial or full avulsion at 8‐year follow‐up. Conclusions: More LAM avulsions were present 8 years compared with 1 year after first delivery in women with subsequent vaginal delivery. Except for one primipara, all women without subsequent vaginal delivery had unchanged LAM avulsion status between 1 year and 8 years after their first delivery. Larger LAM hiatal area was found in women with full avulsion compared to those with normal muscle insertion at 8‐year follow‐up. Vaginal symptoms scores were low and did not differ between women with normal muscle insertion and those with partial or full avulsion at 8‐year follow‐up. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Abstract The pelvic floor responds to changes in trunk pressure, elevating during low‐pressure exhale and descending during high‐pressure exhale. Voicing occurs during exhalation, spanning low‐to‐high trunk‐pressure, yet it is unknown how voicing affects the pelvic floor. The aim of this study was to quantify pelvic floor response to voicing and identify if there are differences for women with stress urinary incontinence. We hypothesized that shouting would cause pelvic floor descent, with greater magnitude for incontinent women. Sixty women (38 incontinent, 22 continent) performed four voicing tasks (counting to “4” in speaking/shouting/low‐pitch/high‐pitch voice) while transperineal ultrasound measured changes in pelvic floor morphology. ANOVA compared variance of responses to voicing and t‐tests compared groups. Bladder neck height shortened, levator plate length increased and levator plate angle decreased more during shouting compared to speaking; consistent with pelvic floor straining. There were no differences for high versus low pitch‐voicing and small group differences based on continence status. Voicing causes pelvic floor muscles to strain, with greater strain during shouting. Changing vocal pitch does not affect pelvic floor morphology and incontinent women had slight differences from continent women. Voicing may be a safe way to lengthen the pelvic floor without provoking incontinence.

The study examined the feasibility of using transperineal intestinal ultrasound (TP-IUS) to assess ulcerative colitis (UC) in pregnant women. Eight pregnant women with UC underwent TP-IUS, clinical assessment, and fecal calprotectin testing. While TP-IUS was well tolerated and feasible throughout pregnancy, no correlation was found between TP-IUS, clinical assessment, or biochemical rectal disease activity in this small cohort. Further research is needed to establish optimal techniques and reference ranges for TP-IUS in pregnant women with UC. [Extracted from the article]

Objectives: The aim of the present study was two‐fold. Firstly, we aimed to develop and describe a technique for measurement of the transverse diameter (TD) of the levator ani muscle (LAM) hiatus in the coronal view using two‐dimensional (2D) transperineal ultrasound (TPUS) in nulliparous women with a term pregnancy. Secondly, we aimed to evaluate the feasibility and reproducibility of 2D‐TPUS assessment of LAM hiatal TD and assess intermethod agreement between 2D‐TPUS and three‐dimensional (3D) TPUS measurement of TD in the axial plane, which is considered the gold standard in nulliparous women with term pregnancy. Methods: We recruited a group of nulliparous women with term pregnancy before the onset of labor. The study was conducted in two phases: Phase 1 involved developing and describing the 2D‐TPUS technique for measuring LAM hiatal TD, and Phase 2 focused on assessing the technique's feasibility, reproducibility and intermethod agreement with 3D‐TPUS measurement of LAM hiatal TD. In Phase 1, we enrolled 30 women. Each woman underwent acquisition of a 3D‐TPUS volume, which was analyzed using multiplanar mode to identify and determine the appearance of the lateral borders of the LAM in the coronal plane, at the level of the plane of minimal hiatal dimensions. These borders were used as landmarks for TD measurement. Additionally, we measured the distance between the plane used for TD measurement and the center of the urethra in the axial view. In Phase 2, we recruited 100 women. Each woman underwent acquisition of three 2D‐TPUS videoclips in the coronal plane, each encompassing a sweep of the entire LAM hiatus, and a 3D volume, all obtained during rest. On the 2D videoclips, TD was measured twice by one operator and once by another operator. In the 3D volume, TD was measured once, by one operator, in the axial plane; this measurement was considered the gold standard. Each operator was blinded to all other measurements during their assessments. We analyzed intraobserver and interobserver reproducibility and performed an intermethod (2D vs 3D) comparison. Bland–Altman analysis was conducted, and Levene's W0 test and Student's t‐test were performed to explore clinical factors that might contribute to systematic differences. Results: In Phase 1, we identified successfully the landmarks denoting the lateral borders of the LAM hiatal TD in the coronal view. These appeared as two symmetrical hypoechogenic indentations located at the inner border of the hyperechogenic structure of the LAM, at the point of maximum distance between the two sides of the LAM. The distance between the urethra and the plane where TD should be measured using 3D‐TPUS in the axial plane had a median of 4 mm and varied from 0 to 9 mm. This enabled us to describe a method for assessing LAM hiatal TD in the coronal plane using 2D‐TPUS. In Phase 2, LAM hiatal TD was measured successfully in all 2D and 3D acquisitions from the entire group of 100 women. The analyses for intraobserver and interobserver reproducibility and the intermethod comparison (2D vs 3D) revealed almost perfect agreement in TD measurements using 2D‐TPUS, with intraclass correlation coefficients of 0.95 (95% CI, 0.92–0.96), 0.87 (95% CI, 0.78–0.92) and 0.85 (95% CI, 0.78–0.90), respectively. The average differences between measurements were 0.1 mm for intraobserver, 1.0 mm for interobserver and 0.2 mm for intermethod repeatability. No systematic differences were observed in any of the measurement sets, except in the interobserver analysis, although this difference was clinically not significant (38.2 vs 37.2 mm, P = 0.01). None of the examined clinical factors (maternal body mass index and maternal age) exhibited a statistically significant impact on intraobserver, interobserver or intermethod reliability. Conclusions: Utilizing our technique, described herein, to measure the LAM hiatal TD in the coronal view using 2D‐TPUS is not only feasible but also highly reproducible and accurate in nulliparous women with term pregnancy. Moreover, it yields measurements that are comparable to those obtained in the reconstructed axial plane generated by 3D‐TPUS. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. Methods: Sixty patients who volunteered for a PFMT assessment at 6–8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). Results: Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. Conclusions: Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women. [ABSTRACT FROM AUTHOR]

