Valsalva动作的腹压值为5Kpa

BACKGROUND In vivo mechanical behaviour of the abdominal wall has been poorly characterised and important details are missing regarding the occurrence and post-operative recurrence rate of hernias which can be as high as 30 %. This study aimed to assess the correlation between abdominal wall displacement and intra-abdominal pressure, as well as abdominal compliance. METHODS Eighteen healthy participants performed audio-guided passive (breathing) and active (coughing, Valsalva maneuver) exercises. Axial dynamic changes of abdominal muscles and visceral area were measured using MRI, and intra-abdominal pressure with ingested pressure sensor. FINDINGS Correlations between abdominal wall displacement and intra-abdominal pressure were specific to participant, exercise, and varying between rectus abdominis and lateral muscles. Strong correlations were found between rectus abdominis displacement and intra-abdominal pressure during breathing (r = 0.92 ± 0.06), as well as lateral muscles displacement with intra-abdominal pressure during coughing and Valsalva maneuver (r = -0.98 ± 0.03 and - 0.94 ± 0.05 respectively). The abdominal pseudo-compliance varied greatly among participants during muscular contraction, the coefficient of variation reaching up to 70 %. INTERPRETATION The combination of intra-abdominal pressure and dynamic MRI measurements enables the identification of participant-specific behaviour pattern. Intra-abdominal pressure and abdominal wall dynamic undergo consistent and predictable interactions. However, this relationship is subject-specific and may not be extrapolated to other individuals. Therefore, both intra-abdominal pressure and abdominal wall motion must be measured in the same participant in order to accurately characterise the abdominal wall behaviour. These results are of great importance for mesh design, surgical decision-making, and personalised healthcare.

Background The abdominal drawing-in maneuver (ADIM) is widely used in sports physical therapy and rehabilitation to selectively activate deep trunk muscles. Although the ADIM is effective for motor control retraining, previous studies suggest that it may be unsuitable as a breathing strategy during high-load tasks because it limits intra-abdominal pressure (IAP) generation. Trunk rotation in the horizontal plane is a fundamental component of many functional and sport-related movements and requires coordinated trunk stability and force production; however, the effects of the ADIM on IAP and torque during trunk rotation remain unclear. Purpose The purpose of the present study was to clarify the effects of the ADIM on IAP and trunk rotational torque during trunk rotation. Study Design Crossover, randomized controlled study. Methods Fifteen healthy young adult males performed seated isometric trunk rotation tasks under two conditions: spontaneous rotation (SR) and trunk rotation with the ADIM (DIR). IAP was measured using a catheter-type pressure sensor. Trunk rotational torque was measured with a custom-manufactured trunk rotation dynamometer. Inspiratory volume was normalized as %inspiratory volume. Outcomes were compared between conditions. Results IAP was significantly greater in SR (96.7 ± 31.4 mmHg) than in DIR (34.9 ± 15.9 mmHg) (p < 0.01, d = 2.48). Torque was also significantly greater in SR (68.7 ± 20.2 Nm) than in DIR (49.1 ± 17.7 Nm) (p < 0.01, d = 1.03). %inspiratory volume was significantly greater in SR (66.9 ± 16.2%) compared with DIR (26.4 ± 17.4%) (p < 0.01, d = 2.41). Large effect sizes were observed for all outcomes. Conclusion Performing trunk rotation with the ADIM attenuated increases in IAP and trunk rotational torque. These findings indicate that ADIM influences both pressure generation and mechanical output during trunk rotation. Level of Evidence 2.

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Intra-abdominal pressure (IAP), as the main mechanical load applied to the abdominal wall, is decisive in the occurrence of ventral hernia. The objective of the study was to propose a comprehensive evaluation of IAP based on a limited risk and discomfort method. A prospective study was carried out in 20 healthy volunteers. The intragastric pressure, validated for estimating IAP, was assessed by an ingestible pressure sensor. Volunteers realized a set of supervised exercises, then resumed their daily activities with the pressure continuously recorded until gastric emptying. Coughing and jumping exercises resulted in the highest IAP levels with maximum peaks of 65 ± 35 and 67 ± 31 mmHg and pressure rates of 121 and 114 mmHg.s-1 respectively. The position did not affect the IAP variation. Men had significantly higher pressure values for pushing against a wall (P < 0.01), Valsalva maneuver and legs raising (P<0.05) exercises. During daily life, IAP greater than 50, 100, and 150 mmHg occurred on average five times, twice, and once per hour, respectively. This study provides a real-life characterization of the IAP allowing the quantification of mechanical solicitation applied to the abdominal wall and the identification of risk situations for the occurrence of ventral hernias.

To detect a patent foramen ovale (PFO) during transesophageal echocardiography (TEE), the Valsalva Maneuver (VM) must be performed effectively. However, it can be difficult for patients to hold their breath for more than 10 seconds and maintain consistent intra-abdominal pressure (40mmHg) while a tube is inserted into their esophagus. As failures of the Valsalva Maneuver (VM) accumulate, the number of attempts increases, and this can lead to greater discomfort for the patient. Therefore, it is important to improve the success rate of VM, and training prior to the examination is necessary to achieve this. This study aimed to examine the effects of Valsalva Maneuver training using a maximum expiratory pressure (MEP) meter on patient discomfort and VM success rate prior to performing transesophageal echocardiography. Design: A quasi-experimental study with a non-equivalent control group and post-test design. The participants in this study were patients scheduled for transesophageal echocardiography. Data for the control group (67 participants) were collected from November 16, 2023, to December 28, 2023, while data for the experimental group (62 participants) were collected from January 2, 2024, to April 17, 2024. The experimental group received Valsalva Maneuver training using a maximum expiratory pressure (MEP) meter, while the control group received education through written materials. The primary outcome variables included patient discomfort (subjective and objective), the number of attempts to successfully perform the Valsalva Maneuver, and the success rate of the Valsalva Maneuver. The data were analyzed using SPSS/WIN 28.0 software with χ2-test and independent t-test. After the intervention, there was no significant difference in subjective discomfort between the experimental and control groups (t=0.08, p=.933), but the experimental group reported significantly lower objective discomfort (t=4.95, p<.001). The number of attempts required to successfully perform the Valsalva Maneuver was lower in the experimental group (t=6.99, p<.001), and the success rate of the Valsalva Maneuver was higher in the experimental group (t=-7.14, p<.001). Valsalva Maneuver training using a maximum expiratory pressure (MEP) meter prior to transesophageal echocardiography was found to be an effective method for reducing patient discomfort and improving the success rate. Therefore, it is recommended to actively implement this training in clinical practice.  

Typically, esophageal hematomas are caused by trauma or iatrogenic factors. This case is the first to report difficult defecation as a potential cause of an esophageal hematoma, highlighting the role of intra-abdominal pressure changes related to everyday activities. The Valsalva maneuver, such as straining during defecation, can lead to significant yet rare injuries to the esophagus. This report contributes to the understanding of esophageal pathologies and underscores the importance of considering this possibility in the diagnosis of unexplained chest pain, dysphagia, or upper gastrointestinal bleeding, even in the absence of direct trauma or medical procedures.

BACKGROUND The abdominal muscles play an important respiratory and stabilization role, and in coordination with other muscles regulate the intra-abdominal pressure stabilizing the spine. The evaluation of postural trunk muscle function is critical in clinical assessments of patients with musculoskeletal pain and dysfunction. This study evaluates the relationship between intra-abdominal pressure measured as anorectal pressure with objective abdominal wall tension recorded by mechanical-pneumatic-electronic sensors. METHODS In a cross-sectional observational study, thirty-one asymptomatic participants (mean age = 26.77 ± 3.01 years) underwent testing to measure intra-abdominal pressure via anorectal manometry, along with abdominal wall tension measured by sensors attached to a trunk brace (DNS Brace). They were evaluated in five different standing postural-respiratory situations: resting breathing, Valsalva maneuver, Müller's maneuver, instructed breathing, loaded breathing when holding a dumbbell. FINDINGS Strong correlations were demonstrated between anorectal manometry and DNS Brace measurements in all scenarios; and DNS Brace values significantly predicted intra-abdominal pressure values for all scenarios: resting breathing (r = 0.735, r2 = 0.541, p < 0.001), Valsalva maneuver (r = 0.836, r2 = 0.699, p < 0.001), Müller's maneuver (r = 0.651, r2 = 0.423, p < 0.001), instructed breathing (r = 0.708, r2 = 0.501, p < 0.001), and loaded breathing (r = 0.921, r2 = 0.848, p < 0.001). INTERPRETATION Intra-abdominal pressure is strongly correlated with, and predicted by abdominal wall tension monitored above the inguinal ligament and in the area of superior trigonum lumbale. This study demonstrates that intra-abdominal pressure can be evaluated indirectly by monitoring the abdominal wall tension.

Previous studies mainly focused on the relationship between the size of the prolapse and injury to the supporting tissues, but the strain and stress distributions of the supporting tissues as well as high-risk areas of injury are still unknown. To further investigate the effect of supporting tissues on organs and the interactions between organs, this study focused on the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system. A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during rest and Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure. Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior–posterior direction. These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.

OBJECTIVES Intra-abdominal pressure (IAP) increases during physical activity. Activities with high IAP are often restricted for women because of potential pelvic floor overloading. Researchers categorize high IAP activities using absolute values (in centimeters of water). Although essential for descriptive purposes, absolute IAP may not be ideal for individualized exercise recommendations. For oxygen consumption, a well-established measure of fitness, exercise scientists use a percentage of the maximal value observed during exercise to create relative exercise intensity prescriptions for an individual. Relative exercise intensity correlates inversely to the maximal value observed. We explore whether this approach and response pattern extend to IAP observed during exercise. METHODS Fifty-five women completed 16 exercises while wearing a vaginal sensor to measure IAP. The highest mean IAP occurred during seated Valsalva/strain (IAPSTRAIN). We calculated relative IAP (in percent) for each participant by dividing the maximal IAP during each exercise by IAPSTRAIN. We examined relationships between relative IAP and IAPSTRAIN for each activity using Pearson r correlations. RESULTS Mean age was 30.4 ± 9.4 years, and body mass index was 22.4 ± 2.6 kg/m. For most women, IAP was greater during strain than during exercises. Relative IAPs negatively correlated with IAPSTRAIN. Excluding one exercise because of small sample sizes, r for all others ranged from -0.35 to -0.80, all statistically significant. CONCLUSIONS The relative IAP responses to many exercises exhibit an inverse relationship to the highest IAP values during strain, consistent with other variables measured during exercise. Relative IAP may provide an alternative to absolute IAP in understanding IAP's effect on pelvic floor health.

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Ultrasound elastography quantitatively measures tissue stiffness and is widely used in clinical practice to diagnose various diseases including liver fibrosis and portal hypertension. The stiffness of soft organs has been shown to be sensitive to blood flow and pressure-related diseases such as portal hypertension. Because of the intricate coupling between tissue stiffness of abdominal organs and perfusion-related factors such as vascular stiffness or blood volume, simple breathing maneuvers have altered the results of liver elastography, while other organs such as the spleen are understudied. Therefore, we investigated the effect of a standardized Valsalva maneuver on liver stiffness and, for the first time, on spleen stiffness using time-harmonic elastography (THE). THE acquires full-field-of-view stiffness maps based on shear wave speed (SWS), covers deep tissues, and is potentially sensitive to SWS changes induced by altered abdominal pressure in the hepatosplenic system. SWS of the liver and the spleen was measured in 17 healthy volunteers under baseline conditions and during the Valsalva maneuver. With the Valsalva maneuver, SWS in the liver decreased by 2.2% (from a median of 1.36 m/s to 1.32 m/s; p = 0.021), while SWS in the spleen decreased by 5.2% (from a median of 1.63 m/s to 1.51 m/s; p = 0.00059). Furthermore, we observed that the decrease was more pronounced the higher the baseline SWS values were. In conclusion, the results confirm our hypothesis that the Valsalva maneuver decreases liver and spleen stiffness, showing that THE is sensitive to perfusion pressure-related changes in tissue stiffness. With its extensive organ coverage and high penetration depth, THE may facilitate translation of pressure-sensitive ultrasound elastography into clinical routine.

To determine terminology and methods for raising intra‐abdominal pressure (IAP) currently used by clinicians to assess pelvic floor dysfunction (PFD) and to measure the effect of these maneuvers on IAP.

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This study analyzes abdominal leak point pressures (ALPP) during Valsalva and cough maneuvers in patients with stress urinary incontinence (SUI) (pure or mixed), with the aim of clarifying the different psychopathological mechanisms of urethral incontinence behind leakage with each. This is a retrospective study of women with stress or mixed incontinence submitted to urodynamic testing with ALPP in 2024. Patients were allocated in mutually exclusive groups: group 1: Valsalva and cough leakage (n=57); group 2: cough leakage (n=20); and group 3: Valsalva leakage (n=10). A comparative analysis using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, New York, United States) was performed. Average ALPP was higher in group 2 (113.8±44.3 cmH2O). ALPP was below 60 cmH2O in 37%, 10%, and 20% of the patients in groups 1, 2, and 3, respectively (p=0.06). Women in group 3 were significantly younger (p=0.001) and pre-menopausal (p=0.02). In a subgroup analysis in group 1, only 31% of the patients had Valsalva leak point pressure (VLPP) superior to cough leak point pressure (CLPP). Body mass index (BMI) was significantly variable between subgroups, being higher in patients whose VLPP was superior to CLPP (p=0.01). Similarly, in a subgroup analysis in group 2, the pressure generated with Valsalva was superior to CLPP only in 25% of the cases. BMI was significantly higher in patients whose Valsalva-generated pressure was superior to CLPP (p=0.004). Cough and Valsalva maneuver are both equally and individually relevant in the setting of ALPP, but not equivalent. Our findings support that each maneuver might be associated with different underlying mechanisms for SUI and both should be performed during ALPP.

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The effect of 10 weeks' specific abdominal strength training (resisted trunk rotations) on intra-abdominal pressure was investigated in 10 healthy males. Isometric rotational force, trunk flexor and extensor torque and intra-abdominal pressure were measured as well as intra-abdominal pressure responses to Valsalva manoeuvres, maximal pulsed pressures, drop jumps and trunk perturbations. The rotational strength increased 29.7% after training without significant change in intra-abdominal pressure. The isometric flexor strength did not change, while the extensor strength increased 11.0%. Valsalva and pulsed pressures increased 11.6 and 9.2%, respectively. The rate of intra-abdominal pressure development during pulsed pressures, drop jumps and trunk perturbations increased after training. The level of intra-abdominal pressure during the latter two tasks remained unchanged. It is concluded that an increase in strength of the trunk rotators with training improves the ability to generate higher levels of voluntarily induced intra-abdominal pressure and increases the rate of intra-abdominal pressure development during functional situations.

Analyses of registries and medical imaging suggest that laparoscopic surgery may be penalized with a high incidence of trocar-site hernias (TSH). In addition to trocar diameter, the location of the surgical wound (SW) may affect TSH incidence. The intra-abdominal pressure (IAP) exerted on the abdominal wall (AW) might also influence the appearance of TSH. In the present study, we used finite element (FE) simulations to predict the influence of trocar location and SW characteristics (stiffness) on the mechanical behavior of the AW subject to an IAP. Two models of laparoscopy patterns on the AW, with trocars in the 5–12 mm range, were generated. FE simulations for IAP values within the 4 kPa–20 kPa range were carried out using the Code Aster open-source software. Different stiffness levels of the SW tissue were considered. We found that midline-located surgical wounds barely deformed, even though they moved outwards along with the regular LA tissue. Laterally located SWs hardly changed their location but they experienced significant variations in their volume and shape. The amount of deformation of lateral SWs was found to strongly depend on their stiffness. Trocar incisions placed in a LA with non-diastatic dimensions do not compromise its mechanical integrity. The more lateral the trocars are placed, the greater is their deformation, regardless of their size. Thus, to prevent TSH it might be advisable to close lateral trocars with a suture, or even use a prosthetic reinforcement depending on the patient's risk factors (e.g., obesity).

