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Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (24 November 2023) | Viewed by 4567

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Special Issue Editors

Prof. Dr. Giulio Aniello Santoro

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Guest Editor

Surgery Unit 2, Regional Hospital Treviso, DiSCOG - University of Padua, 35122 Padua, Italy
Interests: rectal cancer; benign anorectal diseases; pelvic floor disorders

Dr. Ugo Grossi

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Guest Editor

Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Padua, Italy
Interests: inflammatory bowel disorders; pelvic floor disorders; constipation; gastrointestinal diseases; laparoscopic surgery
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Special Issue Information

Dear Colleagues,

Pelvic floor disorders such as pelvic organs prolapse, voiding, evacuation, and sexual disorders, urinary and anal incontinence, and chronic pelvic pain can occur after obstetric trauma, pelvic surgery, aging, and hormonal changes and frequently coexist. Physical examination is often unable to detect the anatomical damages in the ‘complex’ pelvis. Imaging plays an important role in the diagnosis of pelvic floor disorders to visualize abnormalities difficult to assess at the physical examination and/or to correlate symptoms with clinical findings. Technological innovations have improved the diagnostic accuracy of imaging modalities. However, considerable disagreement exists between the results of various anorectal tests in the assessment of evacuation disorders, and they correlate poorly with symptoms and treatment outcomes. Therefore, the integration of imaging techniques helps clarify the main pathophysiological mechanisms to drive treatment strategies toward a more individualized therapy approach.

In this Special Issue, we welcome authors to submit papers on pelvic floor disorders with respect to image-guided diagnosis and therapies.

Prof. Dr. Giulio Aniello Santoro
Dr. Ugo Grossi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pelvic floor disorders
imaging
ultrasonography
fecal incontinence
obstructed defecation

Published Papers (4 papers)

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Research

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12 pages, 2297 KiB

Open AccessArticle

Rectal Sensory and Compliance Testing: A Method Comparison Study between High-Resolution Anorectal Manometry and Barostat Investigations

by Lucian Marinica Grando, Jonas Halfvarson and Michiel van Nieuwenhoven

Diagnostics 2024, 14(4), 351; https://doi.org/10.3390/diagnostics14040351 - 06 Feb 2024

Viewed by 580

Abstract

Abnormal visceral perception and motor function are often observed in patients with fecal incontinence, evacuation disorders and irritable bowel syndrome. The international anorectal physiology working group has proposed a standardization for anorectal function assessment, where rectal sensitivity testing is performed using an elastic balloon attached to a high-resolution anorectal manometry (HRAM) catheter. Rectal compliance, another component of rectal function evaluation, is a pressure–volume relationship that refers to the rectum’s ability to stretch and expand as it receives and holds fecal matter. There are no data available regarding the possibility of compliance testing using HRAM, although this is theoretically possible by correcting for the elastic balloon’s intrinsic properties. The gold standard for measurement of visceral sensitivity and compliance is the rectal barostat, according to the procedure described by the European COST action GENIEUR group. Data on the agreement between the two different procedures are scarce. Hence, we performed a comparative study of the HRAM and barostat investigations in 26 healthy individuals. We hypothesized that by inflating the balloon before the examination, rectal compliance can be measured with HRAM investigations, and we examined correlations and levels of agreement between the methods. Our results demonstrate that assessing rectal compliance with HRAM is technically possible; however, a strong correlation with the rectal barostat was only observed at the maximum tolerable volume (Spearman’s rho = 0.7, p = 0.02). We only found moderate correlations (Spearman’s rho = 0.562, p = 0.019) for compliance according to the barostat methodology and for rectal sensibility testing (Spearman’s rho = 0.57, p = 0.03 for maximum tolerable volume). Bland–Altman plots showed poor levels of agreement between the methods. We conclude that HRAM and the rectal barostat cannot be used interchangeably for compliance or sensitivity assessments. We suggest the development of a non-elastic balloon with a fixed size and shape to assess rectal sensory function and compliance in HRAM testing. Full article

(This article belongs to the Special Issue Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders)

