13th World Congress on Ultrasound in Obstetrics and Gynecology

We proposed a simple US-based evaluation of the anal sphincter

using an off-the-shelf, commonly used high frequency transvaginal
probe placed in the area of the fourchette pointing coronally and
following this sagittal towards the anal area.
During our preliminary studies we obtained clear transverse
and longitudinal pictures of sufficiently high resolution of the
sphincter mechanism. Nulliparous patients, multiparous patients
with and without sphincter trauma at birth were studied along with
symptomatic patients. We then compared the anatomic landmarks
obtained with the transvaginal US probes to those landmarks
obtained with MRI and published in a state of the art work of Stoker
et al(Radiology 2001; 218: 621641). The method developed by us
could image the anatomy of the anal-sphincter unit. Due to its
simplicity it can be performed anyplace a vaginal probe is available
making the more cumbersome use of a transrectal rotary probe
redundant. The future is probably applying 3D US.
Scanning the anterior and posterior perineal compartment in the
female patient is simple, user friendly. It can be accomplished in the
practitioners office making results instantly available for a proper
management of patients with urinary or sphincter problems.

OC175
Transvaginal ultrasound and voiding disorders after TVT
procedure
G. Ducarme, D. Rey, Y. Menard, Y. Youinou and
F. Staerman
France
Objective: This study was carried out to evaluate the ultrasonographic findings on patients with voiding disorders after the
tension-free vaginal tape procedure (TVT).
Patients and methods: Fifty-three women had ultrasonographic
evaluation 3 months after TVT procedure. The prolene tape position
was evaluated with a complete sagittal view and the width of
the tape and the distance between the bladder neck and the tape
were measured. In the same time, patients completely cured by
TVT (group 1), postoperative dysuria (group 2), de novo urge
incontinence (group 3) and ineffective treatment were evaluated with
a self-questionnaire and physical examination. Statistical analysis
was performed using ANOVA test.
Results: The distance between the tape and the bladder neck shows a
significantly difference (p < 0.05) between group 1 and 2 (13.2 mm
compared 7.6 mm) and between group 1 and 3 (13.2 mm compared
17.7 mm). The width of the tape is significantly different between
group 1 and 2 (8.8 mm compared 6.6 mm) and between group
1 and 3 (8.8 mm compared 6.5 mm). The distance between the
tape and the bladder neck in group 2, compared with group 3,
is significantly shorter (7.6 mm compared 17.7 mm). There is no
difference between the width of the tape between group 2 and 3
(6.6 mm compared 6.5 mm).
Conclusion: These results show a correlation between voiding
disorders after TVT procedure and transvaginal ultrasonographic
measurement of the distance between the prolene tape and the
bladder neck.

Oral communication abstracts

Objectives: To assess pelvic floor muscle strength and thickness in
continent and incontinent nulliparous pregnant women.
Methods: 103 nulliparous women at 20 weeks of pregnancy were
studied. Women who reported urinary incontinence once per week,
were classified as incontinent. Perineal ultrasound was used to
measure the thickness of the pelvic floor muscles (urogenital
diaphragm). Muscle strength was measured using a vaginal balloon
catheter connected to a pressure transducer.
Results: 71 women were classified as continent and 32 women
as incontinent. There was a statistically significant difference in
maximal pelvic floor muscle strength between continent (39.5 cm
H2 O (95% CI 35.743.4)) and incontinent (32 cm H2 O (95% CI
27.736.3)) women. Continent women had statistically significantly
thicker pelvic floor muscles during relaxation (p = 0.018) and
contraction (p = 0.006), compared to incontinent women. Increment
in muscle thickness was also higher in continent women (p = 0.021).
There was good correlation between measurements of maximal
pelvic floor muscle strength and perineal ultrasound measurements
of increment in muscle thickness (r = 0.7).
Conclusion: Perineal ultrasound measurements of the urogenital
diaphragm correlates with measurements of pelvic floor muscle
strength and are related to continent status among nulliparous
pregnant women.

OC177
Functional anatomy of the anal canal evaluated with 3D
ultrasound and manometry
D. Pretorius*, N. Prietto, J. Liu, S. Master, C. Nager
and R. Mittal
*Thorton Hospital, USA and University of California, San
Diego, USA

*National Center for Fetal Medicine, NTNU Trondheim,

Norway; Dept of Community Medicine and General
Practice, Norway and The Norwegian Univ of Sport and
Physical Education, Norway

Background: The etiology of anal incontinence is unknown

although it is thought to be related to several factors including
the external anal sphincter (EAS) and internal anal sphincter
(IAS). The puborectalis muscle (PRM) may also play a role in
this mechanism. The purpose of this study was to study the
contribution of all three muscles to anal continence in asymptomatic
women.
Materials and methods: Ten asymptomatic nullipara women
underwent simultaneous 3D ultrasound imaging and manometry
recordings of the anal canal. 3D imaging was performed using
a mechanical, transvaginal probe placed at the vaginal introitus.
Manometry measurements were taken from a catheter with
8 side holes placed circumferentially around it, at the same
level as the imaging. Pressures were measured with both a
station pull through (every 0.5 cm) and a rapid pull through
technique (motor-driven puller, speed 8 mm/s). The ends of the
high pressure zone (HPZ) of the anal canal were defined by
water filled balloons. Data was collected at rest and during
a sustained squeeze. 3D imaging allowed the EAS, IAS and
PRM to be identified clearly in 3 perpendicular planes and
correlated with the pressure readings at specific points in the anal
canal.
Results: The length of the IAS was 27.4 5.1 mm, the EAS was
23.3 2.0 mm, the PRM was 16.6 6.7 mm and the HPZ was
45.4 6.7 mm. The HPZ was demarcated by the IAS and PRM
in the proximal anal canal, the EAS and IAS in the middle and
the EAS in the distal canal. Manometry recordings showed that
during a sustained squeeze, there was an increase in pressure not
only in the EAS but also, to a lesser extent, in the region of the
PRM.
Conclusions: The PRM may play an important role in contraction
of the anal canal.

48

Ultrasound in Obstetrics & Gynecology 2003; 22 (Suppl. 1): 169

OC176
Perineal ultrasound and vaginal squeeze pressure in the
assessment of the pelvic floor muscles in continent and
incontinent nulliparous women
Salvesen*, S. Mrkved, K. B and S. H. Eik-Nes*
K. A.