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OBJECTIVE To compare cardiopulmonary variables and blood gas analytes in guinea pigs (Cavia porcellus) during anesthesia with and without abdominal carbon dioxide (CO2) insufflation at intra-abdominal pressures (IAPs) 4 and 6 mmHg, with and without endotracheal intubation. STUDY DESIGN Prospective experimental trial. ANIMALS A total of six intact female Hartley guinea pigs. METHODS A crossover study with sequence randomization for IAP and intubation status was used. The animals were sedated with intramuscular midazolam (1.5 mg kg-1) and buprenorphine (0.2 mg kg-1) and anesthetized with isoflurane, and an abdominal catheter was inserted for CO2 insufflation. Animals with endotracheal intubation were mechanically ventilated and animals maintained using a facemask breathed spontaneously. After 15 minutes of insufflation, the following variables were obtained at each IAP: pulse rate, respiratory rate, rectal temperature, oxygen saturation, end-tidal CO2 (intubated only), peak inspiratory pressure (intubated only), noninvasive blood pressure and blood gas and electrolyte values, with a rest period of 5 minutes between consecutive IAPs. After 4 weeks, the procedure was repeated with the guinea pigs assigned the opposite intubation status. RESULTS Intubated guinea pigs had significantly higher pH and lower partial pressure of CO2 in cranial vena cava blood (PvCO2) than nonintubated guinea pigs. An IAP of 6 mmHg resulted in a significantly higher PvCO2 (65.9 ± 19.0 mmHg; 8.8 ± 2.5 kPa) than at 0 (53.2 ± 17.2 mmHg; 7.1 ± 2.3 kPa) and 4 mmHg (52.6 ± 10.8 mmHg; 7.01 ± 1.4 kPa), mean ± standard deviation, with intubated and nonintubated animals combined. CONCLUSIONS AND CLINICAL RELEVANCE Although the oral anatomy of guinea pigs makes endotracheal intubation difficult, capnoperitoneum during anesthesia induces marked hypercapnia in the absence of mechanical ventilation. An IAP of 4 mmHg should be further evaluated for laparoscopic procedures in guinea pigs because hypercapnia may be less severe than with 6 mmHg.

OBJECTIVE  To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Adana City Training and Research Hospital, Turkey, from March2019 to March 2020. METHODOLOGY In this study, 30 patients (fissure group), who were diagnosed with anal fissure in the outpatient clinic; and 20 patients (control group), who did not have any problem in anal examination were included. The anorectal tissues and muscles mechanical properties(elasticity,compliance and stiffness) were compared with the shear wave elastography values.Fissure area,internal anal sphincter,external anal sphincter and levator ani muscles elastographic measurements was performed with 5-18 MHzin lithotomy position, at rest and with Valsalva maneuver. RESULTS In elastographic measurement of fissure area (fissure) and normal anorectal tissue (control, AFE); control group values were significantly higher than the fissure group values (p<0.001, and padj <0.001, respectively). Control group valuesof internal anal sphincter in rest and Valsalva maneuver (IAS-R, and IAS-V, respectively) were significantly higher than the fissure group values (p<0.001, padj< 0.001, and p<0.001,  padj <0.001, respectively). There was no significant difference between the elastographic measurement values in rest and valsalva maneuver of the external anal sphincter (EAS-R and EAS-V) (p>0.05). Elastographic measurement values of levator ani muscle (LAM) resting state; were significantly higher in thefissure group than the control group (p<0.001, and padj <0.001, respectively). Elastographic cut-off values that differentiate the fissure group from control group were found to be ≤1kPa forAFE group, ≤44 kPa forIAS-R, ≤0.4kPa forIAS-V,and >11kPa for LAM,respectively. Conclusıon: In anal fissure disease, tissues mechanical properties measured by shear wave elastography showed increased tissue stiffness, which may be added to etiology of this disease. Key Words: Anal fissure, Ultrasonography, Shear wave elastography, Anal sphincter, Tissue elasticity, Tissue stiffness.

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The use of the anterior technique for abdominal wall components separation combined with "onlay" alloplasty (ACST + onlay) in giant incisional hernias (IH) may pose a surgical challenge as it does not exclude increased intra-abdominal pressure (IAP) and the occurrence of abdominal compartment syndrome (ACS). There remains a high incidence of surgical site complications. In our view, the use of intra-abdominal alloplasty combined with anterior separation of the anterior abdominal wall components (ACST + IPOM) will contribute to the improvement of surgical outcomes in giant IH. PURPOSE to improve the results of surgical treatment of giant IH using ACST + IPOM. MATERIALS AND METHODS Analysis of surgical treatment of 164 patients with giant IH aged 30 to 75 (mean age 54.7 ± 3.3). Depending on the surgery, the patients were divided into two groups. Group I (82 patients) consisted of patients who underwent our modified technique, including ACST + IPOM. The surgery in group II (82 patients) involved ACST + onlay. RESULTS AND DISCUSSION As compared with ACST + onlay, ACST + IPOM surgery contributes to a significantly reduced incidence of ACS [6.1% (group II) versus 0 (group I), (p <0.05)], seroma [25.6% versus 7.3%, p <0.05], surgical site infection (SSI) [4.9% versus 2.4%, p> 0.05], meshoma [3.7% versus 0] and hernia recurrences [6.5% versus 1.6%, p> 0.05]. CONCLUSIONS IAP value equal or exceeding 9.1 mmHg (1.2 kPa) during surgery in approximated rectus muscles is prognostic for ACS occurrence and requires intraoperative preventive measures. Utilization of ACST + IPOM in giant IH ensures an optimal abdominal cavity volume without a substantial increase in IAP and reduces the probability of ACS, whereas the use of ACST + onlay results in ACN in 6.1% (p <0.05) patients. Reduced contact of the mesh with the subcutaneous tissue in ACST + IPOM contributes to a significantly lower incidence of seroma [7.3% vs 25.6% (p <0.05)], surgical site infection (SSI) [2.4% vs 4.9% (p> 0.05)], postoperative wound infiltrate [2 (2.4%) vs. 11 (13.4%) (p <0.05)], chronic postsurgical pain [1 (1.6%) vs. 5 (8.1%) (p> 0.05)] and recurrent IH [1 (1.6%) vs. 4 (6.5%) (p> 0.05)] as compared with ACST + onlay technique.

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© BMJ Publishing Group Limited 2023. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A male patient in his fifth decade of life with an extensive history of atherosclerotic cardiovascular disease presented for evaluation of a left flank mass, suspicious for a laparoscopic port site hernia. A noncontrast CT (NCCT) study demonstrated a 2 cm abdominal wall defect in the left flank. In addition, the morphology of the infrarenal aorta was noted to be highly abnormal. The anterior wall of the aorta was seen to have significant posterior excursion, so that the crosssection of the vessel appeared crescent shaped (figure 1). The differential diagnosis of this radiographic finding included nonatherosclerotic arteriopathy or a fibrotic process of the retroperitoneum. At followup, the patient underwent a CT angiogram (CTA) to better characterise the abnormal aortic morphology. The CTA demonstrated complete resolution of the abnormal finding (figure 2). On further questioning, the patient reported that he was asked to bear down during acquisition of the NCCT, to make the left flank mass bulge more prominently. Accordingly, we concluded that the radiographic finding of abnormal aortic morphology was likely attributable to increased thoracoabdominal pressure sustained during the Valsalva manoeuvre. The Valsalva manoeuvre describes forced expiration against a closed glottis. This occurs naturally during routine activities such as sneezing, coughing, vomiting, lifting and straining during a bowel movement. Physiologically, the Valsalva manoeuvre increases intrathoracic pressure, decreasing venous return to the heart and thus affecting cardiac output, heart rate and arterial blood pressure. While clinicians are likely aware of the impact of increased thoracic and abdominal pressure on the morphology of lower pressure venous structures, it is unexpected for the Valsalva manoeuvre to generate sufficient pressure to deform the atherosclerotic aorta. In this case, however, that appears the most likely explanation for the morphological abnormality observed. Our case provides insights that complement and extend the knowledge derived from three previously published reports in the literature. Krol and Hallett described a case in which vomiting during CT generated an involuntary Valsalva, while Habbu et al and Huang and Weiss each reported one case of voluntary Valsalva per hernia imaging protocols in 2019 and 2022, respectively. In all three instances, severe, transient morphological changes to the abdominal aorta were visualised on CT imaging and attributed to the significant rise in intraabdominal pressures. Complementary findings to be aware of included bilateral renal and iliac artery compression, inferior vena cava flattening, and duodenum (third portion) kinking. Our case adds support to the existing literature that this seemingly unlikely vascular phenomenon can be explained by the Valsalva manoeuvre. Altogether, the insights from this paper and previous reports highlight

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There is a great deal of confusion about the use of the Valsalva manoeuvre (VM), and its potential to harm or benefit the pelvic floor when performing resistance training (RT). The VM is completed when expiratory pressure is exerted on a closed or partially closed glottis. This creates a haemodynamic response that corresponds to an increase in blood pressure and then heart rate. For the RT athlete, the VM is a term used to describe bracing of the abdominal musculature to increase trunk stiffness and lumbar stability by intensifying intra-abdominal pressure. This gives individuals a performance advantage during RT. Within pelvic health, the VM is used to assess pelvic floor dysfunction (PFD), and in particular, pelvic organ prolapse. Emerging literature demonstrates that rates of PFD are high in resistance-trained female athletes, and therefore, it has been suggested that avoidance of the VM helps to reduce pelvic floor complaints in this population. However, this is unrealistic given that an involuntary, transient VM occurs at loads greater than 80% of an individual’s one repetition maximum, and removal of the VM would potentially reduce performance in RT athletes. Physiotherapists need to use their evaluation and management skills to improve the symptoms of individuals who participate in RT and experience PFD. This clinical commentary reviews the physiology of the VM, explores rates of PFD in resistance-trained female athletes, and makes recommendations for the evaluation and treatment of these individuals. Unique considerations for the pregnant female participating in RT are also discussed.

Background: Failure to standardize bladder volume in the evaluation of stress urinary incontinence (SUI) may be a contributing factor to the controversy surrounding the diagnostic and prognostic efficacy of urodynamic studies (UDS) in female patients with SUI. This study was conducted to explore the effects of bladder volume on the urethral mobility in female patients with SUI under increased intra-abdominal pressure. Methods: This prospective study enrolled uncomplicated female patients with SUI admitted to the Second Affiliated Hospital of Guilin Medical University and Shaoyang Central Hospital, between January 2021 and January 2024. Relative bladder neck descent (BND), urethral inclination angle (UTA), urethral rotation angle (URA), and posterior urethrovesical angle (PUVA) were compared across different bladder volumes (100 mL, 200 mL, and 300 mL) at resting state or 90 cm H2O of intravesical pressure, generated by Valsava movement, using sonography videourodynamic studies (SVUDS). Analysis of variance (ANOVA) was used to compare numerical data of parameters with a normal distribution. Results: 62 patients were enrolled in this study. There was not a significant difference in UTA and PUVA among the various bladder volumes (100 mL, 200 mL, and 300 mL) at resting state (all p >0.05). However, higher BND (2.23 ± 0.73 cm), UTA (44.7 ± 17.1°), URA (29.4 ± 16.0°), and PUVA (148.7 ± 21.4°) were determined at a bladder volume of 200 mL with the Valsalva movement (VM) reaching 90 cm H2O of intravesical pressure, compared to 100 mL (1.89 ± 0.74 cm, 38.1 ± 17.9°, 23.0 ± 15.5°, and 139.3 ± 19.8°) and 300 mL (1.85 ± 0.74 cm, 37.6 ± 18.8°, 23.8 ± 13.5°, and 143.4 ± 20.8°) (all p <0.05), except for PUVA between 200 mL and 300 mL (p = 0.161). Conclusions: Higher values of BND, UTA, URA, and PUVA at a bladder volume of 200 mL in the Valsalva state of female patients with SUI, compared to 100 mL and 300 mL, suggest that capacity of 200 mL should be standardized for evaluating female SUI.

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We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial. From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver. Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years. Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.

At present the abdominal wall hernia treatmen is clearly trending towards less invasive techniques and we believe the functional CT scan offers great value information for patient selection as well as for surgical planning. We descibe de image key points and landmarks we use to design the best surgical. After 5 years performing eTEP Rives-Stoppa for ventral hernia sugery, we describe the secuential standardized steps we use to evaluate a functional Ctscan to plan the surgical approach. A CT scan, without any oral or intravenous contrast, combining Valsalva maneouver images along with negative pressure will provide the best information of the dynamic behaviour of the abdominal wall. The preoperative study of the volumetric and anatomical landmarks will guide us to tailor surgery. Defect measures: Wide Location Volumen Content Previous mesh, fixation devices placement. Undiagnosed diseases. Anatomic key points Anatomic landmarks Diastasis Abdominal rectus wide Muscular atrophy Distance to: Pubis Xifoid Subcostal margin Semilunar line Quadratus lumborum muscle Preoperative study of the volumetric and anatomical landmarks will guide us to design our surgical strategy: Need for surgical prehabilitation. Patient position. Number and port placement. Spaces we need to approach (retrorectal, pretransversalis, preperitoneal) to repair the defect and deploy the mesh with enough overlap. Need to perform a TAR. Functional CTscan provides us basic information of the patient’s abdominal wall. Thorough anamnesis and physical examination combined with this image test will help us render the best surgical repair.

The article reviews the biomechanical principles of durable abdominal wall reconstructions. The aim is to provide insights and conclusions for future research in this area. Incisional hernia repair implies the creation of a compound made of tissue, textile, and fixation elements. A pulse load bench test for incisional hernia repair has been available since 2014, and its influences are evaluated in three different versions of the test stand. Based on these evaluations, a biomechanical concept for long-term durable reconstructions was determined. To apply the concept to individual patients, computed tomography of the abdomen at rest and during the Valsalva maneuver was used. A load limit can be given for every patient based on the hernia defect area (CRIP- critical resistance to impacts related to pressure). By considering the mesh to defect area ratio, the retention strength of a planned reconstruction can be calculated (GRIP-gained resistance to impacts related to pressure). The gripping coefficients for tissues vary significantly, up to 18 fold. About half of the patients have overall tissue distensions up to 350% or more, with potential high regional variations. The surface retention forces for hernia meshes and for different sutures, tacks, and adhesives span a wide range of 14fold. Suturing a defect strengthens the reconstruction up to 3fold. Furthermore, recalculating data taken from multicentric randomized studies on primary sutures reveals that improved GRIP values are associated with reduced rates of incisional hernia. Repairing consecutive incisional hernias according to the GRIP concept results in no recurrence and low pain levels after one year. A future policy for market access of repair materials should include cyclic load bench testing. Moreover, a tailored approach to incisional hernia repair should take into account the biomechanical aspects involved.

No abstract available

Abstract Background The neuromuscular contribution to increased tone of the pelvic floor muscles (PFMs) observed among those with provoked vestibulodynia (PVD) is unclear. Aim To determine if PFM activity differs between those with provoked PVD and pain free controls, and if the extent of PFM activation at rest or during activities is associated with pain sensitivity at the vulvar vestibule, psychological, and/or psychosexual outcomes. Methods This observational case–control study included forty-two volunteers with PVD and 43 controls with no history of vulvar pain. Participants completed a series of questionnaires to evaluate pain, pain catastrophizing, depression, anxiety and stress, and sexual function, then underwent a single laboratory-based assessment to determine their pressure pain threshold at the vulvar vestibule and electromyographic (EMG) signal amplitudes recorded from three PFMs (pubovisceralis, bulbocavernosus, and external anal sphincter). Outcomes EMG signal amplitude recorded at rest, during maximum voluntary contraction (MVC), and during maximal effort Valsalva maneuver, pressure pain threshold at the vulvar vestibule, and patient-reported psychological (stress, anxiety, pain catastrophizing, central sensitization) and psychosexual (sexual function) outcomes. Results Participants with PVD had higher activation compared to controls in all PFMs studied when at rest and during Valsalva maneuver. There were no group differences in EMG amplitude recorded from the pubovisceralis during MVC (Cohen’s d = 0.11), but greater activation was recorded from the bulbocavernosus (d = 0.67) and the external anal sphincter(d = 0.54) among those with PVD. When EMG amplitudes at rest and on Valsalva were normalized to activation during MVC, group differences were no longer evident, except at the pubovisceralis, where tonic EMG amplitude was higher among those with PVD (d = 0.42). While those with PVD had lower vulvar pressure pain thresholds than controls, there were no associations between PFM EMG amplitude and vulvar pain sensitivity nor psychological or psychosexual problems. Clinical implications Women with PVD demonstrate evidence of PFM overactivity, yet the extent of EMG activation is not associated with vulvar pressure pain sensitivity nor psychological/psychosexual outcomes. Interventions aimed at reducing excitatory neural drive to these muscles may be important for successful intervention. Strengths and limitations This study includes a robust analysis of PFM EMG. The analysis of multiple outcomes may have increased the risk statistical error, however the results of hypothesis testing were consistent across the three PFMs studied. The findings are generalizable to those with PVD without vaginismus, Conclusions Those with PVD demonstrate higher PFM activity in the bulbocavernosus, pubovisceralis, and external anal sphincter muscles at rest, during voluntary contraction (bulbocavernosus and external anal sphincter) and during Valsalva maneuver; yet greater activation amplitude during these tasks is not associated with greater vulvar pressure pain sensitivity nor psychological or psychosexual function.