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9 pages, 1065 KiB

Open AccessArticle

Modified Vaginal Mesh Procedure with DynaMesh^®-PR4 for the Treatment of Anterior/Apical Vaginal Prolapse

by Chia-Ju Lin, Chih-Ku Liu, Hsiao-Yun Hsieh, Ming-Jer Chen and Ching-Pei Tsai

Diagnostics 2023, 13(18), 2991; https://doi.org/10.3390/diagnostics13182991 - 18 Sep 2023

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Abstract

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh^®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh^®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women. Full article

(This article belongs to the Special Issue Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders)

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11 pages, 1551 KiB

Open AccessArticle

Study on 3D High-Resolution Anorectal Manometry Interrater Agreement in the Evaluation of Dyssynergic Defecation Disorders

by Justin Y. van Oostendorp, Pieter van Hagen, Grietje J. H. van der Mijnsbrugge and Ingrid J. M. Han-Geurts

Diagnostics 2023, 13(16), 2657; https://doi.org/10.3390/diagnostics13162657 - 11 Aug 2023

Viewed by 913

Abstract

Anorectal manometry measurements exhibit significant interrater variability. Newer techniques like 3D high-resolution anorectal manometry (3D-HRAM) have the potential to enhance diagnostic accuracy and our understanding of defecation disorders. However, the extent of interrater variability in 3D-HRAM is still unknown. Between January 2020 to April 2022, patients referred for pelvic floor physical therapy (PFPT) due to functional defecation complaints underwent 3D-HRAM testing. In a retrospective analysis, three expert raters independently evaluated the 3D-HRAM results in a blinded matter to assess interrater agreement. The evaluation also determined the level of agreement concerning dyssynergic patterns during simulated defecation. The 3D-HRAM results of 50 patients (37 females) were included. Twenty-nine patients had complaints of fecal incontinence, eleven patients had chronic constipation, and ten patients had several other complaints. There was a substantial agreement (kappa 0.612) between the raters concerning the 3D images on dyssynergic patterns during simulated defecation. Our study emphasizes the need for standardized guidelines in evaluating 3D-HRAM test results to reduce subjectivity and further improve agreement among raters. Implementing these guidelines could improve diagnostic consistency and enhance personalized treatment strategies, increasing the reliability and usefulness of 3D-HRAM testing in clinical practice. Full article

(This article belongs to the Special Issue Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders)

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Other

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6 pages, 1206 KiB

Open AccessInteresting Images

Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence

by Michele Orsi, Giuseppe Cappuccio, Hayato Kurihara, Gabriele Rossi, Giuseppe Perugino, Enrico Ferrazzi and Carmela Coppola

Diagnostics 2024, 14(1), 68; https://doi.org/10.3390/diagnostics14010068 - 27 Dec 2023

Viewed by 816

Abstract

We present the case of a 36-year-old primigravida who gave birth to a 3200 g baby by vacuum-assisted (Kiwi OmniCup™) operative vaginal delivery with mediolateral episiotomy. A “y”-shaped perineal tear with a grade IIIC obstetric anal sphincter injury (OASI) was diagnosed and repaired. Two days after delivery, in the absence of suture dehiscence, she started experiencing complete anal incontinence. A decision was made in association with a proctologic surgeon for an early secondary repair. Before surgery, a Three-dimensional transperineal ultrasound (TPUS) was performed. The exam revealed a major defect of the external anal sphincter at the 11 o’clock position. This allowed for the reopening of only a circumscribed area of the perineal suture and repair of the sphincters using the end-to-end technique. The symptoms regressed completely, and follow-up TPUS demonstrated the gradual wound healing process. Anal incontinence, secondary to obstetric anal sphincter injury (OASI), has a severe negative impact on women’s quality of life. TPUS is an effective method to detect sphincter defects and monitor the healing process. This report investigates the feasibility of identifying the sphincter tear in an incontinent puerperal patient without suture dehiscence in order to target early secondary repair while minimizing its extent. TPUS has proven a safe and effective tool to guide early secondary repair of symptomatic OASI complications while minimizing the invasiveness of the procedure. Multidisciplinary management is crucial to ensure the adequate standard of care. Full article

(This article belongs to the Special Issue Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders)

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