Objective: To examine the concurrent validity and inter‐rater reliability of vaginal palpation as a measure of the quality of the bearing‐down manoeuvre (BDM) and the detection of a paradoxical levator ani muscle contraction (LAM) in pregnant women, compared with 2D transperineal ultrasound (TPUS). Design: Concurrent validity and inter‐rater reliability study. Setting: Physiotherapy clinic. Population: Twenty pregnant women in their third trimester. Methods: The anterior posterior diameter (APD) was measured during the BDM using TPUS by one experienced physiotherapist. An APD that shortened by >2 mm from rest was described as LAM shortening, an APD that moved by 0–2 mm was described as no change and an APD that lengthened by >2 mm was described as LAM lengthening. Vaginal palpation described the LAM during the BDM as no movement, shortening or lengthening. Participants were allowed two attempts and the best attempt was measured. Main outcome measures: APD using TPUS and the assessor's subjective description of LAM during the BDM using vaginal palpation. Results: TPUS detected more paradoxical LAM contractions during the BDM than palpation. Agreement between vaginal palpation and TPUS assessment for BDM was poor. The Fleiss kappa coefficients were 0.457 (90% CI 0.16–0.71) between TPUS and one assessor and 0.326 (90% CI 0.01–0.6) between TPUS and the other assessor. In addition, inter‐rater reliability was poor between observers palpating the BDM, with a Fleiss kappa coefficient of 0.375 (90% CI 0.13–0.64). Conclusions: This study did not find vaginal palpation of the BDM in pregnant women to have concurrent validity or inter‐rater reliability. Clinicians should be aware of potential inaccuracies when palpating the BDM, and, where possible, seek an assessment via TPUS. [ABSTRACT FROM AUTHOR]

• The modifiable risk factors with levator ani muscle avulsion include forceps and vacuum delivery. • The non-modifiable risk factors with levator ani muscle avulsion include obstetric anal sphincter injuries and maternal age. • This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women. Conduct a meta-analysis identifying risk factors associated with LAM avulsion recognised on transperineal ultrasound (TPUS) or magnetic resonance imaging (MRI) in primiparous women after vaginal birth. OVID Medline, Embase and the Cochrane Library from inception to January 2021 were searched. Review Manager 5.3 (The Cochrane Collaboration) was used to analyse data. Odds ratios (OR) with 95% confidence intervals (95% CIs) were calculated. The heterogeneity among studies was calculated using the I2 statistic. Twenty-five studies were eligible for inclusion (n = 9333 women). Major LAM avulsion was diagnosed in an average of 22 % (range 12.7–39.5 %) of cases. Twenty-two studies used TPUS and three used MRI to diagnose avulsion. Modifiable and non-modifiable risk factors were identified. Significant predictors identified were forceps (OR 6.25 [4.33 – 9.0]), obstetric anal sphincter injuries (OR 3.93 [2.85–5.42]), vacuum (OR 2.41 [1.40–4.16]), and maternal age (OR 1.06 [1.02–1.10]). This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. This information could be used to develop a clinically applicable risk prediction model to target postnatal women at risk of LAM avulsion with a view to prevent the onset of pelvic floor organ prolapse. [ABSTRACT FROM AUTHOR]