Background: Maternal pushing techniques during the second stage of labor may affect women's pelvic floor function. The aim of this research was to evaluate the effect of spontaneous open-glottis versus Valsalva closed-glottis pushing during second stage of labour on pelvic floor morbidity and fatigue. Design: A quasi-experimental design (Comparative study) (two groups "control/study" Post-test only). Setting: The research was conducted in obstetrics and gynecological emergency department (labour unit) at Benha University hospitals in Qaliubya governorate, Egypt. Sample: A purposive sample of 180 primipara women who admitted to the previous setting for a period of six months, Valsalva pushing technique group (n=90) and Spontaneous pushing technique group (n=90). Data collection tools: Four tools were used to collect data: A structured interviewing questionnaire (Personal characteristics of studied women and Current labor and delivery outcomes sheet), Pelvic Floor Morbidity Questionnaires (Fecal Incontinence Severity Index, Pelvic Floor Distress Inventory Questionnaire-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7)), Modified Fatigue Impact Scale (MFIS) and Women's Satisfaction Questionnaire. Results: There was a statistically significant difference between both spontaneous open-glottis pushing and Valsalva closed-glottis pushing groups regarding the current labor and delivery outcomes. Moreover, there was a highly statistically significant differences between spontaneous open-glottis pushing and Valsalva closed-glottis pushing groups in relation to duration of second stage of labor, the total mean scores of pelvic floor morbidity questionnaires, postpartum fatigue impact and women's satisfaction; in favor of spontaneous pushing group. Conclusion : Spontaneous open-glottis pushing during the second stage of labor had positive desirable effect on current labor and delivery outcomes, pelvic floor morbidity, postpartum fatigue impact and women's satisfaction. Recommendation: Researchers recommended that until further research is forthcoming, women should be encouraged to follow their own instinctive urge to push (spontaneous pushing).

PURPOSE To evaluate the utility of a defecography phase (DP) sequence in dynamic pelvic floor MRI (DPMRI), in comparison to DPMRI utilizing only non-defecography Valsalva maneuvers (VM). MATERIALS AND METHODS Inclusion criteria identified 237 female patients with symptoms and/or physical exam findings of pelvic floor prolapse. All DPMRI exams were obtained following insertion of ultrasound gel into the rectum and vagina. Steady-state free-precession sequences in sagittal plane were acquired in the resting state, followed by dynamic cine acquisitions during VM and DP. In all phases, two experienced radiologists performed blinded review using the H-line, M-line, Organ prolapse (HMO) system. The presence of a rectocele, enterocele and inferior descent of the anorectal junction, bladder base, and vaginal vault were recorded in all patients using the pubococcygeal line as a fixed landmark. RESULTS DPMRI with DP detected significantly more number of patients than VM (p<0.0001) with vaginal prolapse (231/237, 97.5% vs. 177/237, 74.7%), anorectal prolapse (227/237, 95.8% vs. 197/237, 83.1%), cystocele (197/237, 83.1% vs. 108/237, 45.6%), and rectocele (154/237, 65% vs. 93/237, 39.2%). The median cycstocele (3.2cm vs. 1cm), vaginal prolapse (3cm vs. 1.5cm), anorectal prolapse (5.4cm vs. 4.2cm), H-line (8cm vs. 7.2cm) and M-line (5.3cm vs. 3.9cm) were significantly higher with DP than VM (p<0.0001). CONCLUSIONS Addition of DP to DPMRI demonstrates a greater degree of pelvic floor instability as compared to imaging performed during VM alone. Pelvic floor structures may show mild descent or appear normal during VM, with marked prolapse on subsequent DP images.

This study evaluates the clinical utility of transperineal 3D ultrasound in diagnosing pelvic floor dysfunction (PFD) and assessing uterine morphological changes in women. A total of 150 women with PFD and 100 healthy controls were examined. Measurements included anterior-posterior diameter, transverse diameter, and bladder neck and cervical mobility during Valsalva movement. No significant differences were found in demographic indicators between the groups. However, the observation group showed larger pelvic diaphragm fissures at rest, during tension, and anal contraction compared to controls, while anal levator muscle thickness was significantly lower. During Valsalva, bladder neck mobility and cervical descent were more pronounced in the PFD group, with statistically significant differences (p < 0.05). These findings indicate that transperineal 3D ultrasound provides an accurate, efficient, and detailed visualization of pelvic floor structures, aiding in diagnosis and treatment planning for PFD. The technique holds promise for broader clinical application.

OBJECTIVE To investigate the application of transperineal ultrasound (TPUS) and shear wave elastography (SWE) in the assessment of pelvic floor dysfunction (PFD) after total hysterectomy and to explore associated imaging indicators. METHODS Forty-seven women who underwent total hysterectomy and 70 healthy women were prospectively enrolled in our study. We recorded relevant clinical information, including age, body mass index (BMI), and obstetric history. All participants underwent TPUS and SWE examination at rest, during contraction, and during the maximum Valsalva maneuver. The intra- and inter-observer repeatability of SWE measurements was assessed. And the comparison of the imaging parameters between the two groups was conducted. Further receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of TPUS and SWE in predicting PFD. RESULTS SWE used in this study to quantify LAM elasticity demonstrated satisfactory repeatability with all ICC values higher than 0.75. The incidence of PFD was significantly higher in the case group compared to the control group (57.45 % vs. 38.57 %, P = 0.045). The sagittal hiatal diameter (SHD) was higher while the thickness of the levator ani muscle (LAM) was lower in the case group compared to the normal group (P < 0.05), and the SHD showed a positive correlation with PFD while LAM showed a negative correlation. The elastic modulus values of Emax and Emean were significantly increased during contraction in the case group (P = 0.011 and P = 0.029). Further ROC analysis showed that TPUS alone and the combination of TPUS with SWE were both effective in diagnosing PFD than SWE alone (AUC = 0.946, 0.971 and 0.642 respectively). CONCLUSION Our research highlights the significance of the visual assessment of PFD using TPUS and SWE. A widened SHD, a thinned LAM and decreased compliance of LAM during contraction may be correlated with increased PFD.

Background: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using transperineal ultrasound, and to assess associations with the duration of the second stage of labor and mode of delivery. Methods: This is a planned secondary analysis of a randomized controlled clinical trial (RCT) (NCT04563065) including women with singleton pregnancies at 12–14 weeks of gestation. Participants were randomized to either an exercise group, which followed a supervised physical exercise program three times per week, or a control group, which received standard antenatal care. Transperineal ultrasound was used at the second trimester of pregnancy and six months postpartum to measure urogenital hiatus dimensions at rest, during maximal pelvic floor contraction, and during the Valsalva maneuver, to calculate hiatal contractility and distensibility and to evaluate levator ani muscle insertion. Regression analyses were performed to assess the relationship between urogenital hiatus measurements and both duration of the second stage of labor and mode of delivery. Results: A total of 78 participants were included in the final analysis: 41 in the control group and 37 in the exercise group. The anteroposterior diameter of the urogenital hiatus at rest was significantly smaller in the exercise group compared to controls (4.60 mm [SD 0.62] vs. 4.91 mm [SD 0.76]; p = 0.049). No other statistically significant differences were observed in static measurements. However, contractility was significantly reduced in the exercise group for both the latero-lateral diameter (8.54% vs. 4.04%; p = 0.012) and hiatus area (20.15% vs. 12.55%; p = 0.020). Distensibility was similar between groups. There were no significant differences in the duration of the second stage of labor or mode of delivery. Six months after delivery, there was an absolute risk reduction of 32.5% of levator ani muscle avulsion in the exercise group compared to the control group (53.3% and 20.8%, respectively; p = 0.009). Conclusions: A supervised exercise program during pregnancy appears to modify pelvic floor morphology and function, reducing the incidence of levator ani muscle avulsion without affecting the type or duration of delivery. These findings support the safety and potential protective role of prenatal exercise in maintaining pelvic floor integrity.

Objective To assess the impact of total urethral suspension with posterior pelvic floor reconstruction on sexual function in women with stress urinary incontinence(SUI) and concomitant vaginal laxity syndrome (VLS), including partner satisfaction. Methods Clinical data from 150 pelvic floor dysfunction patients were collected at the First Affiliated Hospital of Kunming Medical University (March 2023–March 2024). Preoperative assessments included demographics, obstetric/surgical history, menopausal status, sexual activity and maximum levator hiatal area during Valsalva maneuver on ultrasound. Seventy-five sexually active patients completed the Pelvic Organ Prolapse/Urinary Incontinent Sexual Function Questionnaire Short Form (PISQ-12), with partner satisfaction and vaginal tightness evaluations. At the 1-year postoperative follow-up, patients underwent outpatient clinical evaluations, including the PISQ-12 questionnaire, assessments of vaginal tightness and partner satisfaction, and pelvic floor ultrasound measurements. Results The subjective cure rate for urinary incontinence was 86.67% with a 10.67% improvement rate. Significant improvements were observed in PISQ-12 scores (preoperative: 17.56 ± 5.56 vs. postoperative: 11.72 ± 4.23; P < 0.01). Partners reported increased overall satisfaction (3.21 ± 0.92–3.81 ± 1.06; P < 0.01) and enhanced perception of vaginal tightness (2.47 ± 0.58–4.17 ± 0.62; P < 0.01). Conclusion The combined surgical procedure demonstrates significant therapeutic efficacy in managing SUI and concomitant VLS, with postoperative outcomes showing substantial improvements in both urinary continence and sexual function. Total urethral suspension provides comprehensive to treat SUI. Posterior pelvic floor reconstruction restores anatomical integrity by reducing the levator hiatus and reconstructing the perineal body, thereby normalizing vaginal axis alignment. The subsequent vaginal tightening achieved through these procedures significantly enhances sexual function for both patients and their partners.

No abstract available

This article presents a curated dataset of transperineal pelvic floor ultrasound videos collected from 111 patients in a clinical setting using a Canon i700 Aplio® ultrasound system with a PVT-675 MV 3D probe. Each video captures the midsagittal view of pelvic floor organs at rest and during the Valsalva maneuver. Eight anatomical structures were manually annotated by an expert sonographer using the CVAT platform, resulting in pixel-level segmentation masks. The dataset is intended to support research in automated pelvic floor assessment, medical image segmentation, and dynamic organ tracking. To facilitate reuse, a public source code repository is provided with scripts for data loading, mask generation, and training of baseline deep learning models, including Feature Pyramid Networks (FPNs). This dataset represents the first annotated ultrasound video resources focused on pelvic floor anatomy and is designed to enable benchmarking, reproducibility, and methodological innovation in computer-assisted diagnosis and medical image analysis.

No abstract available

Objective To develop and validate a nomogram prediction model for postpartum stress urinary incontinence (SUI) in primiparous women, and to evaluate its clinical predictive performance. Methods This retrospective study enrolled 447 primiparous women who delivered at Zhejiang Hospital and completed follow-up at 6–8 weeks postpartum between July 2022 and January 2024. Clinical characteristics and three-dimensional pelvic floor ultrasound parameters were collected. Participants were randomly assigned to a training set (n = 312) and a testing set (n = 135) in a 7:3 ratio. Based on the presence or absence of SUI, participants were categorized into an SUI group (n = 158) and a non-SUI group (n = 289). Independent risk factors were identified using multivariate logistic regression and incorporated into a predictive nomogram, which was subsequently validated. Results Operative vaginal delivery, bladder neck position during maximal Valsalva, urethral rotation angle, retrovesical angle during Valsalva, and levator hiatus area were identified as independent predictors of postpartum SUI. The nomogram demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.93 (95% CI: 0.91–0.96) in both the training and testing cohorts. Calibration curves showed strong concordance between predicted and observed outcomes. Decision curve analysis further confirmed the clinical utility of the model. Conclusion The nomogram, which integrates clinical and sonographic variables, shows promising potential as an individualized tool for predicting the risk of postpartum stress urinary incontinence in primiparous women, thereby supporting early screening and timely intervention.

OBJECTIVES To validate the diagnostic accuracy of pelvic floor ultrasound (PFUS) for pelvic organ prolapse (POP) and its correlation with the Pelvic Organ Prolapse Quantification (POP-Q) staging system by performing a rigorous quantitative comparison of anatomical measurements between women with POP and asymptomatic controls. METHODS In this prospective observational study, 80 women with clinically confirmed POP and 60 asymptomatic controls underwent standardized PFUS and POP-Q examinations. PFUS was utilized to measure bladder, uterine, and rectal positions during maximal Valsalva maneuver. POP-Q staging was conducted by two blinded urogynecologists (inter-rater reliability κ = 0.87). Statistical analyses included Spearman's correlation (ρ), diagnostic performance metrics (sensitivity, specificity, accuracy), and group comparisons using t-tests or chi-square tests. RESULTS The POP group exhibited significant organ descent versus controls, including mean bladder descent (4.5 ± 1.2 cm vs. 1.8 ± 0.3 cm; P = 0.004) and uterine descent (5.2 ± 1.4 cm vs. 2.05 ± 0.40 cm; P = 0.012). PFUS measurements demonstrated strong correlation with POP-Q stages (compartment-specific ρ = 0.87-0.91). Overall agreement was 90.0% (ρ = 0.92, P < 0.001), with high diagnostic accuracy (93.5%), sensitivity (>90%), and specificity (>96%). CONCLUSIONS PFUS is a reliable, non-invasive method to quantify pelvic organ displacement, showing excellent agreement with the clinical standard POP-Q system. Its high diagnostic performance supports its integration into clinical practice for objective diagnosis, severity grading, and comprehensive anatomical characterization of POP. ADVANCES IN KNOWLEDGE This study provides robust evidence validating PFUS as a reproducible objective tool for POP assessment.

Purpose To study the utility of Shear Wave Elastic (SWE) combined with transperineal ultrasound in evaluating pelvic floor function after hysterectomy. Patients and Methods Sixty patients who underwent hysterectomy at our hospital between April 2018 and January 2023 were enrolled as the study group, and another 60 volunteers without hysterectomy were selected as the control group. General conditions, Ultrasonic parameters and related factors of pelvic floor dysfunction were collected and compared between the two groups. Results Ultrasonic diameters, including distance between bladder neck and pubic symphysis, the posterior angle of vesicourethra, the anterior-posterior diameter of levator hiatus and bladder neck mobility, were all different between patients with or without hysterectomy during Valsalva (P < 0.05). For SWE examination, elasticity of left and right levator ani muscle (LAM) at rest, the difference in elasticity of left and right levator ani muscle at rest and during Valsalva were statistically different between the two groups (P<0.001). The incidence of cystocele and uterine/vault prolapse in study group was significantly higher than control group (P < 0.05). The evaluation efficiency of transperineal ultrasound plus SWE was better than that of transperineal ultrasound only. Conclusion Pelvic floor dysfunction is more likely to occur in patients with hysterectomy, especially cystocele and uterine/vault prolapse. The decreased elasticity of levator ani muscle may be one of the factors.

