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Erschienen in: International Urogynecology Journal 7/2019

01.07.2019 | Original Article

In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

verfasst von: Bertrand Gachon, Antoine Nordez, Fabrice Pierre, Laetitia Fradet, Xavier Fritel, David Desseauve

Erschienen in: International Urogynecology Journal | Ausgabe 7/2019

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Abstract

Introduction and hypothesis

We hypothesized that shear wave elastography (SWE) technology might be useful for assessing the elastic properties of the pelvic floor in women. Our primary objective was to evaluate the feasibility of assessing the levator ani muscles using SWE in women. Our secondary aim was to investigate the changes in their elastic properties from rest to Valsalva maneuver.

Methods

During this prospective feasibility study in nonpregnant female volunteers, we collected data on participant age, body mass index (BMI), parity, and time since the delivery. The levator ani muscles of each participant were assessed using SWE technology at rest and during a Valsalva maneuver by measuring the shear modulus (in kilopascals). We then assessed the changes in the shear modulus at rest and during the Valsalva maneuver using a Wilcoxon test.

Results

Twelve parous women participated in this study. The mean time since the last delivery was 14 months, the mean age was 31 years, and mean BMI was 28 kg.m−2. All the assessments performed at rest were successfully completed, but we encountered two failures during the Valsalva maneuver. The mean shear modulus increased by a factor of more than 2 from rest to the Valsalva maneuver for both the right (16.0 vs 35.4 kPa) and left side (17.1 vs 37.6 kPa).

