Abstract
Introduction and hypothesis
Translabial 3D/4D ultrasound is increasingly being used in the diagnostic evaluation of pelvic floor dysfunction. The result of the assessment is influenced by a number of confounders that are generally unrecognised. The aim of this study was to determine the short- to medium-term repeatability of translabial ultrasound measures of female pelvic organ support and pelvic floor anatomy.
Methods
This is a retrospective study analyzing archived ultrasound volume datasets of 106 patients with pelvic floor dysfunction. Every subject was assessed twice at an average interval of 73 days. Outcome measures including hiatal area on Valsalva, descent of the bladder neck, bladder, uterus and rectal ampulla, rectocele depth, diagnosis of true rectocele, and levator integrity (avulsion) were compared at the first and second appointments.
Results
All parameters of organ descent demonstrated good to excellent reliability (ICC 0.73–0.93) except for rectocele descent, which showed moderate reliability (ICC 0.44, CI 0.26–0.58). The most highly repeatable measure was hiatal area on Valsalva or “ballooning” (ICC 0.93, CI 0.90–0.95). For the diagnosis of levator avulsion and true rectocele, agreement was very high (kappa 0.91 for avulsion (CI 0.77–0.94) and kappa 0.73 (CI 0.56–0.84) for true rectocele).
Conclusions
The short- to medium-term repeatability of translabial ultrasound measures of functional pelvic floor anatomy seems to be high. Hiatal area on Valsalva (ballooning) and diagnosis of levator avulsion were the most repeatable measures. The least repeatable measures related to the posterior compartment.
Similar content being viewed by others
References
Dietz HP (2011) Pelvic floor ultrasound in prolapse: What’s in it for the surgeon? Int Urogynecol J 22:1221–1232
Dietz HP (2011) Pelvic floor ultrasound in incontinence: What’s in it for the surgeon? Int Urogynecol J 22(9):1085–1097
Hoff Braekken I, Majida M, Ellstrom-Engh M, Dietz HP, Umek W, Bo K (2008) Test-retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J 19:227–235
Chen R, Song Y, Jiang L, Hong X, Ye P (2011) The assessment of voluntary pelvic floor muscle contraction by three-dimensional transperineal ultrasonography. Arch Gynecol Obstet 284:931–936
Dietz H, Shek K, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585
Dietz H, De Leon J, Shek K (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31:676–680
Peschers UM, Fanger G, Schaer GN, Vodusek DB, DeLancey JO, Schuessler B (2001) Bladder neck mobility in continent nulliparous women. BJOG 108(3):320–324
Siafarikas F, Staer-Jensen J, Braekken I, Bo K, Engh M (2013) Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study. Ultrasound Obstet Gynecol 41(3):312–317
Zhuang R, Song Y, Chen Q, Ma M, Huang H, Chen J et al (2011) Levator avulsion using a tomographic ultrasound and magnetic resonance-based model. Am J Obstet Gynecol 205:232.e1–232.e8
Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17
Dietz H (2004) Ultrasound imaging of the pelvic floor. II. Three-dimensional or volume imaging. Ultrasound Obstet Gynecol 23(6):615–625
Orejuela F, Shek K, Dietz H (2012) The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J 23:175–178
Oerno A, Dietz H (2007) Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 30:346–350
Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18(5):511–514
Dietz HP, Steensma AB (2005) Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol 26:73–77
Dietz H, Bernardo M, Kirby A, Shek K (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22(6):699–704
Dietz H, Abbu A, Shek K (2008) The levator urethral gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol 32:941–945
Bland J, Altman D (1986) Statistical methods for assessing agreement between measurement. Biochim Clin 11:399–404
Van Veelen G, Schweitzer K, Van Der Vaart C (2013) Reliability of pelvic floor measurements on three- and four-dimensional ultrasound during and after first pregnancy: implications for training. Ultrasound Obstet Gynecol 42:590–595
Dietz H, Guzman Rojas R, Shek K (2014) Postprocessing of pelvic floor ultrasound data: how repeatable is it? Aust N Z J Obstet Gynaecol 54(6):553–557
Dietz HP, Wilson PD, Clarke B (2001) The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct 12(3):166–168, discussion 8–9
Dietz H, Wong V, Shek KL (2011) A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol 51:540–543
Conflicts of interest
H.P. Dietz and K.L. Shek have received unrestricted educational grants from GE Medical.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tan, L., Shek, K.L., Atan, I.K. et al. The repeatability of sonographic measures of functional pelvic floor anatomy. Int Urogynecol J 26, 1667–1672 (2015). https://doi.org/10.1007/s00192-015-2759-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-015-2759-9