5 years ago

Pelvic floor muscle assessment at 3-and 4-dimensional transperineal ultrasound in women with endometriosis, with or without retroperitoneal infiltration: a step towards complete functional assessment

Alessandro Arena, Arianna Benfenati, Renato Seracchioli, Valentina Martelli, Simona Del Forno, Aly Youssef, Federica Baruffini, Diego Raimondo, Mohamed Mabrouk
Objectives Previous studies, comparing women with deep infiltrating endometriosis (DIE) and healthy controls, underlined an association between pelvic floor muscle (PFM) hypertonic dysfunction and deep lesions. The aim of the study is to compare the morphometry of pelvic floor muscle (PFM) in women affected by ovarian endometriosis with or without DIE, to assess the impact of retroperitoneal infiltration by the disease on PFM function. Methods A prospective study was conducted between March 2015 to December 2016 on symptomatic women with clinical and sonographic diagnosis of ovarian endometriosis with or without DIE, submitted to laparoscopic surgery. We excluded patients with current or previous pregnancies, previous surgery for deep endometriosis, other causes of chronic pelvic pain, congenital or acquired abnormalities of pelvic floor anatomy. Transperineal, three-dimensional (3D) and four-dimensional (4D) ultrasound for evaluation of PFM morphometry was performed to assess levator hiatus area (LHA) and diameters at rest, during PFM contraction and during Valsalva manoeuvre. All volumes were offline analyzed by an investigator blinded to the clinical data. Results One-hundred fourteen patients were enrolled in the study: 75 with ovarian endometriosis associated with DIE (DIE group) and 39 with isolated ovarian endometriosis (OVA group). Diagnosis of endometriosis was confirmed by histological examination in all patients. Compared to women in OVA group, women in DIE group showed a smaller LHA at rest, during contraction and during Valsalva manoeuvre (p = 0.03, p = 0.03, p = 0.02, respectively) and a smaller change in LHA narrowing during PFM contraction (p = 0.04). Conclusions Women affected by DIE, compared to women with isolated ovarian endometriosis, presented more severe PFM dysfunctions. Because PFM dysfunctions in patients with DIE could be an important cause of pain symptoms and pelvic organ's dysfunctions, transperineal ultrasound could allow a more complete functional assessment and a tailored therapy.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18924

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