Conclusions

An assessment of the elastic properties of the levator ani muscles is feasible for nonpregnant women. The reproducibility of the technique and its application in pregnant women and women with pelvic floor disorders must be investigated.
Literatur
1.
Zurück zum Zitat Lowenstein E, Ottesen B, Gimbel H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J. 2015;26:49–55.CrossRefPubMed Lowenstein E, Ottesen B, Gimbel H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J. 2015;26:49–55.CrossRefPubMed
2.
Zurück zum Zitat Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6.CrossRefPubMedPubMedCentral Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Gyhagen M, Bullarbo M, Nielsen TF, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120:152–60.CrossRefPubMed Gyhagen M, Bullarbo M, Nielsen TF, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120:152–60.CrossRefPubMed
4.
Zurück zum Zitat Gyhagen M, Bullarbo M, Nielsen TF, et al. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120:144–51.CrossRefPubMed Gyhagen M, Bullarbo M, Nielsen TF, et al. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120:144–51.CrossRefPubMed
5.
Zurück zum Zitat Gachon B, Desseauve D. Fradet L, et al. Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects. Prog Urol. 2016;26:385–94.CrossRefPubMed Gachon B, Desseauve D. Fradet L, et al. Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects. Prog Urol. 2016;26:385–94.CrossRefPubMed
6.
Zurück zum Zitat Gachon B, Fritel X. Fradet L, et al. Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J. 2017;28:1223–31.CrossRefPubMed Gachon B, Fritel X. Fradet L, et al. Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J. 2017;28:1223–31.CrossRefPubMed
7.
Zurück zum Zitat Milsom I. Can we predict and prevent pelvic floor dysfunction? Int Urogynecol J. 2015;26:1719–23.CrossRefPubMed Milsom I. Can we predict and prevent pelvic floor dysfunction? Int Urogynecol J. 2015;26:1719–23.CrossRefPubMed
8.
Zurück zum Zitat Wilson D, Dornan J, Milsom I, et al. UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25:1449–52.CrossRefPubMed Wilson D, Dornan J, Milsom I, et al. UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25:1449–52.CrossRefPubMed
9.
Zurück zum Zitat Drusany Starič K, Bukovec P, Jakopič K, et al. Can we predict obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol. 2017;210:196–200.CrossRefPubMed Drusany Starič K, Bukovec P, Jakopič K, et al. Can we predict obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol. 2017;210:196–200.CrossRefPubMed
10.
Zurück zum Zitat Webb SS, Hemming K, Khalfaoui MY, et al. An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool? Int Urogynecol J. 2017;28:367–74.CrossRefPubMed Webb SS, Hemming K, Khalfaoui MY, et al. An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool? Int Urogynecol J. 2017;28:367–74.CrossRefPubMed
11.
Zurück zum Zitat Meister MR, Cahill AG, Conner SN, et al. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215:310.e1–7CrossRef Meister MR, Cahill AG, Conner SN, et al. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215:310.e1–7CrossRef
12.
Zurück zum Zitat Aydeniz A, Dikensoy E, Cebesoy B, et al. The relation between genitourinary prolapse and joint hypermobility in Turkish women. Arch Gynecol Obstet. 2010;281:301–4.CrossRefPubMed Aydeniz A, Dikensoy E, Cebesoy B, et al. The relation between genitourinary prolapse and joint hypermobility in Turkish women. Arch Gynecol Obstet. 2010;281:301–4.CrossRefPubMed
13.
Zurück zum Zitat Norton PA, Baker JE, Sharp HC, et al. Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol. 1995;85:225–8.CrossRefPubMed Norton PA, Baker JE, Sharp HC, et al. Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol. 1995;85:225–8.CrossRefPubMed
14.
Zurück zum Zitat Al-Rawi ZS, Al-Rawi ZT. Joint hypermobility in women with genital prolapse. Lancet. 1982;1:1439–41.CrossRefPubMed Al-Rawi ZS, Al-Rawi ZT. Joint hypermobility in women with genital prolapse. Lancet. 1982;1:1439–41.CrossRefPubMed
15.
Zurück zum Zitat Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.CrossRefPubMed Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.CrossRefPubMed
16.
Zurück zum Zitat Dietz HP, Shek C, De Leon J, et al. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.CrossRefPubMed Dietz HP, Shek C, De Leon J, et al. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.CrossRefPubMed
17.
Zurück zum Zitat Staer-Jensen J, Siafarikas F, Hilde G, et al. Ultrasonographic evaluation of pelvic organ support during pregnancy. Obstet Gynecol. 2013;122:329–36.CrossRefPubMed Staer-Jensen J, Siafarikas F, Hilde G, et al. Ultrasonographic evaluation of pelvic organ support during pregnancy. Obstet Gynecol. 2013;122:329–36.CrossRefPubMed
18.
Zurück zum Zitat Gennisson JL, Deffieux T, Fink M, et al. Ultrasound elastography: principles and techniques. Diagn Interv Imaging. 2013;94:487–95.CrossRefPubMed Gennisson JL, Deffieux T, Fink M, et al. Ultrasound elastography: principles and techniques. Diagn Interv Imaging. 2013;94:487–95.CrossRefPubMed
19.
