4D Translabial ultrasound concordance with digital palpation and - PowerPoint PPT Presentation

TEXT HERE • AUTHORS: Martinho N, Botelho S, Nagib A, Jales R, Juliato C, Turel F, Caagbay D, Riccetto C. 4D Translabial ultrasound concordance with digital palpation and superficial electromyography during dynamic pelvic floor muscles assessment: a cross- sectional study

Disclosure: I have no relevant financial relationship to disclose. Funding for speaker to attend the meeting: Sponsored by the Foundation for Research Support of the State of Sao Paulo (FAPESP), Brazil.

Introduction ü There is no gold standard method; ü Little is known about the correlation between imaging PFM assessment is strongly recommended. methods and other PFM assessment methods. Bo et al. Neurourol Urodyn. 2017;36:221-244 Deegan et al. Neurourol Urodyn 2018;37:33-45

Objective Concordance between: • PFM strength assessed by digital • Pelvic floor morphological palpation changes obtained through 4D • PFM electromyography activity translabial ultrasound (4D TLUS) assesed by sEMG Secondary objective: Which ultrasound parameters better predicts digital palpation?

Cross sectional study Methods Approved by the local Human Research Ethics Committe (CAAE: 42456114.8.0000.5404) Digital palpation Superficial EMG 4D translabial ultrasound (graded by the MOS) (Mean RMS of 3 contractions) (at rest and during contraction) Laycock; Jerwood. Physiother. 2001;87:631-642 Botelho et al. Neurourol Urodyn. 2013;32(5):420-423 Dietz et al. Clin Obstet Gynecol. 2017;60(1):58–81

Methods 4D TRANSLABIAL ULTRASOUND Calculated the difference between measurements at rest and during PFM contraction. v Hiatal area v Puborectal strain Dietz et al., 2005; Thyer et al., 2008 v Levator plate angle v Bladder neck elevation Dietz et al., 2001; Braekken et al., 2008;; Majida et al., 2009

279 women were recruited Results EXCLUDED (n=69) - Current urinary tract infection (n=3) - Cognitive, physical or neurological disorders (n=2) - Brachytherapy or neovagina (n=4) - SUI or/and pelvic organ prolapse surgical history (n=18) - Any pelvic organ prolapse exceeding the vaginal opening (n=7) - PFM contraction grade either zero or one (n=29) - Unable to retrieve ultrasound or EMG data (n=6) FINAL SAMPLE (n=210 women) Mean age: 45.8 years old (range from 20 to 70) Mean BMI: 25.7 kg/m 2 (range from 15.2 to 46.0) 83.3% were multiparous (median parity: 2.0) 68.6% were SUI (mean ICIQ UI-SF: 9.4±7.1)

Results p=0.04 r=0.1 Figure 1. Scatter plot of the correlation between pelvic floor muscles electromyography (PFM sEMG) and the change in levator plate angle.

Results Table 1. Mean changes in ultrasound values in relation to each category of the Modified Oxford Scale. Modified Oxford Scale - M±SD (Min-Max) Multiple p-value 1 2 3 4 comparisons (n=105) (n=75) (n=29) Change in levator 5.82±7.02 10±8.08 11.56±6.93 <.0001 3,4 > 2 plate angle (degree) (-12.03 –26.61) (-15.63 - 28.08) (-4.4 – 29.43) Bladder neck 0.47±0.28 0.65±0.34 0.68±0.30 <.0001 3,4 > 2 elevation (cm) (0.02 - 1.27) (0.08 - 1.47) (0.10 - 1.36) Change in hiatal area 15.32±10.62 23.21±11.85 23.89±12.38 <.0001 3,4 > 2 (%) (-12.77 – 46.76) (-8.44 – 50.45) (-1.85 – 49.91) Puborectal strain -0.13±0.08 -0.20±0.09 -0.22±0.11 <.0001 2 > 3,4 (cm) (-0.34 - 0.09) (-0.38- 0.03) (-0.47 - -0.01) 1 Kruskal-Wallis test. 2 Dunn test.

Results Table 2. Univariate and multivariate analyzes to test which ultrasound parameters predicts the PFM contractility assessed by digital palpation. UNIVARIATE ANALYSIS Grade 2 x 3 1 Grade 2 x 4 1 p-value OR 95% CI OR 95% CI Change in levator 0.0001 1.081 1.035 – 1.129 1.112 1.048 – 1.180 plate angle Bladder neck 2.696 – 2.572 – 0.0001 7.652 9.893 elevation 21.721 38.055 Change in hiatal area <.0001 1.857 1.394 - 2.474 1.957 1.333 - 2.875 Puborectal strain ¶ <.0001 2.475 1.701 - 3.600 2.923 1.780 - 4.831 MULTIVARIATE ANALYSIS R 2 = 21.77% Change in levator 0.0169 1.055 1.008 – 1.104 1.081 1.016 – 1.150 plate angle Puborectal strain ¶ <.0001 0.452 0.307 – 0.665 0.403 0.240 – 0.674

Conclusion ü 4D TLUS significantly correlate with digital palpation and sEMG, being the change in levator plate angle the parameter that best correlates with both methods; ü We recommend 4D TLUS as a beneficial non-invasive clinical tool for evaluation of pelvic floor additional in-depth information.

Thank you for your attention!!! natalia.mmartinho@gmail.com Acknowledgements Process n o : 2015/22521-8