Introduction: To predict early continence recovery following radical prostatectomy (RP) using baseline demographic and clinical data, as well as dynamic transperineal ultrasound (TPUS) parameters of membranous urethral length (MUL). Patients and Methods: A retrospective CHECK-MUL (check of membranous urethral length) study was conducted. We evaluated 154 patients who underwent RP between August 2018 and April 2023. All patients underwent pre- and postoperative dynamic TPUS to measure MUL. Urinary continence was defined as the use of one safety pad or less 3 months post surgery. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). We used logistic regression to assess the association between MUL and early continence recovery. A multivariable logistic regression model was then constructed for the prediction of early continence recovery based on the MUL. Results: The median MUL observed pre- and postoperatively in this study were similar (14.6 mm and 12.9 mm). In the univariable logistic regression analysis, the pre- and postoperative MUL measured by TPUS (odds ratio (OR): 1.12; 95%-CI: 1.02–1.79; p = 0.05 and OR: 1.01; 95%-CI: 1.02–1.12; p < 0.01) directions were independent predictors of early continence recovery 3 months post surgery. In addition, age (OR: 1.23; 95%-CI: 1.11–1.42; p = 0.03), BMI (OR: 1.44; 95%-CI: 1.18–2.92; p = 0.05), and bilateral nerve sparing (OR: 1.24; 95%-CI: 1.02–1.9; p = 0.05) were independent predictors of urinary continence in univariable logistic regression models. Preoperative MUL >15 mm (95% CI 1.28–1.33; p = 0.03) and postoperative MUL >14 mm (95% CI 1.2–1.16; p = 0.05) were significantly associated with early continence recovery at 3 months post surgery. Conclusions: The likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI, and lack of nerve sparing. Preoperative MUL >15 mm and postoperative MUL >14 mm were significantly associated with early continence recovery at 3 months post surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Control of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction. Methods Cross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images. Results The AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p

Purpose This study was conducted to evaluate the prevalence of perineal trauma during childbirth and to assess the correlations of the pelvic floor dimensions and fetal head station with obstetric trauma in a prospectively recruited cohort of women. Methods The study included women with a gestational age of at least 37 weeks, who were carrying a single fetus in a cephalic presentation. Transperineal ultrasound (TPU) was performed prior to the onset of labor or labor induction. The purpose was to measure the anteroposterior diameter (APD) of the levator ani muscle (LAM) and the angle of progression, at both rest and maximum Valsalva maneuver. The head-perineum distance was assessed only at rest. Results A total of 296 women were included. Of the 253 women who delivered vaginally, 19% (48/253) experienced no perineal trauma, 18.2% (46/253) received an episiotomy during childbirth, 34.4% (87/253) sustained a first-degree laceration, 25.3% (64/253) had a second-degree laceration, and 3.2% had a third- or fourth-degree laceration (8/253). Women with episiotomy had a significantly shorter median APD under Valsalva than women without perineal trauma. Furthermore, women with LAM coactivation (identified by a negative difference between the APD at Valsalva and the APD at rest) were approximately three times more likely to undergo an operative vaginal delivery and over five times more likely to sustain a third- or fourth-degree tear during childbirth than women who exhibited normal relaxation of the LAM during the Valsalva maneuver. Conclusion TPU may predict the risk of perineal trauma in women with term pregnancy during childbirth.

Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between structure and function is still debated. This study aimed to explore the relationship between quantitative measurements of anal sphincter and pelvic floor structures as well as the subjective symptoms and objective assessments of sphincter function regarding anal incontinence. Methods: 50 women with pelvic floor dysfunction were recruited for the study. The severity of anal incontinence was assessed using the CACP score. Ultrasound imaging was employed to measure anal sphincter area, while sphincter pressures were evaluated through manometry. The relationships between variables were analyzed using Pearson’s and Spearman’s correlation tests. Results: The mean anal sphincter area was 5.51 cm2 at rest and 4.06 cm2 during maximal contraction. Resting anal sphincter pressure had an average of 46.29 mmHg, and contraction pressure averaged 103.25 mmHg. No significant correlation was found between the anal sphincter area and pressure at rest (r = 0.018) or during contraction (r = −0.210). However, a moderate correlation was observed between the change in sphincter pressure and area during contraction (r = 0.312). The CACP score showed no significant correlation with the sphincter area at rest (r = −0.084) but was weakly correlated during contraction (r = −0.270). Conclusions: Conventional diagnostic tools for evaluating anal incontinence can be uncomfortable and are not always readily available. Perineal sonography presents a promising, less invasive alternative for dynamic assessment of the anal sphincter.