To analyse the effect of pelvic position on ultrasonic measurement parameters of pelvic floor in postpartum women. This study included 132 postpartum participants who visited Fujian Maternity and Child Health Hospital from May 2020 to May 2024. All participants were assessed by medical professionals for general information and pelvic floor four dimensional ultrasound. Ultrasonic measurements were performed in three different positions of the pelvis (anterior pelvic tilt, posterior pelvic tilt, and neutral pelvic tilt) based on lithotomy position. Our results indicated that the differences in the diagnosis of cystocele, uterine prolapse, perineal overactivity, and hiatal ballooning among the neutral position, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P<.001, P<.001, P<.001, and P<.001 respectively). The differences among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt in hiatal area (during contraction), hiatal area (during rest), hiatal area (during valsalva), bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent, hiatal area increase, and hiatal area decrease were statistically significant (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the highest among three groups. The differences in cervical position (at rest), rectal ampulla position (at rest), and bladder neck position (during valsalva), cervical position (during valsalva), and rectal ampulla position (during valsalva) among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P <.001, P =.035, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the lowest among three groups. During the pelvic floor muscle contraction, the posterior pelvic tilt showed the most reduction of hiatal area compared to that in other positions. During Valsalva, not only the most increase of the hiatal area, but also the greatest bladder neck descent, cervical neck descent, and rectal ampulla descent were observed in the posterior pelvic tilt position.

Objectives: The aim of this study is to validate a uniform method for measuring perineal descent which can be used for different imaging methods, to establish cut-off values for this measurement, and to assess diagnostic test accuracy (DTA) of imaging techniques using these cut-off values. Secondly, the study aims to correlate perineal descent to symptoms, signs and imaging findings in women with obstructed defaecation syndrome (ODS) to assess its clinical relevance. Methods: Cross-sectional study of 131 women with symptoms of ODS. Symptoms and signs were assessed using validated methods. These women underwent evacuation proctography (EP), magnetic resonance imaging (MRI), transperineal ultrasound (TPUS) and endovaginal ultrasound (EVUS). Perineal descent was measured on EP and MRI as the position of anorectal junction (ARJ) with respect to the pubococcygeal line (PCL) at rest (i.e., static descent) and during evacuation (i.e., descent at Valsalva). Dynamic perineal descent was measured on all four imaging techniques as the difference between the position of the ARJ at rest and Valsalva. DTA of dynamic perineal descent was estimated using Latent Class Analysis in the absence of a reference standard. Results: Interobserver agreement of dynamic perineal descent measurements was good for MRI and EVUS (ICC 0.86 and 0.85) and moderate for EP and TPUS (ICC 0.61 and 0.59). The systematic differences in measurements between imaging techniques show the need for individual cut-off values. New established cut-off values for dynamic descent are for EP 20 mm, MRI 35 mm, TPUS 15 mm and EVUS 15 mm. Sensitivity was moderate for EP (0.78) and MRI (0.74), fair for TPUS (0.65) and poor for EVUS (0.58). Specificity was similar for all imaging techniques (0.73–0.77). Static perineal descent correlated with symptoms of pelvic organ prolapse (POP) (r = 0.19), prolapse of all three compartments (r = 0.19–0.36), presence of levator ani muscle avulsion (p = 0.01) and increased hiatal area (r = 0.51). Dynamic perineal descent correlated with excessive straining (r = 0.24) and use of laxatives (r = 0.24). Classic symptoms of ODS (incomplete evacuation and digitation) did not correlate with perineal descent measurements. Static and dynamic perineal descent were associated with presence of rectocele, enterocele, intussusception, and absence of anismus. Conclusions: Dynamic perineal descent is a reliable measurement that can be applied to different imaging techniques to allow standardisation. Static descent is more often present in women with POP and dynamic descent is more often present in women with constipation. Perineal descent does not correlate with typical symptoms of ODS. Specificity of TPUS and EVUS is comparable to EP and MRI, hence ultrasound could be used for the initial assessment of pelvic floor dysfunction.

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

The objective was to create and validate the usefulness of a convolutional neural network (CNN) for identifying different organs of the pelvic floor in the midsagittal plane via dynamic ultrasound. This observational and prospective study included 110 patients. Transperineal ultrasound scans were performed by an expert sonographer of the pelvic floor. A video of each patient was made that captured the midsagittal plane of the pelvic floor at rest and the change in the pelvic structures during the Valsalva maneuver. After saving the captured videos, we manually labeled the different organs in each video. Three different architectures were tested—UNet, FPN, and LinkNet—to determine which CNN model best recognized anatomical structures. The best model was trained with the 86 cases for the number of epochs determined by the stop criterion via cross-validation. The Dice Similarity Index (DSI) was used for CNN validation. Eighty-six patients were included to train the CNN and 24 to test the CNN. After applying the trained CNN to the 24 test videos, we did not observe any failed segmentation. In fact, we obtained a DSI of 0.79 (95% CI: 0.73 – 0.82) as the median of the 24 test videos. When we studied the organs independently, we observed differences in the DSI of each organ. The poorest DSIs were obtained in the bladder (0.71 [95% CI: 0.70 – 0.73]) and uterus (0.70 [95% CI: 0.68 – 0.74]), whereas the highest DSIs were obtained in the anus (0.81 [95% CI: 0.80 – 0.86]) and levator ani muscle (0.83 [95% CI: 0.82 – 0.83]). Our results show that it is possible to apply deep learning using a trained CNN to identify different pelvic floor organs in the midsagittal plane via dynamic ultrasound.

Background This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. Methods This prospective cohort study included women who had a first delivery and were in weeks 36–41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. Results There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P  < 0.001). The women with Cesarean section had a smaller hiatus area and circumference ( P  < 0.001 and P  < 0.001). The hiatus diameters decreased with time in both groups (all P  < 0.001) and were smaller after Cesarean section (both P  < 0.001). The bladder neck at maximum Valsalva increased with time (all P  < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P  < 0.001), with the proportions being higher in the Cesarean group ( P  = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P  < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P  = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P  < 0.001). Conclusions In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.

This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions. A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions. Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1–5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10–28 for SUI versus normal conditions. Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.

OBJECTIVE To develop an algorithm for the automated localization and measurement of levator hiatus (LH) dimensions (AI-LH) using 3-D pelvic floor ultrasound. METHODS The AI-LH included a 3-D plane regression model and a 2-D segmentation model, which first achieved automated localization of the minimal LH dimension plane (C-plane) and measurement of the hiatal area (HA) on maximum Valsalva on the rendered LH images, but not on the C-plane. The dataset included 600 volumetric data. We compared AI-LH with sonographer difference (ASD) as well as the inter-sonographer differences (IESD) in the testing dataset (n = 240). The assessment encompassed the mean absolute error (MAE) for the angle and center point distance of the C-plane, along with the Dice coefficient, MAE, and intra-class correlation coefficient (ICC) for HA, and included the time consumption. RESULTS The MAE of the C-plane of ASD was 4.81 ± 2.47° with 1.92 ± 1.54 mm. AI-LH achieved a mean Dice coefficient of 0.93 for LH segmentation. The MAE on HA of ASD (1.44 ± 1.12 mm²) was lower than that of IESD (1.63 ± 1.58 mm²). The ICC on HA of ASD (0.964) was higher than that of IESD (0.949). The average time costs of AI-LH and manual measurement were 2.00 ± 0.22 s and 59.60 ± 2.63 s (t = 18.87, p < 0.01), respectively. CONCLUSION AI-LH is accurate, reliable, and robust in the localization and measurement of LH dimensions, which can shorten the time cost, simplify the operation process, and have good value in clinical applications.

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Abstract Background To use the three-dimensional (3D) ultrasound for assessment of pelvic floor muscle function in non-diabetic females with insulin resistance (IR), and to evaluate its functional relationship with insulin levels. Methods From October 2022 to November 2023, 216 non-diabetic females with insulin-resistant (IR group) and 118 normal females (control group) were sequentially recruited from our hospital for our study. The 3D ultrasound was used to assess the levator hiatus in resting state for all females regarding diameter lines, perimeters and areas; as well as the Valsalva manoeuvre (VM). The t-test and linear regression model were used to analyse the collected data. Results The analysis indicates that there were significant differences in the resting state of the levator hiatus between the IR and the control groups (14.8 ± 5.8 cm2 and 11.6 ± 2.7 cm2, p < 0.05); and in the VM (18.2 ± 6.3 cm2 and 13.4 ± 3. 4 cm2, p < 0.05). In addition, the anterior-posterior (AP) diameters of the hiatus on VM were significantly increased in the IR group (40.0 ± 4.7 mm and 33.0 ± 4.4 mm, p < 0.05). With insulin levels as the dependent variable, multivariate regression analysis shows that insulin levels were significantly correlated with the levator hiatus area on VM (p < 0.05) and waist circumference (p < 0.05). The pelvic organ descent on VM in the IR group was significant (p < 0.05). Conclusions The areas of resting state levator hiatus and on VM were significantly larger in the IR than that in the control groups. In addition, the position of the pelvic organ on VM in the IR group was significantly descended. The insulin levels were correlated with the pelvic floor muscle function. PLAIN LANGUAGE SUMMARY With regard to insulin resistance and pelvic floor function, previous studies focused on the role of polycystic ovaries, metabolic syndrome, and pelvic prolapse. The use of ultrasound can improve understanding of the static, dynamic and organ prolapse conditions. This study aimed to assess pelvic floor muscle function in non-diabetic women with insulin resistance, a condition where the body uses insulin less effectively. A total of 216 women with insulin resistance and 118 without it were examined using 3D ultrasound during rest and while performing the Valsalva manoeuvre. Our results show that the pelvic floor muscles had extra space between them and moved differently in women with insulin resistance than in those without the condition. This suggests that insulin resistance may affect function of pelvic floor muscles to cause adverse consequences.

Background Pelvic organ prolapse (POP) is a prevalent ailment that lowers a woman's quality of life and for which precise diagnosis techniques are required for successful treatment. Advanced imaging techniques may be beneficial for traditional clinical assessments like the Pelvic Organ Prolapse Quantification (POP-Q) system. Objectives The purpose of this study was to look into the relationship between the POP-Q score and four-dimensional pelvic floor ultrasonography parameters in women who have been diagnosed with pelvic organ prolapse. Methods We included 120 female patients who presented with symptoms consistent with pelvic floor dysfunction. Pelvic cancers, a history of hysterectomy, and the incapacity to execute Valsalva maneuvers were among the exclusion criteria. The pelvic floor was imaged in three dimensions using a color Doppler ultrasonography equipment (GE, Voluson E8 Edition) both at rest and during Valsalva maneuvers. Important variables, such as the posterior bladder angle and bladder neck distance, were examined and contrasted with POP-Q evaluations. Results According to the study, an ultrasonography was used to detect Green II prolapse in 63 individuals and Green III prolapse in 57 patients. The ultrasonography results and clinical POP-Q diagnosis agreed rather well (Kappa = 0.572). Furthermore, there was a substantial association found between the four-dimensional ultrasound characteristics and the POP-Q stages, suggesting that ultrasonography is a useful tool for visualizing pelvic floor structures. Conclusions According to the results, four-dimensional ultrasonography has a strong correlation with the POP-Q score and is a useful method for evaluating pelvic floor dysfunction. This imaging modality advances our knowledge of the dynamics of the pelvic floor and might lead to more accurate diagnoses for female patients with prolapsed pelvic organs.

To investigate the application of transperineal ultrasound for assessing pelvic floor muscle (PFM) function in male patients with constipation and to evaluate its clinical value. The study included 32 male patients with constipation and 32 healthy controls, all of whom underwent transperineal ultrasound examinations. Measured parameters included the anorectal angle (ARA), levator plate angle (LPA), excursions of the ARA and LPA, and displacements of the bulb of the penis (BP), mid-urethra (MU), urethra-vesical junction (UVJ), and anorectal junction (ARJ) at rest, during maximal voluntary contraction (MVC), and during maximal Valsalva maneuver. Reliability was evaluated in 20 healthy controls using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. (1) The ICCs for each parameter measured by both the same and different observers were above 0.84, indicating high repeatability. At least 90% of the measurements by the same and different observers fell within the 95% confidence interval (CI). (2) At rest, the ARA in patients with constipation was significantly larger than in healthy men (P < 0.05). During MVC, LPA, the ARA excursion, LPA excursion, BP displacement, UVJ displacement, and ARJ displacement in constipation patients were also significantly larger than in healthy men (P < 0.05). Furthermore, BP displacement, UVJ displacement, and ARA excursion during maximal Valsalva maneuver in constipation patients were significantly larger than in healthy men (P < 0.05). (3) Receiver operating characteristic curve analysis revealed that the following indicators demonstrated area under the curve (AUC) values exceeding 0.75: ARA excursion of MVC, ARA excursion of maximal Valsalva maneuver, resting ARA, and ARJ displacement of MVC, with AUC values of 0.782, 0.778, 0.770, and 0.765, respectively. No significant differences in diagnostic performance were found among these indicators (P > 0.05). Transperineal ultrasound is a reliable and practical technique for assessing the morphology and function of male PFMs. Parameters such as ARA excursion during MVC, ARA excursion during maximal Valsalva maneuver, resting ARA, and ARJ displacement during MVC are valuable for diagnosing PFM dysfunction in constipated patients.

Introduction and hypothesis The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI). Methods This cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI ( n  = 19) and runners who did not ( n  = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated. Results No changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run ( p  ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run ( p  ≤ 0.05). No between-group differences were observed for any outcomes. Conclusions Running appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function.

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This study explored the application of transperineal ultrasound (TPUS) combined with shear wave elastography (SWE) in evaluating the pelvic structure function of women after total hysterectomy. Seventy healthy women and 76 women who underwent total hysterectomy were selected for ultrasound examination. They were divided into normal (nulliparous) group, (parous) group without hysterectomy, and (parous) group with hysterectomy. TPUS combined with SWE was used to evaluate the pelvic floor structure and function in the 3 groups of women. Posterior urethrovesical angle in resting and maximal Valsalva state, anteroposterior diameter of hiatus in the 3 states, the bladder neck descent, the urethral rotation angle, the Young modulus of left and right puborectalisis muscle in resting state, and the incidence of pelvic floor dysfunction diseases were all higher in the group with hysterectomy than in the group without hysterectomy (P < .05). Bladder neck-symphyseal distance and anorectal junction-symphyseal distance in the maximum Valsalva state, and the difference in Young modulus between the left and right PR before and after anus contraction were all lower in the group with hysterectomy than the group without hysterectomy (P < .05). The incidence of pelvic floor dysfunction in postmenopausal patients in the group with hysterectomy was higher than that in premenopausal patients (P < .05). Total hysterectomy had negative effects on female pelvic floor structure and function. TPUS combined with SWE can be used to evaluate pelvic floor function in multiple dimensions.

Background Anterior compartment prolapse is a common pelvic organ prolapse (POP), which occurs frequently among middle-aged and elderly women and can cause urinary incontinence, perineal pain and swelling, and seriously affect their physical and mental health. At present, pelvic floor ultrasound is the primary examination method, but it is not carried out by many primary medical institutions due to the significant shortcomings of training in the early stage and the variable image quality. There has been great progress in the application of deep learning (DL) in image-based diagnosis in various clinical contexts. The main purpose of this study was to improve the speed and reliability of pelvic floor ultrasound diagnosis of POP by training neural networks to interpret ultrasound images, thereby facilitating the diagnosis and treatment of POP in primary care. Methods This retrospective study analyzed medical records of women with anterior compartment organ prolapse (n=1,605, mean age 45.1±12.2 years) or without (n=200, mean age 38.1±13.4 years), who were examined at West China Second University Hospital between March 2019 and September 2021. Static ultrasound images of the anterior chamber of the pelvic floor (5,281 abnormal, 535 normal) were captured at rest and at maximal Valsalva motion, and four convolutional neural network (CNN) models, AlexNet, VGG-16, ResNet-18, and ResNet-50, were trained on 80% of the images, then internally validated on the other 20%. Each model was trained in two ways: through a random initialization parameter training method and through a transfer learning method based on ImageNet pre-training. The diagnostic performance of each network was evaluated according to accuracy, precision, recall and F1-score, and the receiver operating characteristic (ROC) curve of each network in the training set and validation set was drawn and the area under the curve (AUC) was obtained. Results All four models, regardless of training method, achieved recognition accuracy of >91%, whereas transfer learning led to more stable and effective feature extraction. Specifically, ResNet-18 and ResNet-50 performed better than AlexNet and VGG-16. However, the four networks learned by transfer all showed fairly high AUCs, with the ResNet-18 network performing the best: it read images in 13.4 msec and provided recognition an accuracy of 93.53% along with an AUC of 0.852. Conclusions Combining DL with pelvic floor ultrasonography can substantially accelerate diagnosis of anterior compartment organ prolapse in women while improving accuracy.

