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Published in: International Urogynecology Journal 2/2008

01-02-2008 | Original Article

Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function

Authors: Ingeborg Hoff Brækken, Memona Majida, Marie Ellstrøm-Engh, Hans Peter Dietz, Wolfgang Umek, Kari Bø

Published in: International Urogynecology Journal | Issue 2/2008

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Abstract

The aims of the present study were to evaluate test–retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs.
Literature
1.
go back to reference Kegel AH (1956) Stress incontinence of urine in women; physiologic treatment. J Int Coll Surg 25:487–499PubMed Kegel AH (1956) Stress incontinence of urine in women; physiologic treatment. J Int Coll Surg 25:487–499PubMed
2.
go back to reference Bo K (2004) Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct 15:76–84PubMedCrossRef Bo K (2004) Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct 15:76–84PubMedCrossRef
3.
go back to reference Strohbehn K, Ellis JH, Strohbehn JA, DeLancey JO (1996) Magnetic resonance imaging of the levator ani with anatomic correlation. Obstet Gynecol 87:277–285PubMedCrossRef Strohbehn K, Ellis JH, Strohbehn JA, DeLancey JO (1996) Magnetic resonance imaging of the levator ani with anatomic correlation. Obstet Gynecol 87:277–285PubMedCrossRef
4.
go back to reference Chou Q, DeLancey JO (2001) A structured system to evaluate urethral support anatomy in magnetic resonance images. Am J Obstet Gynecol 185:44–50PubMedCrossRef Chou Q, DeLancey JO (2001) A structured system to evaluate urethral support anatomy in magnetic resonance images. Am J Obstet Gynecol 185:44–50PubMedCrossRef
5.
go back to reference Kearney R, Miller JM, DeLancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25:50–54PubMedCrossRef Kearney R, Miller JM, DeLancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25:50–54PubMedCrossRef
6.
go back to reference DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53PubMedCrossRef DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53PubMedCrossRef
7.
go back to reference Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR (2001) Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 185:11–19PubMedCrossRef Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR (2001) Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 185:11–19PubMedCrossRef
8.
go back to reference Tunn R, Paris S, Fischer W, Hamm B, Kuchinke J (1998) Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol Urodyn 17:579–589PubMedCrossRef Tunn R, Paris S, Fischer W, Hamm B, Kuchinke J (1998) Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol Urodyn 17:579–589PubMedCrossRef
9.
go back to reference Dietz HP, Shek C, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585PubMedCrossRef Dietz HP, Shek C, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585PubMedCrossRef
10.
go back to reference Bernstein IT (1997) The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies; biometry. Neurourol Urodyn 16:237–735PubMedCrossRef Bernstein IT (1997) The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies; biometry. Neurourol Urodyn 16:237–735PubMedCrossRef
11.
go back to reference Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 85:220–224PubMedCrossRef Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 85:220–224PubMedCrossRef
12.
go back to reference Peschers U, Schaer G, Anthuber C, DeLancey JO, Schuessler B (1996) Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol 88:1001–1006PubMedCrossRef Peschers U, Schaer G, Anthuber C, DeLancey JO, Schuessler B (1996) Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol 88:1001–1006PubMedCrossRef
13.
go back to reference Dietz HP, Wilson PD, Clarke B (2001) The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct 12:166–168PubMedCrossRef Dietz HP, Wilson PD, Clarke B (2001) The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct 12:166–168PubMedCrossRef
14.
go back to reference Dietz HP, Wilson PD (1998) Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography. Int Urogynecol J Pelvic Floor Dysfunct 9:365–369PubMedCrossRef Dietz HP, Wilson PD (1998) Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography. Int Urogynecol J Pelvic Floor Dysfunct 9:365–369PubMedCrossRef
15.
go back to reference Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C et al (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24:374–380PubMedCrossRef Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C et al (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24:374–380PubMedCrossRef
16.
go back to reference Tubaro A, Artibiani W, Bartram C, DeLancey JD, Dietz HP, Khullar V et al (2005) Imaging and other investigations. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 2005 edition. Health Publication, Plymouth, UK, pp 707–797 Tubaro A, Artibiani W, Bartram C, DeLancey JD, Dietz HP, Khullar V et al (2005) Imaging and other investigations. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 2005 edition. Health Publication, Plymouth, UK, pp 707–797
17.