Background/Objectives: To investigate the utility of transperineal ultrasound in detecting stress urinary incontinence (SUI) and identify optimal anatomical and functional parameters. Methods: Thirty-four women presenting with SUI with or without pelvic organ prolapse between 2012 and 2016 were studied. The control group included patients without SUI who underwent surgery for mild gynecologic disorders or pelvic organ prolapse. The relationship between selected ultrasound parameters and SUI was determined. Results: Among the 20 variables measured in ultrasonography using 4 angles and the bladder–symphysis distance (BSD) values, we found that the difference in the BSD obtained at rest and during the Valsalva maneuver (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.27, p = 0.004), the mean urethral diameter (UD; OR: 4.29, 95% CI: 2.07–8.83, p = 0.0001), and the occurrence of the funneling sign during the Valsalva maneuver (OR: 21; 95% CI: 6.1–71.9, p < 0.0001) were associated with urinary incontinence in the logistic regression analysis. The optimal cut-off point for BSD was >8 mm (area under the curve (AUC), 0.71; sensitivity, 91.2%; specificity, 56.8%; p = 0.001) and that for UD was >6 mm (AUC, 0.84; sensitivity, 82.1%; specificity, 73%; p < 0.001). Conclusions: Transperineal ultrasonography is a useful tool for detecting SUI. Our findings highlighted the utility of several sonographic parameters, mainly the urethral diameter, in the diagnosis of urinary incontinence.

Smaller pelvic floor dimensions seem to have been an evolutionary need to provide adequate support for the pelvic organs and the fetal head. Pelvic floor dimension and shape contributed to the complexity of human birth. Maternal pushing associated with pelvic floor muscle relaxation is key to vaginal birth. Using transperineal ultrasound, pelvic floor dimensions can be objectively measured in both static and dynamic conditions, such as pelvic floor muscle contraction and pushing. Several studies have evaluated the role of the pelvic floor in labor outcomes. Smaller levator hiatal dimensions seem to be associated with a longer duration of the second stage of labor and a higher risk of cesarean and operative deliveries. Furthermore, smaller levator hiatal dimensions are associated with a higher fetal head station at term of pregnancy, as assessed by transperineal ultrasound. With maternal pushing, most women can relax their pelvic floor, thus increasing their pelvic floor dimensions. Some women contract rather than relax their pelvic floor muscles under pushing, which is associated with a reduction in the anteroposterior diameter of the levator hiatus. This phenomenon is called levator ani muscle coactivation. Coactivation in nulliparous women at term of pregnancy before the onset of labor is associated with a higher fetal head station at term of pregnancy and a longer duration of the second stage of labor. In addition, levator ani muscle coactivation in nulliparous women undergoing induction of labor is associated with a longer duration of the active second stage of labor. Whether we can improve maternal pelvic floor relaxation with consequent improvement in labor outcomes remains a matter of debate. Maternal education, physiotherapy, and visual feedback are promising interventions. In particular, ultrasound visual feedback before the onset of labor can help women increase their levator hiatal dimensions and correct levator ani muscle coactivation in some cases. Ultrasound visual feedback in the second stage of labor was found to help women push more efficiently, thus obtaining a lower fetal head station at ultrasound and a shorter duration of the second stage of labor. The available evidence on the role of any intervention aimed to aid women to better relax their pelvic floor remains limited, and more studies are needed before considering its routine clinical application. [ABSTRACT FROM AUTHOR]

The aim was to compare transperineal ultrasound (TPU) with parameters of the Bishop Score during the first stage of labour and evaluate how TPU can contribute towards improving labour management. Digital examination (DE) and TPU were performed on 42 women presenting at the labour ward with regular contractions. TPU measurements included the head–symphysis distance, angle of progression, diameter of the cervical wall, cervical dilation (CD) and cervical length (CL). To examine if TPU can monitor labour progress, correlations of TPU parameters were calculated. Agreement of DE and TPU was examined for CL and CD measurements and for two groups divided into latent (CD < 5 cm) and active stages of labour (CD ≥ 5 cm). TPU parameters indicated a moderate negative correlation of CD and CL (Pearson: r = −0.667; Spearman = −0.611). The other parameters showed a weak to moderate correlation. DE and TPU measurements for CD showed better agreement during the latent stage than during the active stage. The results of the present study add to the growing evidence that TPU may contribute towards an improved labour management, suggesting a combined approach of TPU and DE to monitor the latent first stage of labour and using only DE during the active stage of labour. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to evaluate the prevalence of perineal trauma during childbirth and to assess the correlations of the pelvic floor dimensions and fetal head station with obstetric trauma in a prospectively recruited cohort of women. Methods: The study included women with a gestational age of at least 37 weeks, who were carrying a single fetus in a cephalic presentation. Transperineal ultrasound (TPU) was performed prior to the onset of labor or labor induction. The purpose was to measure the anteroposterior diameter (APD) of the levator ani muscle (LAM) and the angle of progression, at both rest and maximum Valsalva maneuver. The head-perineum distance was assessed only at rest. Results: A total of 296 women were included. Of the 253 women who delivered vaginally, 19.0% (48/253) experienced no perineal trauma, 18.2% (46/253) received an episiotomy during childbirth, 34.4% (87/253) sustained a first-degree laceration, 25.3% (64/253) had a second-degree laceration, and 3.2% had a third- or fourth-degree laceration (8/253). Women with episiotomy had a significantly shorter median APD under Valsalva than women without perineal trauma. Furthermore, women with LAM coactivation (identified by a negative difference between the APD at Valsalva and the APD at rest) were approximately three times more likely to undergo an operative vaginal delivery and over five times more likely to sustain a third- or fourth-degree tear during childbirth than women who exhibited normal relaxation of the LAM during the Valsalva maneuver. Conclusion: TPU may predict the risk of perineal trauma in women with term pregnancy during childbirth. [ABSTRACT FROM AUTHOR]

