Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial.
Adult
Dyspareunia
/ complications
Endometriosis
/ complications
Female
Humans
Imaging, Three-Dimensional
/ methods
Pelvic Floor
/ diagnostic imaging
Pelvic Floor Disorders
/ complications
Perineum
/ diagnostic imaging
Physical Therapy Modalities
Treatment Outcome
Ultrasonography
/ methods
Valsalva Maneuver
3D/4D transperineal ultrasound
chronic pelvic pain
deep infiltrating endometriosis
dyspareunia
pelvic floor muscles
pelvic floor physiotherapy
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
10
12
2020
received:
25
10
2020
accepted:
22
12
2020
pubmed:
12
1
2021
medline:
15
12
2021
entrez:
11
1
2021
Statut:
ppublish
Résumé
Deep infiltrating endometriosis (DIE) is associated with chronic pelvic pain, dyspareunia and pelvic floor muscle hypertonia. The primary aim of this study was to evaluate the effect of pelvic floor physiotherapy (PFP) on the area of levator ani hiatus during Valsalva maneuver, assessed using transperineal ultrasound, in women with DIE suffering from superficial dyspareunia. This was a randomized controlled trial of 34 nulliparous women diagnosed with DIE and associated superficial dyspareunia. After an initial clinical examination, all patients underwent three-dimensional/four-dimensional (3D/4D) transperineal ultrasound to measure the levator hiatal area (LHA) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver, and were asked to rate their pain symptoms using a numerical rating scale (NRS). Eligible women were assigned randomly (1:1 ratio) to no intervention (control group, 17 women) or treatment with five individual sessions of PFP (study group, 17 women). Four months after the first examination, all women underwent a second evaluation of pain symptoms and LHA on transperineal ultrasound. The primary outcome measure was the percentage change in LHA on maximum Valsalva maneuver between the baseline and follow-up examinations. The percentage changes in pain symptoms between the two examinations, including superficial and deep dyspareunia, dysmenorrhea, chronic pelvic pain, dysuria and dyschezia, were also evaluated. Thirty women, comprising 17 in the study group and 13 in the control group, completed the study and were included in the analysis. The percentage change in LHA on maximum Valsalva maneuver between the two examinations was higher in the study group than in the control group (20.0 ± 24.8% vs -0.5 ± 3.3%; P = 0.02), indicating better pelvic floor muscle relaxation. After PFP treatment, the NRS score for superficial dyspareunia remained almost unchanged in the control group (median change in NRS (Δ-NRS), 0 (interquartile range (IQR), 0-0)) while a marked reduction was observed in the study group (median Δ-NRS, -3 (IQR, -4 to -2); P < 0.01). Moreover, there was a significant difference between the PFP and control groups with regards to the change in chronic pelvic pain (median Δ-NRS, 0 (IQR, -2 to 0) vs 0 (IQR, 0-1); P = 0.01). In women with DIE, PFP seems to result in increased LHA on Valsalva maneuver, as observed by 3D/4D transperineal ultrasound, leading to improved superficial dyspareunia, chronic pelvic pain and pelvic floor muscle relaxation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
726-732Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Clement PB. The pathology of endometriosis: A survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol 2007; 14: 241-260.
Giudice LC. Endometriosis. N Engl J Med 2010; 362: 2389-2398.
Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod 2006; 21: 1839-1845.
Uccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, Gallotta V, Cardinale S, Rausei S, Dionigi G, Scambia G, Ghezzi F. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet 2018; 298: 639-647.
Seracchioli R, Mabrouk M, Guerrini M, Manuzzi L, Savelli L, Frascà C, Venturoli S. Dyschezia and Posterior Deep Infiltrating Endometriosis: Analysis of 360 Cases. J Minim Invasive Gynecol 2008; 15: 695-699.
Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 1990; 53: 978-983.
Kondo W, Bourdel N, Tamburro S, Cavoli D, Jardon K, Rabischong B, Botchorishvili R, Pouly JL, Mage G, Canis M. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG 2011; 118: 292-298.
Seracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, Remorgida V, Mabrouk M, Venturoli S. Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG 2007; 114: 889-895.
Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kinsberg S, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn 2018; 37: 1220-1240.
Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, Ferrini G, Vicenzi C, Raimondo D, Villa G, Zukerman Z, Alvisi S, Seracchioli R. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med 2012; 9: 770-778.
Di Donato N, Montanari G, Benfenati A, Monti G, Bertoldo V, Mauloni M, Seracchioli R. Do women with endometriosis have to worry about sex? Eur J Obstet Gynecol Reprod Biol 2014; 179: 69-74.
Yong PJ, Sadownik L, Brotto LA. Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med 2015; 12: 219-227.
Mabrouk M, Del Forno S, Spezzano A, Raimondo D, Arena A, Zanello M, Leonardi D, Paradisi R, Seracchioli R. Painful Love: Superficial Dyspareunia and Three Dimensional Transperineal Ultrasound Evaluation of Pelvic Floor Muscle in Women with Endometriosis. J Sex Marital Ther 2020; 46: 187-196.
Butrick CW. Pathophysiology of Pelvic Floor Hypertonic Disorders. Obstet Gynecol Clin North Am 2009; 36: 699-705.
Aredo JV, Heyrana KJ, Karp B, Shah JP, Stratton P. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Semin Reprod Med 2017; 35: 88-97.
Dietz HP. Pelvic Floor Ultrasound: A Review. Clin Obstet Gynecol 2017; 60: 58-81.
