Search Results (224)

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. Full article

Pelvic organ prolapse (POP) is a common pelvic floor disorder with substantial impact on women’s quality of life, necessitating accurate and reproducible diagnostic methods. This study investigates the use of three-dimensional (3D) transperineal ultrasound, integrated with artificial intelligence (AI), to evaluate pelvic floor biomechanics and identify correlations between biometric parameters and prolapse severity. Thirty-seven female patients diagnosed with genital prolapse (mean age: 65.3 ± 10.6 years; mean BMI: 29.5 ± 3.8) were enrolled. All participants underwent standardized 3D transperineal ultrasound using the Mindray Smart Pelvic system, an AI-assisted imaging platform. Key biometric parameters—anteroposterior diameter, laterolateral diameter, and genital hiatus area—were measured under three functional states: rest, maximal Valsalva maneuver, and voluntary pelvic floor contraction. Additionally, two functional indices were derived: the distensibility index (ratio of Valsalva to rest) and the contractility index (ratio of contraction to rest), reflecting pelvic floor elasticity and muscular function, respectively. Statistical analysis included descriptive statistics and univariate correlation analysis using Pelvic Organ Prolapse Quantification (POP-Q) system scores. Results revealed a significant correlation between laterolateral diameter and prolapse severity across multiple compartments and functional states. In apical prolapse, the laterolateral diameter measured at rest and during both Valsalva and contraction showed positive correlations with POP-Q point C, indicating increasing transverse pelvic dimensions with more advanced prolapse (e.g., r = 0.42 to 0.58; p < 0.05). In anterior compartment prolapse, the same parameter measured during Valsalva and contraction correlated significantly with POP-Q point AA (e.g., r = 0.45 to 0.61; p < 0.05). Anteroposterior diameters and genital hiatus area were also analyzed but showed weaker or inconsistent correlations. AI integration facilitated real-time image segmentation and automated measurement, reducing operator dependency and increasing reproducibility. These findings highlight the laterolateral diameter as a strong, reproducible anatomical marker for POP severity, particularly when assessed dynamically. The combined use of AI-enhanced imaging and functional indices provides a novel, standardized, and objective approach for assessing pelvic floor dysfunction. This methodology supports more accurate diagnosis, individualized management planning, and long-term monitoring of pelvic floor disorders. Full article

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

Background/Objectives: This study aimed to establish the potential osteotropic effect of pine pollen on bone metabolism in male rats during the development of osteopenia induced by orchidectomy (ORX). We also established the effect of gonadectomy and pine pollen on the characteristics of calf muscles. Methods: This study was conducted using 40 male Wistar rats divided into one sham-operated (SHO) and four ORX groups. The SHO rats and one ORX group (negative control) were treated with physiological saline (PhS). The remaining ORX groups received exclusively testosterone (positive control) and two doses of pine pollen (50 and 150 mg/kg b.w.), respectively. The rats were killed 60 days later and their right tibia and left pelvic limbs were isolated. The tibia was analyzed using densitometry, computed tomography, and a bending machine to determine densitometry, structure, and mechanical properties, respectively. The left pelvic limb allowed for measurements of area, density, and fat tissue in the calf muscle. Results: The dose of 150 mg/kg b.w. inhibited the development of atrophic changes, both in the cortical and trabecular bone tissue. The dose of 50 mg/kg b.w. also has a protective effect on bones but is less pronounced and concerns only the trabecular bone tissue. The higher dose of pine pollen inhibited the catabolism of the calf muscles by maintaining the density and surface area as in the SHO group. It also limited the accumulation of intramuscular and subcutaneous adipose tissue. Conclusions: It is worth emphasizing the osteoprotective effectiveness of pine pollen, especially when administered in larger doses, which demonstrates the possibility of its use in the prevention of the development of osteoporosis in males. Full article

Background/Objectives: Vaginal adenocarcinoma is a rare malignancy, accounting for less than 10% of all primary vaginal cancers. It predominantly affects older women but can also occur in younger populations, particularly in association with in utero diethylstilbestrol (DES) exposure. Given its rarity, evidence regarding the optimal management of vaginal adenocarcinoma remains limited. This review aimed to summarize the current understanding of vaginal adenocarcinoma, covering the epidemiology, etiology, diagnostic approaches, treatment modalities, prognosis, and areas requiring further investigation thereof. Methods: We conducted a search for the term “vaginal adenocarcinoma” in the PubMed, Scopus, and Web of Science databases from January 2016 to 28 April 2025. Results: Overall, 83 articles were included in the final review. Among them, 21 cases of vaginal adenocarcinoma were reported. Vaginal adenocarcinoma demonstrates a bimodal age distribution, with clear cell histology commonly linked to DES exposure and endometrioid or mucinous types seen in older patients. Risk factors include DES exposure, chronic inflammation, and human papillomavirus (HPV) infection. The diagnosis relies on a pelvic examination, imaging, and biopsy. Treatment typically involves surgery, radiotherapy, or a combination thereof, tailored to the stage and location, with chemotherapy reserved for advanced cases. The prognosis depends on the histologic subtype, tumor size, stage, and treatment response, with early-stage disease generally associated with better outcomes. Conclusions: Improved awareness of risk factors and early diagnostic strategies is critical to optimize patient outcomes. Research is needed to refine treatment protocols, explore targeted therapies and immunotherapy, and investigate the molecular underpinnings of vaginal adenocarcinoma, particularly non-DES-associated types. Full article