Objective: To determine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery. Methods: This was a single‐center randomized controlled trial. Nulliparous women under epidural anesthesia were randomized at the point of full dilation into the biofeedback group (n = 50) or the control group (n = 50). Both groups received coached maternal pushing during four consecutive contractions, while an experienced obstetrician performed transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing, before and during the first and fourth contractions. Second‐stage duration and delivery outcomes were compared between groups. Results: Visual biofeedback did not affect the duration of the second stage, which lasted for a median of 2.28 (interquartile range (IQR), 1.25–3.10) h in the biofeedback group vs 2.08 (IQR, 1.58–3.02) h in the control group (P = 0.981). AOP was significantly higher in the biofeedback group compared with the control group, both at rest before the fourth contraction (mean ± SD, 142.6° ± 15.9° vs 136.8° ± 13.1°; P = 0.049) and while pushing during the fourth contraction (mean ± SD, 159.3° ± 19.2° vs 149.4° ± 15.1°; P = 0.005). The increase in AOP was significantly higher in the biofeedback compared with the control group between rest and pushing at the last push (mean ± SD, 16.6° ± 11.0° vs 12.6° ± 8.3°; P = 0.041) and between the first rest and last push (mean ± SD, 24.4° ± 13.6° vs 17.9° ± 11.3°; P = 0.011). The rate of intact perineum was similar between groups (12% vs 8%; P = 0.505). Conclusions: Visual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second‐stage duration, possibly due to the short duration of the intervention. Future studies should focus on continuous intervention throughout the second stage of labor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Youssef et al. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Abstract Objective This study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP). Design A transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle. Method Points Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS). Results One hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed. Conclusions Introital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.

Objective: This study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP). Design: A transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle. Method: Points Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS). Results: One hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed. Conclusions: Introital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictive value of joint use of fetal head circumference, fetal abdominal circumference and angle of progression (AOP) for the difficulty of operative vaginal delivery (forceps and vaccum). Methods: This prospective observational study was carried out in Department of Obstetrics of the People′s Hospital of Guangxi Zhuang Autonomous Region from May 2017 to July 2022. A total of 64 nulliparous women with singleton term pregnancies who required instrumentation to expedite vaginal delivery during the second stage of labor were included. Clinical data of pregnant women were collected after admission to the hospital. Fetal head circumference and fetal abdominal circumference were measured. Before performing operative vaginal delivery, AOP at rest and that during uterine contraction were measured by transperineal ultrasound (AOP1: mean of AOPs at rest, AOP2: mean of AOPs during uterine contraction). According to the outcomes of operative vaginal delivery, a case was included into "difficult or failed group" (Group A) when one or more of the following situations occurred: three or more tractions needed; successful operative vaginal delivery requiring sequential instruments (change vacuum to forceps); failed operative vaginal delivery; cesarean delivery due to a subjective impression of a difficult or failed traction; birth injury and the third- or the fourth-degree perineal tear. The rest cases were included into "successful and easy group" (Group B). Fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 were used to establish four different predictive models by employing multivariable logistic regression. Receiver operator characteristic (ROC) curve was used to evaluate the discrimination of four models and the model with the largest area under ROC curve (AUC) was considered as the best one. Hosmer-Lemeshow test assessed the calibration of the optimal model. The optimal one was internally validated by using Bootstrap replicated sampling (1 000 times) method. Results: Statistically significant differences were revealed with regard to fetal head station by vaginal digital examination, duration of the last traction, initial direction of pulling in the last traction, fetal abdominal circumference, AOP1, AOP2, umbilical cord artery pH and rate of neonatal asphyxia (all P＜0.05). A predictive model basing on the combination of fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 showed the largest AUC (AUC=0.917, 95%CI: 0.821-0.972, Z=11.676, P＜0.001). The Hosmer-Lemeshow test showed that χ² =5.873, P= 0.661. Both of discrimination and calibration were good. The model showed good consistency in the internal validation. Conclusions: The simple model based on the combination of fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 showed a predictive value for the difficulty of operative vaginal delivery and provided some basis for clinical decision-making. [ABSTRACT FROM AUTHOR]