go back to reference Peschers UM, Fanger G, Schaer GN, Vodusek DB, DeLancey JO, Schuessler B (2001) Bladder neck mobility in continent nulliparous women. BJOG 108:320–324PubMedCrossRef Peschers UM, Fanger G, Schaer GN, Vodusek DB, DeLancey JO, Schuessler B (2001) Bladder neck mobility in continent nulliparous women. BJOG 108:320–324PubMedCrossRef
18.
go back to reference Reddy AP, DeLancey JO, Zwica LM, shton-Miller JA (2001) On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet Gynecol 185(1):65–70PubMedCrossRef Reddy AP, DeLancey JO, Zwica LM, shton-Miller JA (2001) On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet Gynecol 185(1):65–70PubMedCrossRef
19.
go back to reference Thompson JA, O’Sullivan PB, Briffa K, Neumann P, Court S (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 16(4):285–292PubMedCrossRef Thompson JA, O’Sullivan PB, Briffa K, Neumann P, Court S (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 16(4):285–292PubMedCrossRef
20.
go back to reference Armstrong SM, Miller JM, Benson K, Jain S, Panagopoulos K, DeLancey JO et al (2006) Revisiting reliability of quantified perineal ultrasound: Bland and Altman analysis of a new protocol for the rectangular coordinate method. Neurourol Urodyn 25:731–738PubMedCrossRef Armstrong SM, Miller JM, Benson K, Jain S, Panagopoulos K, DeLancey JO et al (2006) Revisiting reliability of quantified perineal ultrasound: Bland and Altman analysis of a new protocol for the rectangular coordinate method. Neurourol Urodyn 25:731–738PubMedCrossRef
21.
go back to reference Yang JM, Yang SH, Huang WC (2006) Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrasound Obstet Gynecol 28:710–716PubMedCrossRef Yang JM, Yang SH, Huang WC (2006) Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrasound Obstet Gynecol 28:710–716PubMedCrossRef
22.
go back to reference Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18:511–514PubMedCrossRef Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18:511–514PubMedCrossRef
23.
go back to reference Altman DG (1999) Practical statistics for medical research. Chapman & Hall, London Altman DG (1999) Practical statistics for medical research. Chapman & Hall, London
24.
go back to reference Thomas JR, Nelson JK, Silverman SJ (2005) Reaseach methods in physical activity, 5th edn. Human Kinetics, Champaign Thomas JR, Nelson JK, Silverman SJ (2005) Reaseach methods in physical activity, 5th edn. Human Kinetics, Champaign
25.
go back to reference Majida M, Brækken IH, Bo K, Umek W, Dietz HP, Ellstøm Engh M (2006) 3D and 4D ultrasound of the pelvic floor. An interobserver reliability study. Int Urogynecol J Pelvic Floor Dysfunct 17(Suppl 2):136–137 (Abstract) Majida M, Brækken IH, Bo K, Umek W, Dietz HP, Ellstøm Engh M (2006) 3D and 4D ultrasound of the pelvic floor. An interobserver reliability study. Int Urogynecol J Pelvic Floor Dysfunct 17(Suppl 2):136–137 (Abstract)
26.
go back to reference Bo K, Kvarstein B, Jorgensen J, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effect of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 9:489–502CrossRef Bo K, Kvarstein B, Jorgensen J, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effect of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 9:489–502CrossRef
27.
go back to reference Bo K, Talseth T, Holme I (1999) Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 318(7182):487–493PubMed Bo K, Talseth T, Holme I (1999) Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 318(7182):487–493PubMed
28.
go back to reference Morkved S, Bo K, Fjortoft T (2002) Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstet Gynecol 100:730–739PubMedCrossRef Morkved S, Bo K, Fjortoft T (2002) Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstet Gynecol 100:730–739PubMedCrossRef
29.
go back to reference Balmforth JR, Mantle J, Bidmead J, Cardozo L (2006) A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU Int 98:811–817PubMedCrossRef Balmforth JR, Mantle J, Bidmead J, Cardozo L (2006) A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU Int 98:811–817PubMedCrossRef
30.
go back to reference Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G et al (2005) Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 106:774–781PubMed Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G et al (2005) Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 106:774–781PubMed
31.
go back to reference Kegel A (1952) Stress incontinence and genital relaxation. Ciba Clin Sympos 2:35–51 Kegel A (1952) Stress incontinence and genital relaxation. Ciba Clin Sympos 2:35–51
32.
go back to reference DeLancey JO (1994) The anatomy of the pelvic floor. Curr Opin Obstet Gynecol 6:313–316PubMed DeLancey JO (1994) The anatomy of the pelvic floor. Curr Opin Obstet Gynecol 6:313–316PubMed
Metadata
Title
Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function
Authors
Ingeborg Hoff Brækken
Memona Majida
Marie Ellstrøm-Engh
Hans Peter Dietz
Wolfgang Umek
Kari Bø
Publication date
01-02-2008
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 2/2008
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-007-0408-7

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