Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles.
OBJECTIVE
We used a novel technique, high-definition manometry (HDM) that utilizes 256 tactile sensitive microtransducers to define the characteristics of vaginal high-pressure zone.


METHODS
Sixteen nullipara asymptomatic women were studied using HDM, transperineal 2-dimensional dynamic ultrasound and dynamic magnetic resonance (MR) imaging.


RESULTS
Vaginal high-pressure zone revealed higher contact pressures in anterior and posterior directions compared with lateral directions, both at rest and squeeze. At rest, anterior pressure cluster is located 10 mm cephalad to posterior pressure cluster; with squeeze the latter moves in the cranial direction by 7 mm. Ultrasound and MR images revealed that the anorectal angle moves cephalad and ventrally during squeeze. Cephalad movement of posterior pressure cluster during squeeze is similar to the cranial movement of anorectal angle.


CONCLUSIONS
We propose that the vaginal high-pressure zone represents the constrictor function and cranial movement of the posterior pressure cluster represents the elevator function of pelvic floor. HDM may be used to measure the constrictor and elevator functions of pelvic floor muscles.
Raizada
Varuna
V
Pelvic Floor Function and Disease Group, Division of Gastroenterology, University of California, San Diego, San Diego, CA, USA.
Bhargava
Valmik
V
Jung
Sung-Ae
SA
Karstens
Anna
A
Pretorius
Dolores
D
Krysl
Petr
P
Mittal
Ravinder K
RK
D000328:Adult; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000502:physiology; D017773:Pelvic Floor; D011312:Pressure; D011336:Probability; D012016:Reference Values; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D014621:Vagina / Q000502:physiology*; D055815:Young Adult
Gut. 1999 Jan;44(1):77-80
9862829
Arch Sex Behav. 1979 Sep;8(5):425-30
496623
Neurourol Urodyn. 2003;22(7):648-53
14595608
Ann R Coll Surg Engl. 1974 May;54(5):244-52
4829749
Am J Obstet Gynecol. 1948 Aug;56(2):238-48
18877152
Gastroenterology. 1984 Apr;86(4):693-7
6698369
Int Urogynecol J Pelvic Floor Dysfunct. 2005 May-Jun;16(3):236-41
15875241
Obstet Gynecol. 2002 Mar;99(3):433-8
11864670
Invest Urol. 1975 Mar;12(5):412-9
1112669
Obstet Gynecol. 2004 Jul;104(1):168-73
15229017
J Am Med Assoc. 1951 Jul 7;146(10):915-7
14841055
Dis Colon Rectum. 2007 Oct;50(10):1647-55
17762969
Neurourol Urodyn. 2005;24(3):243-7
15714439
Neurourol Urodyn. 1995;14(2):131-9
7780440
Ultrasound Obstet Gynecol. 2004 Jan;23(1):80-92
14971006
Am J Physiol. 1997 Jun;272(6 Pt 1):G1509-17
9227488
Neurourol Urodyn. 2004;23(7):662-7
15382182
Gut. 2005 Apr;54(4):546-55
15753542
Acta Obstet Gynecol Scand. 2005 Feb;84(2):129-33
15683371
Nurs Res. 1986 Jul-Aug;35(4):202-6
3636817
J Clin Invest. 1979 May;63(5):1036-41
447825
Am J Obstet Gynecol. 2007 Jul;197(1):52.e1-7
17618755
Am J Dig Dis. 1977 Apr;22(4):348-54
855850
Int Urogynecol J Pelvic Floor Dysfunct. 2004 Jan-Feb;15(1):39-43; discussion 43
14752597
Acta Obstet Gynecol Scand. 1997 Jul;76(6):567-71
9246965
Am J Obstet Gynecol. 2007 Jul;197(1):68.e1-6
17618762
Obstet Gynecol. 2005 Oct;106(4):774-81
16199635
J Sex Res. 1975 Nov;11(4):353-8
1221225