Nyhus MØ, Oversand SH, Salvesen Ø, Salvesen KÅ, Mathew S, Volløyhaug I. Ultrasound assessment of pelvic floor muscle contraction: reliability and development of an ultrasound-based contraction scale. Ultrasound Obstet Gynecol 2020; 55: 125-131.
Manzini C, Friedman T, Turel F, Dietz HP. Vaginal laxity: which measure of levator ani distensibility is most predictive? Ultrasound Obstet Gynecol 2020; 55: 683-687.
Kamel R, Montaguti E, Nicolaides KH, Soliman M, Dodaro MG, Negm S, Pilu G, Momtaz M, Youssef A. Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor. Am J Obstet Gynecol 2019; 220: 189.e1-189.e8.
Raimondo D, Youssef A, Mabrouk M, Del Forno S, Martelli V, Pilu G, Rizzo N, Zannoni L, Paradisi R, Seracchioli R. Pelvic floor muscle dysfunction on 3D/4D transperineal ultrasound in patients with deep infiltrating endometriosis: a pilot study. Ultrasound Obstet Gynecol 2017; 50: 527-532.
Mabrouk M, Raimondo D, Del Forno S, Baruffini F, Arena A, Benfenati A, Youssef A, Martelli V, Seracchioli R. Pelvic floor muscle assessment on three- and four-dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment. Ultrasound Obstet Gynecol 2018; 52: 265-268.
Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol 2019; 31: 485-493.
Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep 2017; 18: 47.
Bradley MH, Rawlins A, Brinker CA. Physical Therapy Treatment of Pelvic Pain. Phys Med Rehabil Clin N Am 2017; 28: 589-601.
Stein A, Sauder SK, Reale J. The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment. Sex Med Rev 2019; 7: 46-56.
Del Forno S, Arena A, Alessandrini M, Pellizzone V, Lenzi J, Raimondo D, Casadio P, Youssef A, Paradisi R, Seracchioli R. Transperineal Ultrasound Visual Feedback Assisted Pelvic Floor Muscle Physiotherapy in Women With Deep Infiltrating Endometriosis and Dyspareunia: A Pilot Study. J Sex Marital Ther 2020; 46: 603-611.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, Exacoustos C, Installé AJF, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332.
Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2015; 21: 136-152.
Youssef A, Montaguti E, Sanlorenzo O, Cariello L, Awad EE, Pacella G, Ghi T, Pilu G, Rizzo N. A new simple technique for 3-dimensional sonographic assessment of the pelvic floor muscles. J Ultrasound Med 2015; 34: 65-72.
Youssef A, Montaguti E, Sanlorenzo O, Cariello L, Salsi G, Morganelli G, Azzarone C, Pilu G, Rizzo N. Reliability of new three-dimensional ultrasound technique for pelvic hiatal area measurement. Ultrasound Obstet Gynecol 2016; 47: 629-635.
Montaguti E, Cariello L, Dodaro MG, Rizzo N, Pilu G, Youssef A. The role of a new three-dimensional ultrasound technique in the diagnosis of levator ani muscle avulsion. Neurourol Urodyn 2020; 39: 455-463.
Oyama IA, Rejba A, Lukban JC, Fletcher E, Kellogg-Spadt S, Holzberg AS, Whitmore KE. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 2004; 64: 862-865.
De Graaff AA, Van Lankveld J, Smits LJ, Van Beek JJ, Dunselman GAJ. Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. Hum Reprod 2016; 31: 2577-2586.
Pluchino N, Wenger JM, Petignat P, Tal R, Bolmont M, Taylor HS, Bianchi-Demicheli F. Sexual function in endometriosis patients and their partners: Effect of the disease and consequences of treatment. Hum Reprod Update 2016; 22: 762-774.
Morin M, Bergeron S, Khalifé S, Mayrand M, Binik YM. Morphometry of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia Using 4D Ultrasound. J Sex Med 2014; 11: 776-785.
Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev 2017; 5: 495-507.
Klotz SGR, Schön M, Ketels G, Löwe B, Brünahl CA. Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review. Physiother Theory Pract 2019; 35: 516-532.
Van Delft K, Thakar R, Sultan AH. Pelvic floor muscle contractility: Digital assessment vs transperineal ultrasound. Ultrasound Obstet Gynecol 2015; 45: 217-222.
Youssef A, Idris O, Dodaro MG, Badr I, Di Donna G, Kamel R. Three-dimensional ultrasound assessment of pelvic floor: impact of theoretical and practical course on caregiver accuracy. Ultrasound Obstet Gynecol 2020; 55: 554-556.
Vercellini P. Introduction: Management of endometriosis: moving toward a problem-oriented and patient-centered approach. Fertil Steril 2015; 104: 761-763.
da Silva APM, Montenegro ML, Ferreira Gurian MB, de Souza Mitidieri AM, da Silva Lara LA, Poli-Neto OB, Rosa E Silva JC. Perineal massage improves the dyspareunia caused by tenderness of the pelvic floor muscles. Rev Bras Ginecol Obstet 2017; 39: 26-30.
De Souza Montenegro MLL, Mateus-Vasconcelos EC, Candido Dos Reis FJ, Rosa E Silva JC, Nogueira AA, Poli Neto OB. Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles. J Eval Clin Pract 2010; 16: 981-982.
Mabrouk M, Montanari G, Guerrini M, Villa G, Solfrini S, Vicenzi C, Mignemi G, Zannoni L, Frasca C, Di Donato N, Facchini C, Del Forno S, Geraci E, Ferrini G, Raimondo D, Alvisi S, Seracchioli R. Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study. Health Qual Life Outcomes 2011; 9: 98.