Background The levator ani hiatus (LAH) area is closely associated with the occurrence and severity of pelvic organ prolapse (POP). However, no current data on the definition of normal hiatal dimensions in Chinese women have been published. This study aimed to assess the cut-off area of the LAH for the occurrence of objective and severe POP in Chinese women based on a retrospective cross-sectional study with a large sample. Methods Women from the Postpartum Clinic and Rehabilitation Center of the Pelvic Diseases and Urogynecologic Department of a tertiary hospital were recruited between May 2017 and November 2022. All women underwent Pelvic Organ Prolapse Quantification grading and three-dimensional pelvic floor ultrasonography examinations performed by experienced doctors. The LAH area was measured at resting and maximum Valsalva states using ultrasonography. The association between the hiatal areas and the stages of prolapse was analyzed using the univariant Chi-squared test and Wilcoxon rank sum test. Receiver operating characteristic curve analysis was used to obtain the cut-off area of the LAH for the occurrence of objective and severe POP. Results Overall, 1,633 women were recruited in this study. The hiatal area at rest showed a significant association with POP severity, especially in stages 1, 2, and 3. Larger hiatal areas at rest were correlated with more advanced prolapse stages. For the anterior vaginal wall, a cut-off hiatal area of 14.45 cm2 at rest yielded a sensitivity of 0.57 and a specificity of 0.65 [area under the curve (AUC): 0.65; 95% confidence interval (CI): 0.62–0.68] for significant objective POP, which was the smallest among the three pelvic zones. In cases involving the uterus or vaginal fornix, a cut-off hiatal area of 20.30 cm2 at rest achieved a sensitivity of 0.39 and a specificity of 0.75 (AUC: 0.57; 95% CI: 0.50–0.64) for severe POP, representing the largest cut-off among the three pelvic zones. Conclusions For Chinese women, we suggest a cut-off of 14.45 cm2 at rest for ‘normal’ LAH and the hiatal area of ≥20.30 cm2 at rest for a close correlation with severe POP.

Background Despite the high prevalence of hysterectomy, the procedure is associated with a significant risk of subsequent pelvic floor dysfunction (PFD). This study aimed to evaluate pelvic floor alterations following hysterectomy and bilateral adnexectomy using real-time shear wave elastography (SWE) and pelvic floor ultrasonography. Methods This is a retrospective case-control study. A total of 133 patients who underwent hysterectomy and bilateral adnexectomy for benign or malignant pelvic conditions were included. Participants were categorized into three groups based on the time elapsed since surgery: less than 1 year (n=41), 1–3 years (n=45), and more than 3 years (n=47). Additionally, 45 healthy individuals without a history of hysterectomy or bilateral adnexectomy were enrolled as the control group. Pelvic floor ultrasonography was performed to assess parameters at rest and during the Valsalva maneuver. Real-time SWE was used to measure the elasticity of the anterior, middle, and posterior regions of the bilateral puborectalis (PR) muscle during rest, pelvic floor muscle contraction, and the Valsalva maneuver. Comparisons between two groups were conducted using independent t-tests, whereas multiple group comparisons were analyzed using analysis of variance (ANOVA). For intra-group comparisons, paired sample t-tests were used. Results Pelvic floor ultrasonography revealed that, compared to the control group, all postoperative groups exhibited a reduced urethral inclination angle at rest and an increased angle during the Valsalva maneuver (P<0.05). The levator hiatus area (LHA) was significantly larger during the Valsalva maneuver in all postoperative groups compared to the control group (P<0.05). Patients in the 1–3 years and more than 3 years post-surgery groups demonstrated reduced distance from the anterior urethrovesical junction to the reference line and posterior bladder wall distance during both rest and the Valsalva maneuver compared to the control group (P<0.05). Additionally, the more than 3 years post-surgery group indicated an increased bladder neck mobility during the Valsalva maneuver. Real-time SWE measurements showed that PR elasticity was highest during pelvic floor muscle contraction in the control group, followed by the Valsalva maneuver and rest. Among the postoperative groups, PR elasticity at rest was lower than it was in the control group (P<0.05), with further reductions observed during pelvic floor muscle contraction in the 1–3 years and more than 3 years post-surgery groups. Conclusions Real-time SWE and ultrasonography reveal that hysterectomy with bilateral adnexectomy leads to progressive, quantifiable declines in pelvic floor muscle elasticity and structural support. These findings provide objective biomarkers for postoperative assessment and potential targets for personalized rehabilitation.

Objective: To identify the independent risk factors for postpartum stress urinary incontinence by combining pelvic floor ultrasound parameters with clinical information. Methods: Pelvic floor examination and clinical data were collected from 152 postpartum women who underwent pelvic floor ultrasound at Yancheng Third People’s Hospital between December 2023 and September 2024. Independent risk factors for postpartum stress urinary incontinence were identified using multivariate logistic regression analysis. A nomogram model was constructed using R 4.3.1 software and the rms package to evaluate the correlation between the identified factors and the disease. Results: Maximal Valsalva state posterior urethrovesical angle (RVA), bladder neck descent, and Young’s modulus of the resting posterior lip of the urethral sphincter were identified as independent risk factors for postpartum stress urinary incontinence (p < 0.05). The areas under the receiver operating characteristic curve for RVA, bladder neck descent, and posterior lip of the urethral sphincter were 0.840, 0.867, and 0.914, respectively, indicating high diagnostic efficiency. The nomogram model demonstrated that the risk of developing stress urinary incontinence increased with higher RVA and bladder neck descent values and lower posterior lip of the urethral sphincter values, with posterior lip of the urethral sphincter showing the strongest correlation with the disease. Conclusion: RVA (Valsalva), bladder neck descent, and posterior lip of the urethral sphincter are independent risk factors for postpartum stress urinary incontinence. The nomogram model based on these factors demonstrated high diagnostic performance (area under the curve = 0.984), suggesting potential utility for clinical application. However, this model is preliminary and requires validation in larger, multicenter cohorts before widespread use.

OBJECTIVE To compare the effects of pelvic floor muscle exercises (PFME) combined with standard diaphragm exercises and 360° expanded diaphragm exercises on urinary symptoms, pelvic floor muscle (PFM) function, and respiratory function in women with stress urinary incontinence (SUI). DESIGN Randomized controlled study SETTING: The study conducted between November 2023-2024 at Izmir University of Economics PARTICIPANTS: Women with SUI INTERVENTIONS: Participants were randomly allocated into two groups: PFME+Standard diaphragm (n=37) and PFME+360° expanded diaphragm exercises (n=37). The 360° exercises were taught using two sensor-based biofeedback devices. Both groups completed an 8-week program with weekly sessions. MAIN OUTCOME MEASURES Primary outcome=Precontraction of the PFM; secondary outcomes = Incontinence Severity Index (ISI), The International Consultation on Incontinence Questionnaire- short form (ICIQ-SF), PFM and respiratory functions (Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)). RESULTS The sociodemographic and clinical characteristics of the PFME+Standard diaphragm (49.29±6.73 years) and the PFME+360° expanded diaphragm exercises groups (50.97±7.70 years) were similar (p>0.05). Before and after the 8-week exercise program, both groups showed significant improvement in PFM functions as well as in ISI, ICIQ-SF, MIP and MEP values (p<0.05). Additionally, the initiation time for PFM contraction during the Valsalva maneuver (pre-contraction of PFM) was reduced in the PFME+360° expanded diaphragm exercises group after treatment (p=0.010). CONCLUSIONS This study demonstrated that PFME combined with various diaphragm exercises improved urinary symptoms and PFM function in women with SUI. Specifically, PFME with 360° expansion diaphragm exercises reduced the initiation time of PFM contraction during Valsalva. This approach may enhance PFME effectiveness in women with impaired pre-contraction ability. As this study focused only on women, future research should explore the efficacy of similar interventions in gender-diverse populations.

Background Given the high prevalence of pelvic floor disorders (PFD) and their association with structural and functional compromise of the levator ani muscle complex, particularly the puborectalis, this study aims to assess pelvic floor functionality by using intelligent pelvic floor ultrasound combined with real-time shear wave elastography (SWE) to evaluate anatomical integrity, mobility, and tissue elasticity. Methods Seventy-one women presenting symptoms indicative of PFD were enrolled in this study and constituted the PFD group. In contrast, an equal number of women lacking such symptoms comprised the non-PFD group. Among the latter, 54 cases exhibited normal pelvic function, serving as the normal control group. Subsequently, participants were divided into subsets based on pelvic floor ultrasound findings, distinguishing between those with normal and abnormal two-dimensional (2D) and three-dimensional (3D) imaging results. Various parameters from pelvic floor 2D and 3D ultrasound examinations, along with real-time SWE measurements conducted during rest, contraction, and Valsalva maneuvers, were analyzed. Results In the normal control group, there was no significant difference in Young’s modulus between the left and right puborectalis muscles (P>0.05), so data were combined for analysis. Among physiological states, Young’s modulus followed the pattern: contraction [median (interquartile range): 100.90 (80.66, 119.94) kPa] > Valsalva [64.00 (44.57, 82.90) kPa] > resting [46.23 (30.68, 65.84) kPa], with all comparisons showing statistical significance (P<0.05). No significant difference in puborectalis muscle stiffness was observed between the PFD group and the non-PFD group overall (P>0.05). However, within the PFD group, during the resting state, both the 2D abnormal subgroup (45.51±19.20 kPa) and 3D abnormal subgroup [41.72 (28.57, 57.14) kPa] exhibited significantly lower Young’s modulus compared to their respective normal subgroups [2D normal: 61.70±22.74 kPa; 3D normal: 53.50 (38.89, 72.73) kPa; P<0.05]. These differences were not present during contraction or Valsalva (P>0.05). In the non-PFD group, no significant differences in stiffness were found between the 2D/3D abnormal and normal subgroups in any state (P>0.05). Conclusions SWE offers a quantitative assessment of the firmness and resilience of the puborectalis muscle, as well as the changes in muscle firmness across distinct pelvic floor states. This analysis furnishes empirical evidence supporting the manifestation of symptoms associated with PFD.

Aims/Background Pregnancy and childbirth can significantly alter pelvic floor structure and function, particularly during the postpartum period, often resulting in dysfunction. Although maternal age and the number of vaginal deliveries have been reported as risk factors for pelvic floor dysfunction, studies on how these factors interact to impact pelvic floor dysfunction and recovery in the postpartum period are limited. Therefore, this study explored the integrated effects of age groups and the number of vaginal deliveries on pelvic floor electromyography and structural indicators among postpartum women. Methods This retrospective cohort study collected data of 245 postpartum women 42-60 days after delivery from the clinic's records of the Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences between January 2020 and December 2022. Of these patients, 108 were multiparous and 137 were primiparous. Based on age, participants were divided into two groups: ≤30 (n = 102) and >30 (n = 143) years groups. Pelvic floor recovery was compared across these subgroups using ultrasound and electromyography (EMG). Results Findings revealed age-related disparities in electromyography findings of slow-twitch pelvic floor muscles. Postpartum women aged ≤30 years exhibited higher endurance contraction variability of slow-twitch muscles (p = 0.049). Pelvic floor ultrasound showed that women aged >30 years had greater anorectal angles (p = 0.024) and levator hiatus areas (p = 0.034) after the Valsalva maneuver. Multiparous women exhibited increased variability in slow-twitch muscle contractions (p = 0.026) and prolonged relaxation time (p = 0.031). Primiparous women showed higher post-resting average values (p = 0.009). Pelvic floor ultrasound indicated greater bladder neck mobility (p < 0.001), levator hiatus area (p = 0.013), and urinary incontinence prevalence (p = 0.026) in multiparous women. When cross-grouped, multiparas ≤30 years exhibited higher pre-resting EMG values (p = 0.035). Additionally, tonic contraction variability (p = 0.014), tonic contraction relaxation time (p = 0.025), and post-resting mean values (p = 0.003) showed significant differences, particularly in women over 30. In contrast, multiparas demonstrated both increased bladder neck mobility (p = 0.004) and significant differences in the anorectal angle (p < 0.001) and levator hiatus area (p = 0.038) compared to other groups. Conclusion Reproductive-aged women over 30 years with multiple deliveries exhibit compounded pelvic floor dysfunction, particularly in slow-twitch muscle coordination and structural support parameters (anorectal angle and levator hiatus area), informing targeted rehabilitation strategies to optimize rapid recovery.

The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. Sixty patients who volunteered for a PFMT assessment at 6–8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.

Graphical abstract Stress urinary incontinence often results from pelvic support structures’ weakening or damage. This dysfunction is related to direct injury of the pelvic organ’s muscular, ligamentous or connective tissue structures due to aging, vaginal delivery or increase of the intra-abdominal pressure, for example, defecation or due to obesity. Mechanical changes alter the soft tissues’ microstructural composition and therefore may affect their biomechanical properties. This study focuses on adapting an inverse finite element analysis to estimate the in vivo bladder’s biomechanical properties of two groups of women (continent group (G1) and incontinent group (G2)). These properties were estimated based on MRI, by comparing measurement of the bladder neck’s displacements during dynamic MRI acquired in Valsalva maneuver with the results from inverse analysis. For G2, the intra-abdominal pressure was adjusted after applying a 95% impairment to the supporting structures. The material parameters were estimated for the two groups using the Ogden hyperelastic constitutive model. Finite element analysis results showed that the bladder tissue of women with stress urinary incontinence have the highest stiffness (α1 = 0.202 MPa and µ1 = 7.720 MPa) approximately 47% higher when compared to continent women. According to the bladder neck’s supero-inferior displacement measured in the MRI, the intra-abdominal pressure values were adjusted for the G2, presenting a difference of 20% (4.0 kPa for G1 and 5.0 kPa for G2). The knowledge of the pelvic structures’ biomechanical properties, through this non-invasive methodology, can be crucial in the choice of the synthetic mesh to treat dysfunction when considering personalized options.

BACKGROUND & AIMS The contribution of the abdominal muscles to normal defecation and disturbances thereof in defecatory disorders (DD) are unknown. METHODS In 30 healthy and 60 constipated women with normal rectal balloon expulsion time (BET) (n=26) or prolonged BET (ie, defecatory disorder, DD, n=34), seated anorectal pressures (manometry) and thickness (ultrasound) of the external and internal oblique and transversus abdominis muscles were simultaneously measured at rest, during hollowing, squeeze, evacuation, and a Valsalva maneuver. RESULTS Compared to healthy women with a normal BET, DD women had a lower rectal and greater anal pressure increase during evacuation (P ≤.05) and more activation of the internal oblique and the transversus abdominis muscles during squeeze (P<.05). The change in transversus abdominis thickness during a Valsalva maneuver vs hollowing (rho=0.5,P=.002) and separately vs evacuation (rho=0.7,P<.0001) were correlated in DD but not in healthy women with a normal BET. A principal component (PC) analysis of anorectal pressures and muscle thicknesses during evacuation uncovered a PC (PC3) that was associated with a prolonged BET. Higher PC3 scores were associated with low rectal and high anal pressures at rest and during evacuation, thinner external oblique, and thicker internal oblique muscle during evacuation. A greater PC3 score was associated with increased odds for DD versus health (OR[95% CI]=2[1.1-3.6]), and separately versus constipation with a normal BET (OR[95% CI]=3[1.6-5.7]). CONCLUSION Taken together, these findings reveal three, possibly interrelated, disturbances suggestive of dyscoordination in DD: aberrant activation of abdominal muscles during squeeze in DD, dyscoordination of the abdominal muscles during various tasks in constipated women, and abdomino-anal dyscoordination.