Zurück zum Zitat Hug F, Tucker K, Gennisson JL, et al. Elastography for muscle biomechanics: toward the estimation of individual muscle force. Exerc Sport Sci Re. 2015;43:125–33.CrossRef Hug F, Tucker K, Gennisson JL, et al. Elastography for muscle biomechanics: toward the estimation of individual muscle force. Exerc Sport Sci Re. 2015;43:125–33.CrossRef
20.
Zurück zum Zitat Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:396–409.CrossRefPubMed Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:396–409.CrossRefPubMed
22.
Zurück zum Zitat Gennisson JL, Muller M, Gabor P, et al. Quantification of elasticity changes in the myometrium during labor using supersonic shear imaging: a feasibility study. Ultrasonics. 2015;56:183–8.CrossRefPubMed Gennisson JL, Muller M, Gabor P, et al. Quantification of elasticity changes in the myometrium during labor using supersonic shear imaging: a feasibility study. Ultrasonics. 2015;56:183–8.CrossRefPubMed
23.
Zurück zum Zitat Muller M, Ait-Belkacem D, Hessabi M, et al. Assessment of the cervix in pregnant women using shear wave elastography: a feasibility study. Ultrasound Med Biol. 2015;41:2789–97.CrossRefPubMed Muller M, Ait-Belkacem D, Hessabi M, et al. Assessment of the cervix in pregnant women using shear wave elastography: a feasibility study. Ultrasound Med Biol. 2015;41:2789–97.CrossRefPubMed
24.
Zurück zum Zitat Orno AK, Dietz HP. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol. 2007;30:46–350. Orno AK, Dietz HP. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol. 2007;30:46–350.
25.
Zurück zum Zitat Dietz HP, Shek KL. Levator defects can be detected by 2D translabial ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:807–11.CrossRefPubMed Dietz HP, Shek KL. Levator defects can be detected by 2D translabial ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:807–11.CrossRefPubMed
26.
Zurück zum Zitat Eby SF, Song P, Chen S, et al. Validation of shear wave elastography in skeletal muscle. J Biomech. 2013;46:2381–7.CrossRefPubMed Eby SF, Song P, Chen S, et al. Validation of shear wave elastography in skeletal muscle. J Biomech. 2013;46:2381–7.CrossRefPubMed
28.
Zurück zum Zitat MacDonald D, Wan A, McPhee M, et al. Reliability of abdominal muscle stiffness measured using elastography during trunk rehabilitation exercises. Ultrasound Med Biol. 2016;42:1018–25.CrossRefPubMed MacDonald D, Wan A, McPhee M, et al. Reliability of abdominal muscle stiffness measured using elastography during trunk rehabilitation exercises. Ultrasound Med Biol. 2016;42:1018–25.CrossRefPubMed
29.
Zurück zum Zitat Lacourpaille L, Hug F, Bouillard K, et al. Supersonic shear imaging provides a reliable measurement of resting muscle shear elastic modulus. Physiol Meas. 2012;33:19–28.CrossRef Lacourpaille L, Hug F, Bouillard K, et al. Supersonic shear imaging provides a reliable measurement of resting muscle shear elastic modulus. Physiol Meas. 2012;33:19–28.CrossRef
30.
Zurück zum Zitat Kruger JA, Budgett SC, Wong V, et al. Characterising levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand. 2017;96:1234–42.CrossRefPubMed Kruger JA, Budgett SC, Wong V, et al. Characterising levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand. 2017;96:1234–42.CrossRefPubMed
31.
Zurück zum Zitat Kruger JA, Nielsen PM, Budgett SC, et al. An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women. Neurourol Urodyn. 2015;34:133–8.CrossRefPubMed Kruger JA, Nielsen PM, Budgett SC, et al. An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women. Neurourol Urodyn. 2015;34:133–8.CrossRefPubMed
32.
Zurück zum Zitat Chen L, Low LK, DeLancey JO, et al. In vivo estimation of perineal body properties using ultrasound quasistatic elastography in nulliparous women. J Biomech. 2015;48:1575–9.CrossRefPubMedPubMedCentral Chen L, Low LK, DeLancey JO, et al. In vivo estimation of perineal body properties using ultrasound quasistatic elastography in nulliparous women. J Biomech. 2015;48:1575–9.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Silva MET, Brandao S, Parente MPL, et al. Biomechanical properties of the pelvic floor muscles of continent and incontinent women using an inverse finite element analysis. Comput Methods Biomech Biomed Engin. 2017;20:842–52.CrossRefPubMed Silva MET, Brandao S, Parente MPL, et al. Biomechanical properties of the pelvic floor muscles of continent and incontinent women using an inverse finite element analysis. Comput Methods Biomech Biomed Engin. 2017;20:842–52.CrossRefPubMed
34.
Zurück zum Zitat Nordin MLT, Campello M, Nordin M, et al. In: Nordin M, Frankel VH, editors. Basic biomechanics of the musculoskeletal system. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 102–25. Nordin MLT, Campello M, Nordin M, et al. In: Nordin M, Frankel VH, editors. Basic biomechanics of the musculoskeletal system. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 102–25.
Metadaten
Titel
In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women
verfasst von
Bertrand Gachon
Antoine Nordez
Fabrice Pierre
Laetitia Fradet
Xavier Fritel
David Desseauve
Publikationsdatum
01.07.2019
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 7/2019
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-018-3693-4

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