Purposes: To report our experience in a prospective study of implementing a transperineal ultrasound system to monitor intra‐fractional prostate motion for prostate stereotactic body radiotherapy (SBRT). Material and Methods: This IRB‐approved prospective study included 23 prostate SBRT patients treated between 04/2016 and 11/2019 at our institution. The prescription doses were 36.25 Gy to the Low‐Dose planning target volume (LD‐PTV) and 40 Gy to the High‐Dose PTV (HD‐PTV) in five fractions with 3 mm planning margins. The transperineal ultrasound system was successfully used in 110 of the 115 fractions. For intra‐fraction prostate motion, the real‐time prostate displacements measured by ultrasound were exported for analysis. The percentage of time prostate movement exceeded a 2 mm threshold was calculated for each fraction of all patients. T‐test was used for all statistical comparisons. Results: Ultrasound image quality was adequate for prostate delineation and prostate motion tracking. The setup time for each fraction under ultrasound‐guided prostate SBRT was 15.0 ± 4.9 min and the total treatment time per fraction was 31.8 ± 10.5 min. The presence of an ultrasound probe did not compromise the contouring of targets or critical structures. For intra‐fraction motion, prostate movement exceeded 2 mm tolerance in 23 of 110 fractions for 11 of 23 patients. For all fractions, the mean percentage of time when the prostate moved more than 2 mm in any direction during each fraction was 7%, ranging from 0% to 62% of a fraction. Conclusion: Ultrasound‐guided prostate SBRT is a good option for intra‐fraction motion monitoring with clinically acceptable efficiency. [ABSTRACT FROM AUTHOR]

Objectives: We herein evaluated the effects of gestational weight gain (GWG) on postpartum pelvic floor function using transperineal ultrasound (TPUS). Methods: We analyzed retrospectively the data from 228 primiparous women with singleton pregnancies who were evaluated for postpartum pelvic floor function between February 2022 and October 2022. According to the 2009 Institute of Medicine guidelines regarding GWG, subjects were separated into three groups: inadequate GWG, recommended GWG, and excessive GWG. All underwent TPUS 6–10 weeks postpartum to assess bladder neck descent between rest and Valsalva (BND), retrovesical angle at Valsalva (RVA), urethral rotation angle between rest and Valsalva (URA), the area of levator hiatus at Valsalva (LHA), and abnormal pelvic floor function. Univariate and multivariate regression analyses were applied to explore the association measures between GWG and the pelvic floor. A P‐value <.05 was considered statistically significant. Results: Of the 228 primiparous women, 113 (49.6%) showed excessive GWG. Univariate analysis revealed that there were no statistical differences in ultrasonic parameters of the pelvic floor among the three groups (P >.05). After adjusting for potential confounders and using the recommended GWG group as a reference group, inadequate GWG was significantly associated with BND ≥25 mm (OR = 0.36, 95% CI = 0.14–0.93), and excessive GWG was significantly associated with uterine prolapse (OR = 2.79, 95% CI = 1.13–6.92). Conclusions: GWG was associated with the ultrasonic parameters of the female pelvic floor in the early postpartum period. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

X-ray-induced acoustic computed tomography (XACT) is a promising imaging modality to monitor the position of the radiation beam and the deposited dose during external beam radiotherapy delivery. The purpose of this study was to investigate the feasibility of using a transperineal ultrasound transducer array for XACT imaging to guide the prostate radiotherapy. A customized two-dimensional (2D) matrix ultrasound transducer array with 10000 (100×100 elements) ultrasonic sensors with a central frequency of 1 MHz was designed on a 5 cm×5 cm plane to optimize three-dimensional (3D) volumetric imaging. The CT scan and dose treatment plan for a prostate patient undergoing intensity modulated radiation therapy (IMRT) were obtained. In-house simulation was developed to model the time varying X-ray induced acoustic (XA) signals detected by the transperineal ultrasound array. A 3D filtered back projection (FBP) algorithm has been used for 3D XACT image reconstruction. Results of this study will greatly enhance the potential of XACT imaging for real time in vivo dosimetry during radiotherapy.

Introduction: To predict early continence recovery following radical prostatectomy (RP) using baseline demographic and clinical data, as well as dynamic transperineal ultrasound (TPUS) parameters of membranous urethral length (MUL). Patients and Methods: A retrospective CHECK-MUL (check of membranous urethral length) study was conducted. We evaluated 154 patients who underwent RP between August 2018 and April 2023. All patients underwent pre- and postoperative dynamic TPUS to measure MUL. Urinary continence was defined as the use of one safety pad or less 3 months post surgery. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess urinary incontinence (UI). We used logistic regression to assess the association between MUL and early continence recovery. A multivariable logistic regression model was then constructed for the prediction of early continence recovery based on the MUL. Results: The median MUL observed pre- and postoperatively in this study were similar (14.6 mm and 12.9 mm). In the univariable logistic regression analysis, the pre- and postoperative MUL measured by TPUS (odds ratio (OR): 1.12; 95%-CI: 1.02–1.79; p = 0.05 and OR: 1.01; 95%-CI: 1.02–1.12; p < 0.01) directions were independent predictors of early continence recovery 3 months post surgery. In addition, age (OR: 1.23; 95%-CI: 1.11–1.42; p = 0.03), BMI (OR: 1.44; 95%-CI: 1.18–2.92; p = 0.05), and bilateral nerve sparing (OR: 1.24; 95%-CI: 1.02–1.9; p = 0.05) were independent predictors of urinary continence in univariable logistic regression models. Preoperative MUL >15 mm (95% CI 1.28–1.33; p = 0.03) and postoperative MUL >14 mm (95% CI 1.2–1.16; p = 0.05) were significantly associated with early continence recovery at 3 months post surgery. Conclusions: The likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI, and lack of nerve sparing. Preoperative MUL >15 mm and postoperative MUL >14 mm were significantly associated with early continence recovery at 3 months post surgery.