Introduction: Chronic constipation (CC) is a common issue in primary care and gastroenterology. Defined variably by patients and clinicians, CC per Rome III criteria requires symptoms for six months, present three or more days per month for three months. Dyssynergic defecation (DD), a functional constipation type, involves the failure of pelvic floor muscles to relax during defecation. This study examines the relationship between DD, puborectalis muscle thickness, and subcutaneous adipose tissue thickness via MR defecography. Material and Method: After ethical approval, MR defecography images of 110 patients from Ankara Bilkent City Hospital were analyzed retrospectively. Exclusions included pelvic floor descensus, rectal mass, cystocele, rectocele, or movement artifacts. The study comprised 52 DD patients and 52 matched controls. Measurements of subcutaneous adipose tissue at L5-S1 and puborectalis muscle thickness were performed on T2-weighted images. Results: DD patients had significantly higher abdominal subcutaneous adipose tissue and puborectalis muscle thickness than controls (p=0.021, p=0.001). No significant gender differences were noted. ROC analysis revealed cut-off values of 23 mm for adipose tissue and 4.8 mm for puborectalis muscle thickness. Positive predictive values for DD were 62% for adipose tissue >23 mm, 74% for puborectalis muscle thickness >4.8 mm, and 90% for both criteria. Discussion: MR defecography is essential for diagnosing DD. This study is the first to investigate the link between DD and puborectalis muscle thickness. Increased abdominal subcutaneous adipose tissue suggests a connection between DD and obesity, possibly due to increased intra-abdominal pressure leading to higher puborectalis muscle tone. Conclusion: Puborectalis muscle thickness >4.8 mm and abdominal subcutaneous adipose tissue thickness >23 mm are key parameters for diagnosing DD in MR defecography. These findings underscore the importance of MR defecography in diagnosing and understanding DD, leading to more precise and individualized treatments.

Introduction The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI. Aim To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI. Material and methods Sixty-six patients (41 men and 25 women) with colorectal cancer undergoing elective laparoscopic colorectal surgery were randomized into 3 groups, according to different IAP levels during CO2 pneumoperitoneum (10 mm Hg, 12 mm Hg and 15 mm Hg). We recorded the incidence of AGI after surgery by assessing the following parameters: time to first flatus/defecation, time to first bowel movement, time to tolerance of semi-liquid food and the occurrence of vomiting/diarrhea. Moreover, inflammatory mediators were measured before the induction of CO2 pneumoperitoneum and on postoperative day 1. Results Acute gastrointestinal injury occurred in 15 (27.3%) patients. In all 3 study groups, the elevation of IAP during CO2 pneumoperitoneum did not significantly increase the occurrence of symptoms of AGI, vomiting or diarrhea. Lower IAP levels did not significantly accelerate recovery of gastrointestinal function or shorten postoperative hospital stay. The changes in serum IL-6 after surgery did not correlate with the value of IAP. Conclusions The level of IAP elevation during laparoscopic colorectal surgery does not increase the occurrence of AGI after surgery.

No abstract available

Purpose Maintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI). Methods A total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the Mesure du Handicap Urinaire. The perineal examination consisted of rating the strength of the levator ani muscle (0–5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm H2O), and pressure transmission ratio (%). Results Of the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88–0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve>0.80). s-UCP values less than or equal to 20 cm H2O had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant. Conclusions s-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.

PURPOSE The main purpose of this study is to obtain a finite element biomechanical model that accurately mimics pelvic organ prolapse in women, to study pelvic floor supporting structures' biomechanical properties and function. We used thin-sectional high-resolution anatomical images (Chinese Visible Human, CVH) to reconstruct a detailed three-dimensional (3D) biomechanical finite element model of the female pelvic floor supporting structure including cardinal ligament, uterosacral ligament, levator ani muscle (LAM) and perianal body. The Valsalva maneuver was simulated by loading the uterus and bladder with a pressure increasing from 0 to 10 kPa. The stress, strain and displacement of supporting structures were calculated. The cardinal ligament, the uterosacral ligament and the LAM were stressed greatly when the uterus moved downward, and the maximum stress could reach 0.267 MPa, 1.51 MPa and 0.065 MPa respectively, and the maximum strain could reach 0.154, 0.16, 0.265, and the maximum displacement could reach 1.786 cm, 1.946 cm and 0.567 cm. Displacement of the perineal body also occurred, and its stress, strain and displacement were 0.092 MPa, 0.381, 0.73 cm. The stress, strain and displacement of the supporting structure around the urethra were 0.339 MPa, 0.169, 1.491 cm. Our model based on CVH has more detailed anatomical structures, which is superior to that based on MRI. Our simulation results were consistent with previous findings, which verified the unbalance of abdominal pressure and pelvic floor supporting structures will lead to POP, which provide a theoretical basis for pelvic floor anatomy and function as well as obstetrical surgery.

No abstract available

No abstract available

In clinical practice, it is well known that an increase in intra-abdominal pressure can lead to disorders in the functioning of internal organs, cause the development of multiple organ failure and the formation of pelvic organ prolapse. Despite the fact that the pelvic bottom along with the muscles of the anterior abdominal wall and the diaphragm, takes an active part in the formation of intra-abdominal pressure, so far there are practically no morphological studies of the muscles of the pelvic diaphragm and their reactive changes that occur in response to an increase in intra-abdominal pressure. The aim of the study was to study the ultrastructural rearrangements of the levator ani muscle in response to experimentally formed states of increase and decrease in intra-abdominal pressure. The work was performed on 21 male outbred adult white laboratory rats. It has been established that after damage to the myofibrillar apparatus of the muscle fibers of the levator ani muscle in response to an increase in intra-abdominal pressure, the processes of sarcoplasmic adaptation and activation of the synthetic apparatus begin in them, which leads to a gradual restoration of their structure to its initial state. These changes are subject to certain time dynamics. 4 weeks after the increase in intra-abdominal pressure, a slight atrophy of the myofibrillar apparatus is observed and expansions of the intermyofibrillar cytoplasmic matrix appear. In mitochondria distinctly expressed irreversible changes in mitochondria occur, many mitochondria die. Subsequently, a significant amount of glycogen granules appears between the myofibrils, the structure of the myons is restored. Eight weeks after the start of the experiment, the structure of most muscle fibers is restored almost completely. The structure of the levator ani muscle did not change during the simulation of reduced intra-abdominal pressure in comparison with the control group at all periods of observation. In general, the study shows that the levator ani muscle skeletal muscle tissue has a high mechanic-dependent plasticity, which manifests itself in compensatory rearrangements of the ultrastructure of its fibers in response to changes in intra-abdominal pressure.

Background This single-center study involved 33 women diagnosed with pelvic organ prolapse (POP), aiming to evaluate the levator ani muscle (LAM) using pre- and post-surgery magnetic resonance imaging (MRI). Material/Methods MRI data of 33 women were analyzed before and after POP surgery. Diagnoses used the Pelvic Organ Prolapse Quantification (POP-Q) system, including 10 cases of stage II, 5 of stage III, and 18 of stage IV with pelvic organ prolapse. All participants underwent pelvic floor reconstruction surgery. Morphological parameters, including the levator hiatus’s length, width, area, and the distance between the LAMs and the pubic symphysis’s inferior point, were assessed before and after surgery. Results Significant pre- and post-surgery differences were observed in the levator hiatus’s shape, length, width, and area, and the distance between levator ani and pubic symphysis in both static and Valsalva states. Conclusions We found structural changes in the LAM morphology in women with POP, as assessed by MRI, suggesting potential improvements in clinical function.

Background: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. Objective: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. Study Design: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary‐level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. Results: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r = ‐0.230, P = .021) and active second stage (r = ‐0.338, P = .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158–3.752; P = .014). There was no significant difference between women who underwent operative delivery (n = 46) when compared with the spontaneous vaginal delivery group (n = 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P = .49). Conclusion: Levator ani coactivation is associated with a longer active second stage of labor.

Objective This study investigated the predicting value of the ratio of levator hiatus diameter (LHS) to fetal head circumference (HC) in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum. Methods A total of 120 first-time women who gave vaginal delivery at 37 weeks of pregnancy were selected as the subjects in our hospital during March 2021 to March 2022. The subjects were divided into the second stage of labor > 1 h group and the second stage of labor ≤ 1 h group, according to the delivery time of the second stage of labor. According to the 6-week postpartum follow-up ultrasound examination with or without levator ani injury, they were divided into levator ani injury group and no injury group. All primipara women underwent three-dimensional ultrasonography at 37 weeks of gestation, and the resting LHS, Valsalva LHS, fetal HC and the ratio of resting LHS and fetal HC were compared. The correlation between these factors and the length of the second labor stage was analyzed using Pearson correlation analysis. The value of these factors in predicting labor progression and postpartum levator ani injury was assessed by receiver operating characteristic (ROC) curves. Results The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the levator ani injury group were lower than these in the no injury group, while fetal HC in the levator ani injury group was higher than that in the no injury group (P < 0.05). The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the second stage of labor > 1 h group were lower than these in the second stage of labor ≤ 1 h group, while fetal HC in the second stage of labor > 1 h group was higher than that in the second stage of labor ≤ 1 h group (P < 0.05). A significant negative correlation was observed between resting LHS/HC and total labor process (=-0.333, P < 0.01). ROC curve analysis showed that the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting prolongation of the second stage of labor were 0.741, 0.740, 0.702, and 0.843 respectively. Besides, the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting the total labor process were 0.657, 0.684, 0.768, and 0.836 respectively. The AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting postpartum levator ani muscle injury were 0.769, 0.773, 0.747, and 0.885 respectively.These results suggested that the ratio of resting LHS and fetal HC may have certain clinical value in predicting levator ani injury in pregnant women. Conclusion LHS, fetal HC and the ratio of resting LHS and fetal HC are significantly correlated with labor progression and postpartum levator ani injury, which have certain value in predicting labor progress and postpartum levator ani injury. Therein, the ratio of resting LHS and fetal HC has the highest predictive value, and early detection of the ratio of resting LHS and fetal HC is helpful to guide the selection of appropriate delivery mode.

To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis‐uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP).

Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area. Methods We carried out a planned secondary analysis from a randomized controlled study. Primiparous women ( n =175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants ( n =87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants ( n =88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Between-group comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data. Results Six months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva. Conclusions Supervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.

Background The levator ani muscle (LAM) comprises the main component of female pelvic floor support structure and plays an important role in maintaining the normal position of pelvic organs. Early detection of its injury is critical to ensure the health of the pelvic floor. Vaginal delivery exacerbates LAM injury, and LAM injury changes the normal pelvic floor structure. Therefore, this study used ultrasound to measure the degree of pelvic organ decline enabling qualitative assessment of the severity of prolapse. To investigate whether vaginal delivery leads to greater LAM trauma and pelvic organ support loss than does cesarean delivery, we utilized combined two-dimensional (2D) and three-dimensional (3D) ultrasound to better evaluate the changes of pelvic floor structure in different delivery modes. Methods From December 2021 to October 2023, 130 patients with a full-term singleton pregnancy (weighing 2.50–4.00 kg) who underwent pelvic floor ultrasound examination were divided into a forceps group, a non-forceps group (spontaneous delivery was achieved without the aid of other means), and a cesarean section group. The ultrasound images and clinical data of the three groups were analyzed. 2D and 3D ultrasound of the pelvic floor was used to measure the levator ani-urethral gap (LUG) in a constrictive anal state, the levator ani hiatus area (LHA) in the Valsalva state, the degree of pelvic organ descent, and the degree of LAM injury. The differences between different groups were compared. Chi-square test and one-way analysis of variance (ANOVA) were used to compare whether there were differences among the three groups. Bonferroni correction was performed. Results The injury degree of LAM in the forceps group, the non-forceps group, and the cesarean section group decreased in turn, and the difference was statistically significant (P<0.001). In the Valsalva state, the lowest points of the anterior and middle pelvic organs in the forceps group and the non-forceps group were farther from the reference line than those in the elective cesarean section group, and the difference was statistically significant (P<0.001). Anterior pelvic prolapse was more severe than middle pelvic prolapse across all delivery groups (the Chi-squared value for anterior pelvic prolapse was 22.919; that for the middle pelvic organs was 14.541). Conclusions Transperineal 2D combined with 3D ultrasound can effectively evaluate the effects of different delivery modes on the LAM and pelvic floor structure. Vaginal delivery increases the incidence of LAM injury and anterior and middle pelvic prolapse. The use of forceps can aggravate the degree of LAM injury, but it is not a high risk factor for prolapse. Pregnancy has a more significant effect on anterior pelvic prolapse than it does on middle pelvic prolapse.

Abstract Objective To assess the correlation between fetal head regression and levator ani muscle (LAM) co-activation under Valsalva maneuver. Study design This study was a secondary analysis of a prospective cohort study on the association between the angle of progression (AoP) and labor outcome. We scanned a group of nulliparous women at term before the onset of labor at rest and under maximum Valsalva maneuver. In addition to the previously calculated AoP, in the present study, we measured the anteroposterior diameter of LAM hiatus (APD) on each ultrasound image. LAM co-activation was defined as APD at Valsalva less than that at rest, whereas fetal head regression was defined as AoP at Valsalva less than that at rest. We calculated the correlation between the two phenomena. Finally, we examined various labor outcomes according to the presence, absence, or co-existence of these two phenomena. Results We included 469 women. A total of 129 (27.5%) women presented LAM co-activation while 50 (10.7%) showed head regression. Only 15 (3.2%) women showed simultaneous head regression and LAM co-activation. Women with coexisting LAM co-activation and head regression had the narrowest AoP at Valsalva in comparison with other study groups (p < .001). In addition, they had the highest risk of Cesarean delivery (40%) and longest first, second, and active second stage durations, although none of these reached statistical significance. Conclusion In nulliparous women at term before the onset of labor fetal head regression and LAM co-activation at Valsalva are two distinct phenomena that uncommonly coexist.

The relationship between the anorectal angle (ARA) and the levator ani muscle (LAM) is well known. In this study, we aimed to demonstrate that the ARA changes when LAM avulsion occurs after vaginal delivery. This was a secondary, observational retrospective study with data obtained from three previous studies. Using transperineal ultrasound, the presence of avulsion was assessed when abnormal insertion of the LAM was observed in three central slices. In addition, the ARA was assessed in the midsagittal plane (at rest, in Valsalva and at maximum contraction) as the angle between the posterior border of the distal part of the rectum and the central axis of the anal canal. The ARA was higher in patients with bilateral LAM avulsion than in patients without LAM avulsion at rest (131.8 ± 14.1 vs. 136.2 ± 13.8), in Valsalva (129.4 ± 15.5 vs. 136.5 ± 14.4) and at maximum contraction (125.7 ± 15.5 vs. 132.3 ± 13.2). The differences between both groups expressed as the odds ratio (OR) adjusted for maternal age were 1.031 (95% confidence interval (CI), 1.001–1.061; p = 0.041) at rest, 1.036 (95% CI, 1.008–1.064; p = 0.012) in Valsalva and 1.031 (95% CI, 1.003–1.059; p = 0.027) at maximum contraction. In conclusion, LAM avulsion produces an increase in the ARA at rest, during contraction and in Valsalva, especially in cases of bilateral LAM avulsion.

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18–5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.

Morphological organization of the levator ani muscle still remains unclear due to methodological problems in the study of the pelvic floor muscles. Therefore, the study of the histological structure of muscle tissue m. levator ani in animals is of not only theoretical but also practical importance for the study and modeling of pelvic floor dysfunction conditions in animal models. The aim is to study the enzymohistochemical and ultramicroscopic organization of the levator ani muscle in white laboratory rats. Material and methods. The study was performed on 10 laboratory Wistar rats (5 females and 5 males) aged 12–14 months. The metabolic profile of muscle fibers was determined using the Nachlass succinate dehydrogenase test. Imaging and linear measurements were carried out on a Leica UC 7 microscope (Germany), using its software. Ultrathin sections were counterstained with uranyl acetate and lead citrate, viewed nd photographed using a Hitachi HT 7700 Exalens (Japan) electron microscope. Results. All types of muscle fibers are present in levator ani muscle: slow fibers and rapid muscle fibers of typs IIA and IIB. It has been established that the total cross-sectional area of white type fibers is 3 times greater than the total area of other fibers. Significant sex differences were found in relative square parameters of glycolytic fibers in m. levator ani (p=0,009). At the ultrastructural level, it was found that in some muscle fibers the mitochondrial apparatus is well developed, in others, mitochondria are few in number, have smaller sizes, are located singly between myofibrils, without forming clusters. In such fibers, there are large accumulations of glycogen between the myofibrils. Conclusion. In the laboratory rat, the levator ani muscle is heterogeneous both in metabolic activity of muscle fibers and in ultrastructural organization. This feature of the muscle involves not only static work in creating intra-abdominal pressure and retaining the pelvic organs, but also isotonic contraction, acting as a synergist to ensure the movement of the tail.

