University of Twente Student Theses

Pelvic floor muscle therapy, pessary wearing or both? : Evaluating the effect of pelvic floor muscle therapy additional to pessary wearing, compared to pessary wearing alone, for the treatment of pelvic organ prolapse by means of 4D transperineal ultrasound

Schulten, M.K. (2023) Pelvic floor muscle therapy, pessary wearing or both? : Evaluating the effect of pelvic floor muscle therapy additional to pessary wearing, compared to pessary wearing alone, for the treatment of pelvic organ prolapse by means of 4D transperineal ultrasound.

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Abstract:	Objective: Limited studies evaluated if pelvic floor muscle therapy (PFMT) combined with pessary wearing (combined therapy) provides greater efficacy compared to pessary wearing alone (pessary therapy) in the treatment of pelvic organ prolapse (POP).1–3 Besides, they only focused on biometric parameters and did not quantitatively assess the behavior and function of the muscle. Therefore, in this study muscle strain is utilized to evaluate the change in muscle function of the musculus puborectalis (PRM) after combined therapy, compared to pessary therapy, by means of 4D transperineal ultrasound (TPUS). Additionally, interobserver variability in PRM segmentation was investigated, to evaluate its impact on strain analysis. Method: A retrospective study was conducted including 17 women divided into two groups, the Combined therapy group (n = 7) and the Pessary therapy group (n = 10). 4D TPUS performed before and after treatment was used to assess the accumulated displacement estimates (cm), accumulated principal strain (%), and the mean principal strain (MPS; %) of the PRM. Besides, the area of the levator hiatus (LH) in rest and the difference in anteroposterior (AP) diameter of the LH between rest and maximum contraction are evaluated. Interobserver variability was assessed by the Dice Similarity Coefficient (DSC), average Hausdorff distance (HD) and 95% HD. Results: For the MPS, no significant difference is observed between first and follow-up ultrasound in both groups (Combined therapy, p = 0.263; Pessary therapy, p = 0.489). For the LH area, there was a significant increase for the Combined therapy group (p = 0.036), although a decrease was expected. No significant difference was observed for the Pessary therapy group (p = 0.729). For the AP-diameter the statistical test did not reveal a significant difference between first and follow-up ultrasound for both groups (Combined therapy, p = 0.110; Pessary therapy, p = 0.610). Furthermore, for all three parameters no significant difference was observed between the two groups (MPS, p = 0.422; LH area, p = 0.475; AP-diameter, p = 0.165), and no correlation existed between the parameters. However, acccumulated displacement estimates and accumulated principal strain images reveal an unexpected, highly variating pattern in muscle deformation. Therefore, it cannot be presumed that quantitative outcomes are accurate. Segmentations of different observers showed moderate overlap in comparison metrics, but a variety in MPS values. Conclusion: A step has been made in the evaluation of the effectivity of PFMT additional to pessary wearing, compared to pessary wearing alone. However, the unexpected variability of the accumulated displacement estimates and accumulated principal strain, prevents the formulation of a conclusion. Therefore, this study highlights the need for further research with a prospective dataset and larger study population. Besides, strain software and image tracking need to be optimized. Automatic image segmentation via deep learning needs to be implemented, to prevent observer bias in PRM segmentation.
Item Type:	Essay (Master)
Faculty:	TNW: Science and Technology
Subject:	44 medicine, 50 technical science in general
Programme:	Technical Medicine MSc (60033)
Link to this item:	https://purl.utwente.nl/essays/97277
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