Background and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm × 9 cm × 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury. Full article

Background: Acute visceral pain is among the most common symptoms of patients seeking in-hospital treatment and is related to various thoracic, abdominal, and pelvic diseases. It is characterized by distinguishable sensory qualities and can be described on a sensory-discriminative and affective-motivational level. These sensory qualities correlate with the activation of cerebral areas involved in the neuronal processing of visceral pain and can be visualized using functional neuroimaging. Methods: An ALE (activation likelihood estimation) meta-analysis of a total of 21 studies investigating different balloon distention paradigms during either PET or fMRI was performed to demonstrate the neuroanatomical correlates of visceral pain. The ALE meta-analysis was performed using the GingerAle software version 3.0.2 and was displayed with the Mango software 4.1 on an anatomical MNI template. Results: Summarizing studies investigating the functional neuroanatomy of visceral pain, bihemispheric activation of the insula, the thalamus, and clusters involving the right inferior parietal lobe/postcentral gyrus as well as the left postcentral gyrus/parietal inferior lobe were observed. Conclusions: This ALE meta-analysis substantiates the concept of two distinguishable neuroanatomical pathways of visceral pain which are related to either the sensory-discriminative or the affective-motivational dimension of pain processing. Full article

X-ray imaging protocols in radiology departments often exhibit variability in exposure parameters and geometric setups, leading to inconsistencies in image quality and potential variations in patient dose. Objectives: This study aimed to harmonise and optimise chest and pelvis X-ray imaging protocols by standardising exposure parameters and geometric setups across departmental systems, minimising radiation dose while ensuring adequate image quality for accurate diagnosis. Methods: The image quality of five pelvic and three chest protocols across different radiographic systems was evaluated both quantitatively and visually. Visual image quality for both chest and pelvis protocols was assessed by radiologists and radiographers using the Visual Grading Analysis (VGA) method. Additionally, the quantitative image quality figure inverse (IQF_inv) metric for all protocols was determined using the CDRAD image quality phantom. Moreover, the patient radiation dose for both chest and pelvis protocols was evaluated using dose area product (DAP) values measured by the systems’ built-in DAP metres. Results: Different quantitative image quality and radiation dose to patients were achieved in various protocol settings for both chest and pelvis examinations, but the visual image quality assessment showed satisfactory image quality for all observers in both the pelvis and chest protocols. The selected protocols for harmonising chest radiography across all imaging systems result in reduced radiation exposure for patients while maintaining adequate image quality compared to the previously used system-specific protocol. Conclusions: The clinical protocol for chest and pelvis radiography has been standardised and optimised in accordance with patient radiation exposure and image quality. This approach aligns with the ALARA (As Low As Reasonably Achievable) principle, ensuring optimal diagnostic information while minimising the radiation risks. Full article

Background/Objectives: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. MS lesions can affect the motor, sensory, and visual nerves, leading to impaired balance, muscle tension, and pain. The occurrence of the above can significantly affect quality of life. There is therefore a need to use objective methods of functional assessment for balance and gait disorders in patients with MS. The aim of the study was to assess the functional status and quality of life in people with multiple sclerosis with the simultaneous use of an accelerometer and baropodometric mat. Methodology: The research was conducted using functional tests: Tinetti test, Tandem Pivot Test, timed up and go test, and the Berg Balance Scale. In addition, the Sensor Medica baropodometric mat and the Baiobit balance and gait assessment system were used to objectively assess balance and gait. The assessment was performed once. The study involved 34 participants diagnosed with relapsing–remitting multiple sclerosis compared to a control group consisting of healthy individuals with similar demographic data to the study group. Results: Significant differences were found between the study and control groups in both functional and baropodometric assessments as well as when using an accelerometer in the pelvic area. Conclusions: Higher disturbances and differences are detected in the pelvic area; therefore, it is necessary to consider assessment using the simultaneous measurement of the displacement of the center of gravity located both on the pelvis and on the feet during the performance of different tasks—static and dynamic. Full article

