Evaluation of mobility of the pelvic floor in women with urinary incontinence and genital prolapse using three-dimensional modeling

Kasyan G.R., Tupikina N.V., Pushkar' D.Yu.

Objectives: This study presents a new potentially useful three-dimensional non-invasive tool for studying pelvic organ prolapse (POP).

Material & Methods: Patients suffering from POP, stress urinary incontinence (SUI) and healthy volunteers were included in the study. All participants were scanned at rest and during Valsalva using an Artec™ 3D portable scanner (Artec Group, Russia). After the generation of the 3D model of the pelvic floor, the volume of the prolapsed vaginal wall was measured as dynamic prolapse increment (DPI), which is defined as a growth in the prolapse volume from rest to maximal Valsalva maneuver.

Results: 72 women participated in this study. The mobility of the pelvic floor of women suffering from SUI was 1.6 times higher when compared with patients without SUI. During comparison of the subgroups of patients with POP it was noted that the figure of 75% DPI is a threshold for the onset of symptoms POP, and abnormal mobility of the pelvic floor is marked with a 52% growth in prolapse volume when compared with the norm. For some patients with severe POP the increase in the prolapse volume was not related to the further descent of the most prominent point. Instead, the increase was caused by the enlargement of the other compartments, such as the cystocele or enterocele. This enlargement occurred in 3D manner and could not be validated using the POP-Q system.

Conclusion: the three-dimensional modeling of the pelvic floor helps to reveal pathological mobility of the pelvic floor in POP before its clinical manifestations, providing an opportunity for preventive interventions and objectification dynamic monitoring data, as well as to determine the functional reserves of the mobility of the pelvic floor when planning surgical treatment of pelvic dysfunction.

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