Características anatômicas e funcionais do assoalho pélvico em nulíparas submetidas a ultrassonografia endovaginal tridimensional e avaliação da concordância interobservador

Abstract

Understanding the pathogenesis of pelvic floor dysfunction (AP) requires extensive knowledge of anatomy. Recent advances in imaging technologies have opened new possibilities for research. However, 30% of surgeries are failures and the main cause is the lack of knowledge of the complex anatomy and the difficulty in diagnosing diseases of this region. The aim of this study was to evaluate the anatomy of the AP nulliparous asymptomatic at rest and Valsalva maneuver, using transvaginal ultrasonography threedimensional (UTV-3D). Nulliparous asymptomatic volunteers underwent echodefecography to identify dynamic changes in the Posterior Compartment (CP), including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional (no relaxation or paradoxical contraction of puborectalis) and evaluated with 3D UTV biometric indexes to determine the urogenital gap (HU) of the anus, the thickness of the pubovisceral muscle (PVM), urethral length, anorectal angle position of the anorectal junction and position of the bladder neck. All measurements were compared at rest and during Valsalva, and determined perineal and bladder neck descent. The interobserver variability was assessed using the intraclass correlation coefficient. Thirty four volunteers were evaluated with echodefecography and TVU-3D. From these, 20 were included in the study. The 14 excluded showed dynamic changes in CP. During the Valsalva maneuver, the hiatal area was higher. The urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during Valsalva differ significantly with respect to the position of the anorectal junction and the bladder neck. The average value of the descending perineum and the descent of the bladder were 0.6 cm and 0.5 cm above the pubic symphysis, respectively. The intraclass correlation coefficient ranged from 0.62 to 0.93. We conclude that thefunctional biometric indices, normal perineal descent, and the values of descent of the bladder neck were determined for young nulliparous asymptomatic women using UTV. The method was reliable to measure the structures of the pelvic floor at rest and during the Valsalva maneuver, and therefore may be appropriate to identify dysfunction in symptomatic patients.