Integrated total pelvic floor ultrasound is a combination of endoanal, transperineal, and endovaginal ultrasound used for the static and dynamic assessment of the entire pelvic floor. It can be used as a screening investigation for defaecatory dysfunction so that defaecatory radiological imaging may be avoided. It enables assessment of concomitant pelvic floor disorders such as anterior and middle compartment dysfunctions. Other advantages include the ability to perform in the outpatient rooms in a one stop clinic, alongside clinical assessment, and anorectal physiology, whilst avoiding separate radiology appointments and radiation exposure. Moreover, it has the potential to be used as a visual biofeedback tool.Integrated total pelvic floor ultrasound is user dependent and currently there are no fixed protocols for performance or reporting protocols. As integrated total pelvic floor ultrasound becomes more commonplace this is something which should be addressed.This article outlines the clinical utility, practicalities, and guidance for the interpretation of imaging which may be used. It is the basis for integrated total pelvic floor ultrasound workshops which have been held at the International Continence Society conference over the last 5 years.

Objectives: To evaluate the concordance between an automatic software program and manual evaluation in reconstructing, delineating, and measuring the levator hiatus (LH) on maximal Valsalva maneuver. Methods: This was a retrospective study analyzing archived raw ultrasound imaging data of 100 patients underwent transperineal ultrasound (TPUS) examination. Each data were assessed by the automatic Smart Pelvic System software program and manual evaluation. The Dice similarity index (DSI), mean absolute distance (MAD), and Hausdorff distance (HDD) were calculated to quantify delineation accuracy of LH. Agreement between automatic and manual measurement of levator hiatus area was assessed by intraclass correlation coefficient (ICC) and Bland–Altman method. Results: The satisfaction rate of automatic reconstruction was 94%. Six images were recognized as unsatisfactory reconstructed images for some gas in the rectum and anal canal. Compared with satisfactory reconstructed images, DSI of unsatisfactory reconstructed images was lower, MAD and HDD were larger (p = 0.001, p = 0.001, p = 0.006, respectively). The ICC was up to 0.987 in 94 satisfactory reconstructed images. Conclusions: The Smart Pelvic System software program had good performance in reconstruction, delineation, and measurement of LH on maximal Valsalva maneuver in clinical practice, despite misidentification of the border of posterior aspect of LH due to the influence of gas in the rectum. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the correlation between the overall rest–stress distance measured by transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress incontinence (USI), and determine a cut-off value of rest–stress distance for predicting urethral hypermobility (UH). Methods: Women with USI scheduled for mid-urethral sling surgery were retrospectively recruited. UH was defined as a Q-tip angle more than or equal to 30 degrees. Ultrasonic measurement of the overall rest–stress distance was defined as the linear distance of bladder-neck position change from resting status to maximal strain. Results: Among the 132 enrolled women, the Pearson correlation coefficient between the overall rest–stress distance in TPUS and Q-tip test angle was 0.9104 (95% CI, 0.8758–0.9357, p < 0.001). In receiver-operating-characteristic-curve analysis, a rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH (sensitivity = 76.47%, specificity = 93.3%; area = 0.937, 95% confidence interval: 0.881–0.972). Conclusions: The overall rest–stress distance in TPUS correlated well with the Q-tip test angle, indicating that it can be an alternative method for the assessment of USI. A rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH in women with USI. [ABSTRACT FROM AUTHOR]

