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239 - IN-VIVO PSEUDO-COMPLIANCE MEASUREMENT USING TRANSPERINEAL ULTRASOUND IMAGES

239

IN-VIVO PSEUDO-COMPLIANCE MEASUREMENT USING TRANSPERINEAL ULTRASOUND IMAGES

VAN KEULEN1, N. SINDHWANI 2, G. CALLEWAERT 1, S. HOUSMANS 1, F. TUREL 3, H. DIETZ 4, J. A. DEPREST 1;
1Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium, 2Department of Development and Regeneration, Cluste, Univ. of Leuven, Leuven, Belgium, 3Univ. of Sydney, Sydney, Australia, 4Univ. of Sydney, Springwood, Australia.

Introduction: Pelvic organ prolapse (POP) is caused by a decreased ability of the pelvic floor structures to provide sufficient biomechanical support. On ultrasound images, the biomechanical state of the tissues may be judged by performing mobility measurements such as bladder neck descent (BND) and rectal descent (RD).
Objective: We propose pseudo compliance measurements of the pelvic floor for anterior and posterior compartment prolapse based on mobility measurements done on ultrasound images with concurrent intra-abdominal pressure (IAP) measurements.
Methods: 74 patients from a tertiary urogynecological center were examined for this study using the POPQ system, and organ descent was staged accordingly, from stage 0 to stage 3. Of 74 patients 3 had no clinical prolapse, 16 had uni-compartmental prolapse (7 anterior and 9 posterior) and 55 had prolapse of both the anterior and posterior compartment. 12, 12, 48 and 2 patients had respectively no, grade 1, 2 or 3 posterior compartment prolapse. 10,16, 41, and 7 patients had no, grade 1, 2 or 3 anterior compartment prolapse. During multichannel urodynamic testing the maximum IAP at full Valsalva was noted. This was followed by 4D transperineal imaging of three Valsalva maneuvers during which IAP values were recorded once they had reached steady state and were held over at least 6 seconds. At each Valsalva a 4D ultrasound volume data set was recorded simultaneously and archived. On each of the three sequences at different IAPs, bladder neck descent (BND), rectal descent (RD) and the change in the area of the levator hiatus (HA) were measured as proxy strain measurements. A compliance measure for each of the three strain measures, Cbnd, Crd and Cha, as measured for the BND, RD and the HA measurements was recorded. The compliance is obtained by calculating the slope of the best fitted line on the three pressure-strain readings. The compliances of patients with grades 0, 1, 2, or 3 anterior or posterior compartment prolapse were checked for statistical differences using the students’ t-test at p <0.05.
Results: Figure 1 shows compliance measures for patients with grade 0, 1, 2 or 3 anterior and/or posterior compartment prolapse. Generally, the Cbnd and Crd tends to decrease with increasing grade of anterior and posterior compartment prolapse respectively. Cha tends to decrease for both anterior and posterior compartment prolapse patients. Cbnd and Cha were significantly different of patients that had no anterior compartment prolapse when compared to patients that had any clinical grade anterior prolapse (p<0.001 and p = 0.024 respectively). Similarly, Crd and Cha of patients that had no posterior compartment prolapse were significantly different from that of patients that did (p = 0.031 and p<0.001, respectively). The table shows a complete p-value matrix comparing the three compliance measures across patients with different clinical severity.

Table showing p values of comparisons made for compliance measures of patients with anterior and pos

 

Comparisons for anterior compartment prolapse patients

Comparisons for anterior compartment prolapse patients

Comparisons for anterior compartment prolapse patients

Comparisons for posterior compartment prolapse patients

Comparisons for posterior compartment prolapse patients

Comparisons for posterior compartment prolapse patients

 

Cbnd

Crd

Cha

Cbnd

Crd

Cha

No prolapse vs prolapse

<0.001*

0.51

0.024*

0.145

0.031*

<0.001*

Grade 0 vs Grade 1

0.657

0.211

0.38

0.593

0.49

0.092

Grade 0 vs Grade 2

<0.001*

0.514

0.051

0.163

0.039*

<0.001*

Grade 0 vs Grade 3

0.077

0.761

0.096

0.551

0.275

0.191

Grade 1 vs Grade 2

<0.001*

0.376

0.248

0.668

0.189

0.135

Grade 2 vs Grade 3

0.137

0.863

0.13

0.588

0.402

0.309

Grade 1 vs Grade 3

0.055

0.258

0.034*

0.564

0.111

0.103


Conclusions: These results indicate a progressive decline in tissue compliance with severity or anterior and posterior compartment prolapse. As expected, the trend is most prominent for Cbnd in patients with anterior prolapse and for Crd in patients with posterior prolapse. Cha shows a trend for both anterior and posterior prolapse. Due to the low number of patients in certain groups, especially those with grade 3 prolapse, the differences between different grades may not have consistently reached significance.
References: N/A