[Purpose] This study aimed to explore the application value of yoga intervention in early postpartum recovery of the levator ani muscle hiatus (LAH) area. [Participants and Methods] Females in natural labor from May 2020 to November 2020 in the Third People’s Hospital of Sun Yat-sen University Ultrasound Research Center were prospectively included for a pelvic ultrasound examination. The control group received no intervention. The experimental group received 60-min yoga once a week from week 1 to week 12 postpartum. A pelvic ultrasound examination was performed on the week 6 and week 12 postpartum. The LAH area was measured at rest, during contraction and Valsalva maneuver. [Results] A total of 128 participants who met the inclusion criteria were selected and randomly assigned to the control group (n=66) and the experimental group (n=62) in pre and post intervention design. No significant differences were found in age, parity, body mass index, and fetal weight between the control and experimental groups. Further, no significant difference was observed in the LAH area between the control and experimental groups at rest, during contraction and Valsalva maneuver on the week 6 postpartum. However, the LAH area in experimental group significantly reduced at rest, during contraction and Valsalva maneuver on the week 12 postpartum. The differences of LAH area (date week 6 minus date week 12) in the control group at rest, during contraction and Valsalva maneuver were 0.12 ± 3.12 cm2, 0.80 ± 2.29 cm2, and 0.80 ± 4.22 cm2, while in the control these were 1.95 ± 3.41 cm2, 1.39 ± 1.91 cm2, and 3.81 ± 5.49 cm2, respectively. Compared with control group, the differences of LAH area significantly increased in experimental group at rest and during Valsalva maneuver. [Conclusion] Yoga intervention can help in the recovery of LAH.

BACKGROUND Obstetrical levator ani muscle avulsion is detected after 10%-30% of vaginal deliveries and is associated with pelvic organ prolapse later in life. However, the mechanism by which levator avulsion may contribute to prolapse is unknown. OBJECTIVES This study investigated the extent by which size of the levator hiatus and pelvic muscle weakness may explain the association between levator avulsion and pelvic organ prolapse. STUDY DESIGN This was a supplementary study of a longitudinal cohort of parous women enrolled 5-10 years after first delivery and assessed annually for prolapse (defined as descent beyond the hymen) for up to 9 annual visits. For this substudy, vaginally parous participants were assessed for levator avulsion using 3-dimensional transperineal ultrasound. Ultrasound was performed at a median interval of 11 years from delivery. Ultrasound volumes also were used to measure levator hiatus area with Valsalva. Pelvic muscle strength was measured with perineometry. Women with and without pelvic organ prolapse were compared for levator avulsion, levator hiatus area, and pelvic muscle strength, using multivariable logistic regression yielding a measure of mediation. Bootstrap methods were used to calculate the confidence interval corresponding to the measure of mediation by hiatus area and pelvic muscle strength. RESULTS Prolapse was identified in 109 of 429 (25%) and was significantly associated with levator avulsion (odds ratio, 4.17; 95% confidence interval, 2.28-7.31). Prolapse also was associated with levator hiatus area (odds ratio, 1.52 per 5 cm2; 95% confidence interval, 1.34-1.73) and inversely with muscle strength (odds ratio, 0.87 per 5 cm H2O; 95% confidence interval, 0.81-0.94). In a multivariable logistic model including levator avulsion, levator hiatus area, and strength, the association between levator avulsion and prolapse was substantially attenuated and indeed was no longer statistically significant (odds ratio, 1.75; 95% confidence interval, 0.91-3.39). Hiatus area and strength mediated 61% (95% confidence interval, 34%-106%) of the association between avulsion and prolapse. Furthermore, since the 95% confidence interval for this estimate contained 100%, it cannot be ruled out that the 2 markers fully mediate the effect of avulsion on prolapse. CONCLUSIONS The strong association between pelvic organ prolapse and levator avulsion can be explained to a large extent by a larger levator hiatus and weaker pelvic muscles after levator avulsion.

The primary aim of the present study was to assess the association between levator ani muscle (LAM) integrity and function on the one hand, and the risk of urinary incontinence (UI) on the other. A secondary objective was to assess the association between fundal pressure in the second stage of labor (Kristeller maneuver) and the risk of postpartum UI.

To assess the predictive value of measures of levator hiatal distension at rest and on maximum Valsalva maneuver for symptoms of vaginal laxity.

Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

PURPOSE To investigate the elasticity of the levator ani musle (LAM) with the patients suffering from stress urinary incontinence (SUI) by transperineal elastography. METHODS Conventional transperineal ultrasound and elastography were performed in the patients with SUI on quiescent condition and maximal Valsalva. Transperineal ultrasound and elastography were repeated after Kegel exercises. The scoring system and strain ratio (SR) values were recorded and analyzed. RESULTS After Kegel exercises, the ratio of subjective improvement or cure was 81 % (102/126). Mean elasticity score (ES) and SR of LAM were significantly higher than the value before on maximal Valsalva, respectively. Mean ES and SR of LAM after Kegel exercises were similar with the value before on quiescent condition, respectively. CONCLUSION The improvement of SUI was associated with the stiffer LAM assessed by elastography. Women with SUI who have softer LAM were more likely to have symptoms of SUI and Kegel exercise could strengthen the stiffness of LAM. BRIEF SUMMARY The improvement of SUI was associated with the stiffer LAM assessed by elastography.

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Here we present a protocol to examine the levator ani hiatus in males and females with pelvic organ prolapse, during the Valsalva maneuver and while evacuating acoustic gel, using a horizontally oriented 1.5 T magnetic resonance (MR) scanner. On midsagittal images, the vertical distance of pelvic organs is measured in millimeters relative to the hymen plane (female) and to the lower border of the symphysis pubis (male), preceded by - (above) or + ( below) signs. On axial images, the levator ani area is calculated in square centimeters with a free-hand tracing method from three key images, passing through the midsymphysis (level I), tangential to the lower border of the symphysis (level II), and at the maximal anterior rectal wall bulging (level III). Areas at rest and strained are compared to find evidence of a percentage of increase. The purpose is to provide objective evidence of the maximal extent of pelvic organs descent and hiatus enlargement without the interference of foreign objects or the examiner's proximity, so as to overcome the limitations of pelvic examination and transperineal sonography (i.e., subjectivity and sex-related limitations [female only]).

OBJECTIVE To explore whether operation can change the elasticity of levator ani in deep infiltrating endometriosis (DIE) with operation and pharmacotherapy using transperineal elastography. METHODS Total thirty-four patients who were diagnosed as DIE were included in the study. Transperineal elastography were performed in all cases preoperatively and postoperatively. The levator ani was evaluated by means of the scoring system and strain ratio (SR) values on maximal Valsalva and quiescent condition, respectively. RESULTS On quiescent condition, the preoperative mean elastography scores and SR of the levator ani were statistically significantly higher than the postoperative ones in both shaving technique group and segmental colorectal resection group. And on maximal Valsalva, the preoperative mean elastography scores and SR of the levator ani were statistically significantly lower than the postoperative ones in both groups. After surgery and 6 cycles of GnRHa therapy, the mean elastography score and SR of the levator ani were statistically significantly lower than before GnRHa therapy in shaving technique group on quiescent condition. And on maximal Valsalva, the mean elastography score and SR were statistically higher than before GnRHa therapy. However, in segmental colorectal resection group, the differences were not observed before and following 6 cycles of GnRHa therapy. CONCLUSION The elasticity of levator ani of DIE was changed by both shaving technique and segmental colorectal resection. And transperineal elastography could access the alterations.

OBJECTIVES Obstetric levator avulsion may be an important risk factor for prolapse. This study compares the size of the levator hiatus, the width of the genital hiatus, and pelvic muscle strength between vaginally parous women with or without levator avulsion, 5 to 15 years after delivery. METHODS Parous women were assessed for levator ani avulsion, using 3-dimensional transperineal ultrasound. Women with and without levator ani avulsion were compared with respect to levator hiatus areas (measured on ultrasound), genital hiatus (measured on examination), and pelvic muscle strength (measured with perineometry). Further analysis also considered the association of forceps-assisted birth. RESULTS At a median interval of 11 years from first delivery, levator avulsion was identified in 15% (66/453). A history of forceps-assisted delivery was strongly associated with levator avulsion (45% vs 8%; P < 0.001). Levator avulsion was also associated with a larger levator hiatus area (+7.3 cm; 95% confidence interval [CI], 4.1-10.4, with Valsalva), wider genital hiatus (+0.6 cm; 95% CI, 0.3-0.9, with Valsalva), and poorer muscle strength (-14.5 cm H2O; 95% CI, -20.4 to -8.7, peak pressure). Among those with levator avulsion, forceps-assisted birth was associated with a marginal increase in levator hiatus size but not genital hiatus size or muscle strength. CONCLUSIONS Obstetric levator avulsion is associated with a larger levator hiatus, wider genital hiatus, and poorer pelvic muscle strength. Forceps-assisted birth is an important marker for levator avulsion but may not be an independent risk factor for the development of pelvic muscle weakness or changes in hiatus size in the absence of levator avulsion.

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Intra‐abdominal pressure (IAP) measurement is an important parameter for intensive care unit (ICU) patients, helping ICU nurses identify and respond to intra‐abdominal hypertension (IAH) and changes in patient condition. The quality of IAP measurement depends on ICU nurses' knowledge, attitudes, and correct nursing practices. While previous studies have investigated the knowledge, attitude, and practice (KAP) regarding IAP measurement among paediatric ICU nurses, the KAP of adult ICU nurses has not been explicitly assessed.

Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 mmHg, − 3.2–2.6 mmHg, and − 1.6–4.6 mmHg for supine, reverse Trendelenburg, and HOB elevation positions with a percentage error of 35%, 28%, and 21%, respectively. Concordance coefficients were highest in reverse Trendelenburg positions (100.0%) compared to supine (95.3%) and HOB elevation (92.1%) positions. The error-grid analysis indicated no medium/high-risk errors for supine and reverse Trendelenburg and a 2.7% medium-risk error at HOB elevation positions. The results of this validation of a new continuous IAP monitoring device in ICU patients showed excellent results when compared to the gold standard. Changing the body position from supine to reverse Trendelenburg or HOB elevation increases the IAP.

Intra‐abdominal hypertension is a common serious complication in critically ill patients. Intra‐abdominal pressure (IAP) measurement is the only reliable method of detecting and managing IAP. Various factors influence the knowledge, attitude and practice of IAP measurement.

Objective The objective of this study was to evaluate the effectiveness of diaphragmatic ultrasonography in conjunction with intra-abdominal pressure (IAP) measurement for assessing diaphragm function and determining the optimal timing for weaning from mechanical ventilation (MV). Methods A cohort of 100 patients undergoing MV at the intensive care department of the Affiliated Hospital of Hebei University between January 2023 and July 2023 was enrolled. Spontaneous breathing trials (SBTs) were performed once patients met the weaning criteria. At the 30-minute mark of the SBT, diaphragmatic ultrasonography and IAP measurements were conducted. Based on weaning outcomes, patients were categorized into successful and failed weaning groups. Diaphragmatic excursion (DE), diaphragm thickening fraction (TFdi), diaphragmatic rapid shallow breathing index (D-RSBI), and IAP were compared between groups. The predictive value of these parameters in determining optimal weaning timing was analyzed using receiver operator characteristic (ROC) curves. Results Compared to the failed weaning group, the successful weaning group exhibited significantly lower values of D-RSBI and IAP values along with higher values of DE, TFdi, diaphragm thickness at end-inhalation (DTei), and diaphragm thickness at end-exhalation (DTee) (p < 0.05). In the single-parameter analysis, the area under the curve (AUC) values for D-RSBI, DE, TFdi, and IAP were 0.880 (95% CI: 0.811–0.948), 0.981 (95% CI: 0.960–1.000), 0.907 (95% CI: 0.872–0.972), and 0.838 (95% CI: 0.748–0.929), respectively. The optimal cut-off values were 13.5 breaths /(min*cm), 1.2 cm, 29.3%, and 5.6 mmHg, respectively. In combined parameter analysis, the combination of IAP and DE demonstrated the highest predictive accuracy. Conclusion The integration of diaphragmatic ultrasonography with IAP measurement is an effective approach for predicting weaning outcomes in patients undergoing MV. This combined assessment may assist clinicians in optimizing weaning strategies and improving patient outcomes.

Introduction Elevated intra-abdominal pressure (IAP) hampers the effective functioning of intra- and extra-abdominal organs. Despite the abundance of knowledge, routine measurement of IAP still needs to be widely incorporated in managing at-risk patients. The present study intends to assess the need for IAP measurement on abdominal wound healing in emergency laparotomy patients. Methods This prospective study was carried out over 24 months in patients undergoing emergency laparotomy. The IAP was measured at admission, immediately after surgery, and during the early postoperative period at 6, 12, 24, 48, and 72 hours. The patients were evaluated for the development of wound-related complications over a follow-up period of three months post-operatively. Results Seventy-two patients were enrolled. At admission, 54 (75%) patients had intra-abdominal hypertension (IAH), of which three patients had evidence of abdominal compartment syndrome. Thirty-one (43%) patients developed postoperative wound infections. The overall incidence of wound infection was significantly higher in patients with IAH (54.3% vs. 24%, p-value = 0.04, Pearson's Chi-squared test). The frequency of wound dehiscence was greater (19.6 % vs. 4.3 %, p-value 0.14, Fischer's exact test) in patients with IAH. The median duration of hospital stay (13 vs. 8 days, p-value 0.02, Mann-Whitney U test) and healing time (30.5 vs. 18 days, p-value 0.02, Mann-Whitney U test) was significantly higher in patients with IAH. Conclusion Measurement of IAP is a relatively simple procedure that should be incorporated into the routine postoperative care of surgical patients. The presence of elevated IAP can identify the subset of patients at risk of increased postoperative wound complications.

BACKGROUND Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children. OBJECTIVES The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement. METHODS A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework. RESULTS Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six "barrier" domains and four "facilitator" domains. The six "barrier" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four "facilitator" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity. CONCLUSIONS The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.

Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson’s and Lin’s correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and −0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.

Background: Twenty-five percent of critically ill patients in the intensive care unit have intra-abdominal hypertension, which causes high morbidity and mortality. The gold standard non-invasive method for measuring intra-abdominal pressure to diagnose intra-abdominal hypertension is intravesical pressure measurement. Unfortunately, the standard method has several limitations. The aim of this study is to invent a new, non-invasive method to diagnose intra-abdominal hypertension. Methods: This is a cross-sectional study to determine the accuracy of the new non-invasive intra-abdominal pressure measurement by physical examination and ultrasound to diagnose intra-abdominal hypertension compared to the intravesical pressure measurement. Hypothesis: We hypothesize that physical examination and ultrasound can be used to diagnose intra-abdominal hypertension and the ratio of maximal anteroposterior to transverse abdominal diameter minus fat thickness and intra-abdominal pressure has a correlation. Ethics and dissemination: The study received ethical approval from the Institutional Review Board of Faculty of Medicine, Chulalongkorn University. We plan to disseminate the results in peer-reviewed journals related to critical care medicine or surgery and at national or international conferences.