Background Ultrasonography of the pelvic floor, either by the trans-perineal or the endo-vaginal/introital approach, has been effectively utilized in the diagnostic workup of urinary incontinence. Anterior and posterior urethral angles, funneling of bladder neck, urethral hypermobility and bladder base position can be evaluated using pelvic floor ultrasonograph. Objective To assess the impact of variability of ultrasound technique (transvaginal ultrasound; TVS, and transperineal; TPUS) on the measurement of the resting urethral angles in a sample of continent Iraqi women. Methods This study included 100 healthy continent adult females, The numerical values of the urethral angles were obtained by both TVS and TPUS techniques in a sample of women attending Ultrasound Unit in Al-Imamein Al-kadhimein Medical City during 2017. The α angle mean of studied women measured by TVS was 91.92 while that measured by TPUS was 78.67 with highly significant difference between both techniques (p<0.001). Conversely, the ẞ angle mean of studied women measured by TVS was 102.25 while that measured by TPUS was 112.08 with highly significant difference between both techniques (p<0.001). As a result, the α angle was higher among continent women by TVS and ẞ angle was higher among continent women by TPUS. Although no significant difference, the average α angle increased with increased age of continent women while average ß angel was decreased with increased age of continent women. The average α angle of continent women was significantly increased among obese multiparous women at age group <40 years age (p=0.007). The average B angle of continent women was significantly increased among obese multiparous women at age group <40 years age (p<0.001). Conclusion The ultrasound approach whether TVS or TPUS have an essential impact on the measured numerical value of different urethral angles, and the women age, parity and body habitus individually and in combination affect the measurement of the urethral angles. [ABSTRACT FROM AUTHOR]

Although the fetal head position has traditionally been evaluated by digital examination (DE), it has a failure rate ranging between 20 and 70%; hence, intrapartum transabdominal ultrasonography (TUS) has become relevant. We aimed to evaluate the utility of the TUS to identify the fetal head positions in vacuum-assisted deliveries. We performed a prospective observational study including 101 pregnant patients in active labor who required a vacuum-assisted delivery. The fetal head position was assessed by a DE and a TUS prior to vacuum cup placement. After delivery, the optimal vacuum cup placement was evaluated as the distance between the chignon and the flexion point ≤2 cm. The general concordance rate between the DE and TUS was 72.2%, with the poorest concordance rate for occiput posterior positions at 46.1%. In five cases (4.9%), it was not possible to determine the fetal head position through the DE. The correlation was higher in low and medium planes, with 77% and 68.1% concordance rates, respectively, while it was lower in high planes (60%). In 90.1% of cases, the vacuum cup placement was optimal. Our findings show that intrapartum transabdominal ultrasonography is a useful technique to identify the fetal head position allowing optimal placement of the vacuum cup necessary for correct vacuum-assisted delivery.

Introduction: Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three‐dimensional endoanal ultrasound (3D‐EAUS). Material and methods: Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT 04480684). 3D‐EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. Results: Seventy‐three women were included. A median of two ultrasound scans were performed in each patient (range 1–16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. Conclusions: We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future. [ABSTRACT FROM AUTHOR]

The aim was to compare transperineal ultrasound (TPU) with parameters of the Bishop Score during the first stage of labour and evaluate how TPU can contribute towards improving labour management. Digital examination (DE) and TPU were performed on 42 women presenting at the labour ward with regular contractions. TPU measurements included the head–symphysis distance, angle of progression, diameter of the cervical wall, cervical dilation (CD) and cervical length (CL). To examine if TPU can monitor labour progress, correlations of TPU parameters were calculated. Agreement of DE and TPU was examined for CL and CD measurements and for two groups divided into latent (CD < 5 cm) and active stages of labour (CD ≥ 5 cm). TPU parameters indicated a moderate negative correlation of CD and CL (Pearson: r = −0.667; Spearman = −0.611). The other parameters showed a weak to moderate correlation. DE and TPU measurements for CD showed better agreement during the latent stage than during the active stage. The results of the present study add to the growing evidence that TPU may contribute towards an improved labour management, suggesting a combined approach of TPU and DE to monitor the latent first stage of labour and using only DE during the active stage of labour.

Anorectal malformations (ARMs) encompass a complex spectrum of congenital anomalies and H/N type anorectal malformations are extremely rare. In the presence of colostomy, an augmented pressure colostogram with or without retrograde or micturating cystourethrogram is the investigation of choice. Transperineal ultrasound is an imaging technique that allows a fairly accurate morphological assessment of ARMs along with dynamic evaluation of the anorectal structures and pelvic floor anatomy. Here we describe the role of transperineal ultrasound as an adjunctive modality in diagnosis of one such complex anomaly.

Introduction: This study investigated the relationship between anatomical compression introduced via ultrasound probe pressure and maximum perineum dose in prostate radiotherapy patients using the Clarity transperineal ultrasound (TPUS) system. Methods: 115 patient ultrasound and computed tomography scans were retrospectively analysed. The probe to prostate apex distance (PPA), probe to inferior corpus spongiosum distance (PICS) and maximum perineum dose were calculated. Compression was represented by the PICS and the calculated corpus to prostate ratio (CPR). Demographics included treatment technique, image quality, body mass index (BMI) and age. Multiple linear regression analysis assessed the relationship between compression measures and perineum dose. Results: The maximum dose to perineum ranged from 1.81 to 45.56 Gy, with a median of 5.87 Gy (Interquartile range (IQR) 3.17). The PICS distance and CPR recorded was 1.67 cm (IQR 0.63) and 0.51 (range 0.29–0.85) respectively. Regression analysis demonstrated both PICS and CPR were significant predictors of maximum dose to the perineum (p