Reproducibility in pelvic floor biometric parameters of nulliparous women assessed by translabial three-dimensional ultrasound using Omniview reformatting technique.

AIM: To assess the reproducibility of pelvic floor biometric parameters by translabial three-dimensional ultrasound compared with the OmniView® reformatting technique. MATERIAL AND METHODS: We performed a cross-sectional study involving 47 nulliparous women without symptoms of pelvic floor dysfunction. The hiatal area and right pubovisceral muscle width measurements were performed in the axial plane using both 3D ultrasound in the rendering mode and OmniView® techniques. To determine the occurrence of standardized error between examiners and the two sonographic methods, the paired t-test was used. The intra- and inter-observer reliability and agreement were estimated by concordance correlation coefficient (CCC) and limits of agreement, respectively. RESULTS: We did not observe significant statistical differences among both measurements performed by the first examiner, both examiners and both methods in the assessment of the hiatal area; however, the measurements of the right pubovisceral muscle were significantly lower using OmniView®. The intra-observer reliability was good in the evaluation of all pelvic floor parameters; however, the inter-observer reliability was good only to the 3D rendering mode (CCC=0.87). The intra-observer agreement was good in the assessment of all pelvic floor parameters; however, the inter-observer agreement was found to be good only when 3DUS in the rendering mode was used (<+/-15%). CONCLUSION: Both 3D ultrasound in the rendering mode and OmniView® reformatting techniques were concordant in the assessment of pelvic floor parameters; however, the 3D ultrasound rendering in the mode demonstrated better inter-observer reliability and agreement.

Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women. METHODS: Fifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique. RESULTS: The PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment. CONCLUSIONS: Our findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.

Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment.

INTRODUCTION AND HYPOTHESIS: This trial aimed to compare the outcomes of native vaginal tissue repair versus polypropylene mesh repair for the treatment of severe genital prolapse. METHODS: This multicenter randomized trial included 184 women, with POP-Q stage 3 or 4. They were randomly assigned to undergo surgical treatment using native tissue repair (n = 90) or synthetic mesh repair (n = 94). Native tissue repair surgery was performed according to site-specific defects, including sacrospinous ligament fixation for apical defects. Mesh repair (Prolift™) was performed in accordance with manufacturer recommendations. Hysterectomy was performed in all cases of uterine prolapse. Statistical tests were used to compare between-group and within-group differences before the surgery and at 1-year follow-up. We considered cure to have occurred when the POP-Q point evaluation was equal to or less than 0 and POP-Q point C better than or equal to half the total vaginal length (TVL) after 1 year. The patients answered the Prolapse Quality-of-Life Questionnaire (PQoL) and the Sexual Quotient Female Version (QS-F) questionnaire. RESULTS: Both groups were homogeneous preoperatively. There were no differences between the groups in operative time, complications or pain. At 1-year follow-up, anatomical cure rates were better in the mesh group in the anterior compartment (p = 0.019). Significant improvement in PQoL scores at 1-year follow up were observed in each group; between-group comparisons of changes in PQoL scores revealed greater improvement in the mesh group. CONCLUSION: Both techniques were effective. Anatomical efficacy was superior in the mesh group regarding the anterior compartment; quality of life changes were also greater in the mesh group. Complications were significantly higher in the mesh group.