: Background: Intra-abdominal pressure (IAP) measurement is used to detect intra-abdominal hypertension (IAH), which may predispose patients to certain physiological derangements of the splanchnic circulation. The patient does not need to be in the supine position for continuous measurement of IAP. Hence, this study evaluated the impact of differing head of bed elevations (HOB) on bladder pressure when used as a surrogate IAP measurement in severely intubated patients. Aim of the study: The aim of the study was to determine the effect of head of bed elevation on intra-abdominal pressure measurement among mechanically ventilated patients. Materials and Method: Research design: the design of this study was a quasi-experimental. Setting: this study was conducted at the general ICU of Damanhur Medical Institute. Subjects: A convenience sample of 60 mechanically ventilated patients was involved. Tool: this study used an assessment tool which consists of four parts; part I: it was used to identify characteristics and clinical data of patients. Part II: this part was used to identify ventilator data. Part III: it was used to identify vital signs which include pulse, temperature systolic, diastolic and mean blood pressure. Part IV: this part was used to identify IAP measurements. Methods: Body mass index (BMI), vital signs, ventilator parameters and Intra-abdominal pressure (IAP) were assessed at different head of bed elevation angles; supine, 15°, 30°and 45°. Results: IAP was found to be increased significantly with increases in HOB angle. Moreover, it was increased significantly, specifically at 45°. Age and BMI positively correlated with IAP with significant differences. Conclusion: There was no difference in the measurement values of IAP: supine position, HOB elevation 15° and 30°. There was a difference in the measurement at 45° position.

Introduction: Increased intra-abdominal pressure (IAP) has an important impact on morbidity and mortality in critically ill patients. The SERENNO Sentinel system (Serenno Medical, Yokne’am Illit, Israel) is a novel device that allows automatic and continuous IAP measurements. Aims: Pre-clinical validation in a bench model study comparing the new device with the gold standard method and two other continuous IAP measurement devices. Methods: IAP measurement with the novel SERENNO device (IAPSER) was compared with the gold standard IAPH2O (water column height) and two other automatic and continuous IAP measurement devices: IAPCiM measured via the CiMON device (Pulsion Medical Systems, Munich, Germany) and IAPSPIE measured using the Spiegelberg device (Spiegelberg, Hamburg, Germany), which previously received the CE mark for clinical applications. The IAP measurement was performed six times (n = 6) at each pressure value (between 0 and 35 mmHg) with different methods and the height of the water column in a bench-top phantom was used as the reference IAP for further interpretations. In addition to the quadruple comparisons, intra- and inter-observer variability of IAP measurements were also calculated. Correlation studies and Bland and Altman’s analyses were performed in addition to the concordance study. Results: The CiMON and Spiegelberg devices showed a greater dynamic range and standard deviation when recording IAPCiM and IAPSPIE compared with IAPSER. In general, the maximum and minimum values of IAP recorded with each device (at each level of IAPH2O) were significantly different from each other. However, the average values were in very good agreement. The highest correlation was observed between IAPSER and IAPH2O, and IAPSER and IAPSPIE (R = 0.99, p = 0.001 for both comparisons and intra- and inter-observer measurements). Although the CiMON and SERENNO systems were in very good agreement with each other, a slightly smaller correlation coefficient was found between them (R = 0.95, p = 0.001, and R = 0.96, p = 0.001 for intra- and inter-observer measurements, respectively). When compared to the gold standard (IAPH2O), Bland and Altman’s analysis showed a mean difference of +0.44, −0.25, and −0.04 mmHg for the intra-observer measurements and +0.18, −0.75, and −0.58 mmHg for the inter-observer measurements for IAPSER, IAPCiM, and IAPSPIE, respectively. IAPSER showed a small positive bias (overestimation), while IAPCiM and IAPSPIE showed a negative bias (underestimation) when compared to IAPH2O. Further statistical analysis showed a concordance coefficient of 100% with an excellent ability of the SERENNO system in tracking IAPH2O changes. Conclusions: Pre-clinical validation of a new IAP monitoring device (SERENNO) showed very promising results when compared with the gold standard and other continuous techniques; however, clinical trials should be followed as the next stage of the validation process. Based on the actual research guidelines, the SERENNO system can be used interchangeably with the gold standard.

Intra-abdominal hypertension, defined as an intra-abdominal pressure (IAP) equal to or above 12 mmHg is one of the major risk-factors for increased morbidity (organ failure) and mortality in critically ill patients. Therefore, IAP monitoring is highly recommended in intensive care unit (ICU) patients to predict development of abdominal compartment syndrome and to provide a better care for patients hospitalized in the ICU. The IAP measurement through the bladder is the actual reference standard advocated by the abdominal compartment society; however, this measurement technique is cumbersome, non-continuous, and carries a potential risk for urinary tract infections and urethral injury. Using microwave reflectometry has been proposed as one of the most promising IAP measurement alternatives. In this study, a novel radar-based method known as transient radar method (TRM) has been used to monitor the IAP in an in vitro model with an advanced abdominal wall phantom. In the second part of the study, further regression analyses have been done to calibrate the TRM system and measure the absolute value of IAP. A correlation of –0.97 with a p-value of 0.0001 was found between the IAP and the reflection response of the abdominal wall phantom. Additionally, a quadratic relation with a bias of −0.06 mmHg was found between IAP obtained from the TRM technique and the IAP values recorded by a pressure gauge. This study showed a promising future for further developing the TRM technique to use it in clinical monitoring.

Introduction: Acute abdomen is one of the most common surgical emergencies faced by a surgeon. Monitoring Intra-Abdominal Pressure (IAP) in patients with acute abdomen referred for exploratory laparotomy may help guide the need for early intervention. Aim: This study was performed to determine whether preoperative IAP had any significant association with organ failure as assessed using SOFA score. Furthermore, effect of IAP on patient outcome in terms of hospital stay, mortality was also evaluated. Materials and methods: 60 patients above 18 years of age presenting with acute abdomen requiring exploratory laparotomy were included in this prospective observational study from November 2013 until March 2015. IAP and SOFA scores were calculated at the time of admission. The outcome of patients was assessed in terms of hospital stay, morbidity and mortality. The correlation between IAP and SOFA scores was also assessed to determine the risk of organ failure. The inferences were drawn with the use of SPSS v22.0 statistical software. ANOVA, Chi-square and Student's t-test were used in the analysis. Results: There was a positive correlation between SOFA score and IAP; and this correlation was found to be statistically significant with Pearson's correlation coefficient being 0.6247 and significance levels being <0.0001. Both hospital stay and mortality positively correlated with the degree of IAP. Conclusions: IAP should be routinely measured in patients with acute abdomen requiring exploratory laparotomy. Patients with preoperatively raised IAP should be referred for emergency surgery as soon as possible for better outcome.

Background: Intracranial pressure (ICP)--guided therapy is the standard of care in the management of severe traumatic brain injury (TBI). Ideal ICP monitoring technique is not yet available, based on its risks associated with bleeding, infection, or its unavailability at major centers. Authors propose that ICP can be gauged based on measuring pressures of other anatomical cavities, for example, the abdominal cavity. Researchers explored the possibility of monitoring intra-abdominal pressure (IAP) to predict ICP in severe TBI patients. Methods: We measured ICP and IAP in severe TBI patients. ICP was measured using standard right frontal external ventricular drain (EVD) insertion and connecting it to the transducer. IAP was measured using a well-established technique of vesical pressure measurement through a manometer. Results: A total of 28 patients (n = 28) with an age range of 18–65 years (mean of 32.36 years ± 13.52 years [Standard deviation]) and the median age of 28.00 years with an interquartile range (21.00–42.00 years) were recruited in this prospective study. About 57.1% (n = 16) of these patients were in the age range of 18–30 years. About 92.9% (n = 26) of the patients were male. The most common mode of injury (78.6%) was road traffic accidents (n = 22) and the mean Glasgow Coma Scale at presentation was 4.04 (range 3–9). The mean ICP measured at the presentation of this patient cohort was 20.04 mmHg. This mean ICP (mmHg) decreased from a maximum of 20.04 at the 0 h’ time point (at the time of insertion of EVD) to a minimum of 12.09 at the 96 hr time point. This change in mean ICP (from 0 h to 96 h) was found to be statistically significant (Friedman Test: χ2 = 87.6, P ≤ 0.001). The mean IAP (cmH2O) decreased from a maximum of 16.71 at the 0 h’ time point to a minimum of 9.68 at the 96 h’ time point. This change was statistically significant (Friedman Test: χ2 = 71.8, P ≤ 0.001). The per unit percentage change in IAP on per unit percentage change in ICP we observed was correlated to each other. The correlation coefficient between these variables varied from 0.71 to 0.89 at different time frames. It followed a trend in a directly proportional manner and was found to be statistically significant (P < 0.001) in each time frame of the study. The rise in one parameter followed the rise in another parameter and vice versa. Conclusion: In this study, we established that the ICP of severe TBI patients correlates well with IAP at presentation. This correlation was strong and constant, irrespective of the timeframe during the treatment and monitoring. This study also established that draining cerebrospinal fluid to decrease ICP in severe TBI patients is reflected in IAP. The study validates that IAP is a strong proxy of ICP in severe TBI patients.

Intra-abdominal hypertension and the abdominal compartment syndrome are well-known, serious, life-threatening clinical entities in acute care surgery. A common characteristic of these syndromes is the permanent and irreversible damage that may affect the organs which can be found inside the given compartment if quick intervention cannot be provided. All factors which may and can lead to a sudden increase in the intra-abdominal pressure can be found among the triggering factors of abdominal compartment syndrome. Despite the modern and quick diagnostics, and the adequate surgical interventions performed in time, the mortality of this syndrome is extremely high (38-71%). It affects practically all vital organ systems: cardiovascular, respiratory, urinary and central nervous system. There are four major compartments in the human body: the head, the chest, the abdomen and the extremities. When two or more compartments have elevated pressures the name of the clinical entity is polycompartment syndrome, first described in 2007. The only possible way of establishing the diagnosis is to measure the intra-abdominal pressure, a widespread manner of which is the measurement through the bladder. Treatment of abdominal and polycompartment syndrome is nearly always surgical decompression with temporary abdominal wall closure or open abdominal treatment. Clinicians need to be aware of the real existence of polycompartment syndrome and the complex and constant interplay of raised pressure between compartments. This highlights the importance of research and development of new intra-abdominal pressure measurement techniques.

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Background: The SmartPill, a multisensor ingestible capsule, is marketed for intestinal motility disorders. It includes a pressure sensor, which could be used to study intra-abdominal pressure (IAP) variations. However, the validation data are lacking for this use. Material and Methods: An experimental study was conducted on anesthetized pigs with stepwise variations of IAP (from 0 to 15 mmHg by 3 mmHg steps) generated by laparoscopic insufflation. A SmartPill, inserted by endoscopy, provided intragastric pressure data. These data were compensated to take into account the intrabdominal temperature. They were compared to the pressure recorded by intragastric (IG) and intraperitoneal (IP) wired sensors by statistical Spearman and Bland–Altmann analysis. Results: More than 4500 pressure values for each sensor were generated on two animals. The IG pressure values obtained with the SmartPill were correlated with the IG pressure values obtained with the wired sensor (respectively, Spearman ρ coefficients 0.90 ± 0.08 and 0.72 ± 0.25; bias of −28 ± −0.3 mmHg and −29.2 ± 0.5 mmHg for pigs 1 and 2). The intragastric SmartPill values were also correlated with the IAP measured intra-peritoneally (respectively, Spearman ρ coefficients 0.49 ± 0.18 and 0.57 ± 0.30; bias of −29 ± 1 mmHg and −31 ± 0.7 mmHg for pigs 1 and 2). Conclusions: The SmartPill is a wireless and painless sensor that appears to correctly monitor IAP variations.

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Background: Intra-abdominal pressure measurement (IAP) is a critical hemodynamic assessment used in the intensive care unit (ICU) to identify patients at risk for intra-abdominal hypertension and subsequent abdominal compartment syndrome. Aim: Assess the effect of supine versus right lateral position on intra-abdominal pressure measurements and respiratory dynamics for critically ill patients. Design & Setting: Quasi-experimental research design was carried out in the Surgical Intensive Care Unit of Emergency Tanta University Hospitals which is affiliated to the Ministry of Higher Education and Scientific Research. Subjects : A purposive sample of sixty critically ill patients ranging in age from 21 to 60 years. Tools: Three tools were utilized Tool (I): Critically Ill Patients Assessment Tool: It included 3 parts as the following: Part (a): Patients’ Demographic Characteristics, Part (b): Patients’ Clinical Data , and Part (c): Patients' Hemodynamic Parameters, Tool (II): Intra-abdominal Pressure Measurements Recording Sheet, and Tool (III): Respiratory Dynamics Assessment Sheet. Results: No a statistically significant difference regarding Intra-abdominal pressure measurements when the head of the bed (HOB) angle had been changed from 0° to 15° in supine position and right lateral position where P > 0.05. Moreover, lung compliance negatively correlated with IAP with highly statistically significant differences where P<0.01. Meanwhile, airway resistance, respiratory rate & BMI positively correlated with IAP with highly statistically significant differences where P= 0.000. Conclusions: There were no significant differences between IAP measurements in the supine position versus right lateral position. Recommendations: It can be recommended that further studies are needed to evaluate the various methods of IAP measurements, and the study should be replicated on large probability sample on different setting to generalize results.

Dynamic monitoring of intra-abdominal pressure is a reliable basis for diagnosing intra-abdominal hypertension and abdominal compartment syndrome, which are independent risk factors for death. The latest evidence on abdominal pressure monitoring has been updated, but the gap between these updates and the actual practice of critical care nurses remains unknown. This study aimed to assess the behaviour and cognition of adult critical care nurses in China regarding intra-abdominal pressure measurement. A national cross-sectional study of Chinese adult critical care nurses was conducted from May to August 2024 using a developed questionnaire. The survey assessed measurement methods, patient positioning, zero reference points, value reading timing, and nurses’ understanding of intra-abdominal pressure. A total of 1068 valid questionnaires were included. Of these, 768 (71.9%) respondents had measured intra-abdominal pressure. The main reason for not monitoring intra-abdominal pressure was a lack of training (60%). The bladder pressure was regarded as the gold standard by 754 (98.2%) participants, of whom 642 (85.1%) chose the traditional (intermittent) technique for intra-abdominal pressure measurement. The cognition score ranged from 2 to 19, the median was 9.0 with an interquartile range of 8.0, and associated factors included age, hospital level, education level, marital status, professional title, and number of years working in the clinic. Adult critical care nurses in China exhibit inadequate overall cognition regarding intra-abdominal pressure monitoring, with particularly deficient understanding of fundamental concepts, including normal IAP thresholds, diagnostic criteria for intra-abdominal hypertension, and risk factor identification. It is imperative to enhance the focus on monitoring intra-abdominal pressure. Furthermore, it is essential to provide regular training for adult critical care nurses, grounded in the latest evidence, to elevate both the standardisation of procedures and the level of cognitive understanding in this area. Not applicable.

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Continuous intra-abdominal pressure (IAP) monitoring is critical for the early detection and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Current standard IAP monitoring is based on intravesical pressure (IVP) monitoring, limited by intermittent measurements, infection risks, and labor-intensive procedures. This study introduces the PressureDot® Capsule, an ingestible, wireless device designed for continuous, non-invasive IAP monitoring by gastrointestinal pressure. The PressureDot® Capsule’s performance was evaluated through benchtop and in vivo testing by a porcine model. In benchtop tests, the capsule demonstrated a high correlation with a reference pressure meter (two tests performed, R2 = 0.97 and R2 = 0.94, respectively), confirming its measurement accuracy under controlled conditions. In vivo testing further validated its feasibility, with strong correlations observed between the capsule and true IAP (two tests performed, R2 = 0.81 and R2 = 0.94, respectively). Compared to conventional methods, the PressureDot® Capsule offers advantages, including continuous monitoring, reduced infection risk, labor efficiency, and suitability for outpatient care. Its compact design enhances patient compliance, making it a promising solution for clinical and athletic applications. These findings support PressureDot® Capsule’s potential as a transformative tool for real-time IAP monitoring across diverse healthcare settings.Clinical Relevance— The PressureDot® Capsule enables continuous, non-invasive intra-abdominal pressure monitoring, reducing infection risks and labor demands while improving patient outcomes in critical care and outpatient settings.

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