(1) Background: This study aimed to develop a deep learning model using a convolutional neural network (CNN) to automate Risser grade assessment from pelvic radiographs. (2) Methods: We used 1619 pelvic radiographs from patients aged 12–18 years with scoliosis to train two CNN models—one for the right pelvis and one for the left. A multimodal approach incorporated 224 × 224-pixel regions of interest from radiographs, alongside patient age and gender. The models were optimized with Adam, weight decay, rectified linear unit (ReLU) activation, dropout, and batch normalization, while synthetic data augmentation addressed class imbalance. Performance was evaluated through accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (ROC AUC). (3) Results: The right pelvis model achieved 83.64% accuracy; the left pelvis model reached 80.56%. Both models performed well for Risser Grades 0, 2, and 4, with the right pelvis model achieving a microaverage F1-score of 0.836 and ROC AUC of 0.895. The left pelvis model achieved a microaverage F1-score of 0.806 and ROC AUC of 0.872. Challenges arose from class imbalance in less frequent grades. (4) Conclusions: CNN models effectively automated Risser grade assessment, reducing clinician workload and variability. Full article

Deep learning (DL) techniques have demonstrated remarkable capabilities in recognizing complex patterns in medical imaging data. In recent years, DL has been increasingly applied in clinical medicine for disease diagnosis and progression prediction. This study aimed to develop and validate a DL model for detecting sacroiliitis using pelvic anteroposterior (AP) radiographs. We retrospectively analyzed 1853 patients with pelvic AP radiographs, including 3706 sacroiliac joints (SIJs). Pelvic AP radiographs served as input data for the DL model development, while the presence or absence of sacroiliitis confirmed by pelvic computed tomography (CT) was used as the reference standard output data. Based on CT findings, 1463 of 1853 right SIJs showed evidence of sacroiliitis, while 390 had no sacroiliitis. Similar findings were observed in the left SIJs. The dataset was split with 70% (1297 images) for training and 30% (556 images) for validation. The areas under the curve (AUC) for our DL model on the validation dataset were 0.871 (95% confidence interval (CI): 0.834–0.907) and 0.869 (95% CI: 0.834–0.907) for the left and right SIJs, respectively. Diagnostic accuracies for sacroiliitis on the left and right sides were 85.4% and 86.3%, respectively. These results demonstrate that a DL model trained on pelvic AP radiographs with CT-confirmed diagnoses can effectively aid in the diagnosis of sacroiliitis. Full article

Sentinel lymph node (SLN) mapping has been investigated as part of surgical staging in women with early-stage cervical cancer (CC); however, pelvic lymphadenectomy (PLND) remains the standard of care. This study aimed to assess feasibility and safety of SLN detection using superparamagnetic iron oxide (SPIO) nanoparticles as a tracer in CC. Thirty CC patients presumed to be stage I were included in this study with SPIO administered intracervically as a tracer for SLN mapping using a magnetometer and followed by PLND. The endpoints of the study included the proportion of successful SLN detection, the average number of SLNs per patient, and the proportion of pathologically positive results per patient and per node. The diagnostic accuracy of SPIO nanoparticles for detection of metastatic SLNs was evaluated by Receiver Operating Characteristic (ROC) curve analysis, with the area under the ROC curve (AUC) used to demonstrate the studied method’s sensitivity. Safety endpoints were a summary of all reported adverse events. SLNs were detected in all cases, bilaterally in 27 patients (90%). The median number of SLNs per patient was 3.5. Four cases had metastatic SLNs. The general malignancy rate per patient was 13.3%, and per node, it was 0.8%. The malignancy detection rate of SLNs was 100% per patient and 80% per node. The AUC of 1.0 (p < 0.001) confirmed the diagnostic value of the SPIO technique for the detection of metastatic SLNs, with a sensitivity of 100%. No adverse events related to the SPIO administration were reported. SPIO nanoparticles, as a tracer for SLN mapping in early-stage CC patients, demonstrated satisfactory accuracy parameters and safety; however, these data need to be evaluated by further research. Full article

Background: Pelvic organ prolapse (POP) and stress incontinence (SUI) are very common medical conditions, affecting women’s quality of life worldwide. Current surgical and conservative therapies often yield variable outcomes and carry risks of complications or recurrence. Platelet-rich plasma (PRP) has emerged as a promising regenerative approach in various medical disciplines. Its application in urogynecology remains relatively new and emerging. The objective of this study was to review and consolidate existing evidence regarding the application of PRP injections for treating POP and/or SUI. Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). The search strategy included MEDLINE (PubMed), Web of Science, and Scopus databases, covering articles published up to February 2025, with no restrictions on publication date. Results: We included in our review a total of 13 manuscripts and 320 patients at the end of the screening process. A total of ten SUI studies, comprising 273 patients, and three POP studies, involving 47 patients, satisfied all the review criteria. Both clinical entities reported high subjective improvement following PRP treatment. Moreover, PRP appeared to have no significant adverse effects. Conclusions: Our scoping review suggests that PRP may have potential benefits in the treatment of POP and SUI. Nevertheless, the current evidence on its application in this area remains limited. Therefore, well-designed, large-scale randomized controlled trials (RCTs) with extended follow-up periods are urgently needed, in the era of personalized medicine. Full article

Background/Objectives: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. Methods: A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov–Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. Results: A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. Conclusions: The Ramadanov–Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability. Full article

Background: Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. Objective: This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. Methods: We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. Results: We identified ten patients with a median age at disease onset of 45 months (range 17–133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. Conclusions: In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease. Full article