Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)

INTRODUCTION AND OBJECTIVES: This study presents a new potentially useful three-dimensional (3D) non-invasive tool to determine the basic 3D models of the pelvic floor, static and dynamic, in patients with pelvic organ prolapse (POP) which help to identify the main types of pelvic floor defects and to create an individual approach to their reconstruction. METHODS: We scanned 42 patients who were suffering from POP (no less than Grade 2 by Pelvic Organ Prolapse Quantification (POP-Q)) at rest and during Valsalva maneuver by using an Artec 3D optic portable scanner. Pelvic floor 3D models were generated. We calculated the volume of the prolapsed vaginal wall using Dynamic prolapse increment (DPI). It was defined as an increase in the prolapse volume from the rest to its maximal Valsalva probe (DPI 1⁄4 (Vval e Vrest) / Vrest %). RESULTS: The average value of the DPI in women with POP was 648% (95% CI 194-1102%). It indicated the presence of an advanced mobility of the pelvic floor and the need to use mesh surgical correction of POP in some cases. According to generated pelvic floor 3D models, six basic types of pelvic defects were allocated. The central defects of an anterior vaginal wall along with mixed one (cystocele combined with uterine prolapse or rectocele) were the most common defects of the pelvic floor (in 24 and 26%, respectively). The lateral defect occurred in 7%, the asymmetric one in 10%, urethra cystocele in 19%, the isolated uterine defect 10% and enterocele 5% (Figure 1). CONCLUSIONS: The detection of types of pelvic floor defects in women with POP by 3D modeling may allow creating of synthetic implants for an individual pelvic floor reconstruction, taking into account patients’ reserves of pelvic floor mobility. It will contribute reducing the risk of possible functional complications of surgical correction of POP. The further investigations of the pelvic floor dynamic features in women are necessary.