DATA INTERPRETATION FOR VAGINALTACTILE IMAGING
V. R. LUCENTE 1, H. VANRAALTE2, M. MURPHY 3, V. EGOROV 4;
1The Inst. for Female Pelvic Med. & Reconst,Allentown, PA, 2Princeton Urogynecology, Princeton, NJ,3IFPM&RS, North Wales, PA, 4Artann Lab.,Trenton, NJ.
Introduction: Currently, thereis no systematic quantitative methodology for the evaluation offemale pelvic floor conditions, before or after treatment for POP orSUI that is universally applied in clinical practice. Perhaps becausethere are no accepted biomechanical diagnostic tests that could beused for a patient-specific biomechanical model to assist in choosingthe optimal treatment options for that patient.
Objective:To develop a new biomechanical paradigm and interpretation of thefemale pelvic floor conditions before a treatment.
Methods:We enrolled 138 subjects into an observational case-controlled study.Vaginal tactile imaging (VTI) was used for biomechanical assessmentof the pelvic floor along the entire length of the anterior,posterior and lateral vaginal walls at rest, with manually applieddeflection pressures and with muscle contraction, muscle relaxation,and Valsalva maneuver. VTI allows a large body of measurements toevaluate individual variations in tissue elasticity, support defectsas well as pelvic muscle function in patients [1, 2]. Presuming thatpelvic floor support is a complex interplay between supportiveligaments and both passive and active muscle function, we haveattempted to characterize multiple pelvic floor structures from theacquired VTI data.
Results: All of the 138 women enrolledin the study were successfully examined with the VTI. The studysubjects had both normal pelvic support and pelvic organ prolapse(stage I-IV). The average age was 60±15 (range 26 to 90 years old).We transposed a set of 31 VTI parameters in to a quantitativecharacterization of ligamentous structures (pubourethral, arcustendineus, cardinal, uterosacral, perineal) and muscles(puborectalis, pubococcygeus, pubovaginal, puboperineal, levatorplate, ilicoccygeal). Interpretation of the acquired VTI data fornormal pelvic floor support and prolapse conditions is proposed basedon biomechanical assessment of functional anatomy. Globalbiomechanical assessment of the pelvic floor and then tailoringtreatment of its biomechanical dysfunction is the logical route toimprove clinical success (see Figure 1).
Conclusions: Vaginal tactileimaging allows biomechanical characterization of basic female pelvicfloor structures (muscles and ligaments) and tissues in vivowhich may allow personalized assessment and treatment of POP andSUI.
References: 1. Biomechanics of the Female PelvicFloor, Elsevier 2016: 317-48.
2. Int. Urogyn. J. 2012; 23(4):459-466.
Reported research was supported bythe National Institute On Aging of the National Institutes of Healthunder Award Numbers R44 and SB1 AG034XXX. The content is solely theresponsibility of the authors and does not necessarily represent theofficial views of the National Institutes of Health.