Geburtshilfe Frauenheilkd 2014; 74 - PO_Gyn_Uro05_02
DOI: 10.1055/s-0034-1388312

Effect of patient positioning in ultrasound evaluation of bladder neck mobility and genital hiatus area – pilot study

SB Albrich 1, A Henriques 2, A Dionysopoulou 1, K Rommens 3, S Porta 3, J Steetskamp 3, C Skala 3
  • 1Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Urogynäkologie, Mainz, Germany
  • 2Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Hospital de Santa Maria – Centro Hospitalar Lisboa Norte, Unidade de Uroginecologia, Lisboa, Portugal
  • 3Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Urogynäkologie, Mainz, Germany

Background: Based on studies in the past, we wanted to answer two questions:

What is the impact of posture on bladder neck mobility and genital hiatal area?

Methods: Enrolled into the pilot study were 14 consecutive patients referred with urogynecological symptoms.

After interview and voluntary urination, bladder neck descent and genital hiatus area were assessed by 2D and 4D ultrasound with the women at rest, with pelvic floor muscle contraction (PFMC) and during valsalva. Analysis was performed by 2 investigators. This examination was tested first in supine lithotomy then in standing position. Descriptive statistical analysis and parametrical tests (paired T test and co-variance) were used.

Results: Average age was 63,7 years, five had levator avulsions on ultrasound.

Average hiatal area was: at rest 22,85 cm2 in supine, 25,13 cm2 in standing position (Δ 2,29 cm2) p = 0,099; with PFMC was 20,31 cm2 in supine, 20,47 cm2 in standing position (Δ 0,17 cm2) p = 0,44; with valsalva 27,39 cm2 in supine, 30,58 cm2 standing (Δ 3,19 cm2) p = 0,01.

The average of bladder neck descent was 1,61 cm in supine position and 1,19 cm standing (Δ -0,42 cm) p = 0.02.

Conclusions: The effect of a pelvic floor contraction was not significantly influenced by posture that is in agreement with other studies. In our preliminary analysis standing position had an impact on hiatal area on valsalva. Bladder neck descent was inferior in standing position because. This may explain why POP is more evident in standing position.