title: Pelvic floor muscle dysfunction on 3D/4D transperineal ultrasound in patients with deep infiltrating endometriosis: a pilot study.
abstract: OBJECTIVE
  Pelvic floor muscle (PFM) dysfunction seems to play an important role in the pathophysiology of pelvic pain, including that associated with deep infiltrating endometriosis (DIE). The aim of this study was to evaluate the static and dynamic morphometry of the PFM using three-dimensional (3D) and four-dimensional (4D) transperineal ultrasound in women with DIE compared with asymptomatic healthy women.
  
  
  METHODS
  This was a pilot, prospective study conducted at our tertiary center between March and November 2015. Fifty nulliparous women with DIE (study group) and 35 nulliparous asymptomatic healthy women (control group) were included. 3D/4D transperineal ultrasound examination of the PFM was performed in both groups. Levator hiatal area (LHA) and anteroposterior and left-right transverse diameters were evaluated at rest, on maximum PFM contraction and on maximum Valsalva maneuver. Persistent levator ani muscle (LAM) coactivation during Valsalva maneuver was investigated.
  
  
  RESULTS
  Compared with the control group, women with DIE had a smaller LHA at rest (P = 0.03) and during Valsalva maneuver (P < 0.01). Furthermore, reduction in LHA during PFM contraction (P < 0.001) and enlargement in LHA during Valsalva maneuver (P = 0.01) were significantly less marked. In comparison with controls, women with DIE presented a higher frequency of LAM coactivation during Valsalva maneuver, although this difference did not reach statistical significance (P = 0.05).
  
  
  CONCLUSIONS
  3D and 4D transperineal ultrasound is an objective and non-invasive method for PFM morphometry and may have a role in detecting PFM dysfunction in women with DIE. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: D
authors.identifier: http://orcid.org/0000-0002-3235-4378
authors.initials: D
authors.lastname: Raimondo
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Youssef
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.|Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Mabrouk
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Del Forno
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Martelli
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pilu
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Rizzo
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Zannoni
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Paradisi
authors.affiliation: Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Seracchioli
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D009119:Muscle Contraction / Q000502:physiology*; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography; D014636:Valsalva Maneuver / Q000502:physiology*
keywords: 3D transperineal ultrasound; 4D transperineal ultrasound; deep infiltrating endometriosis; pelvic floor muscle; perineal dysfunction