Alterações morfológicas do assoalho pélvico decorrentes do tratamento fisioterapêutico para incontinência urinaria medidas por meio do ultrassom transperineal

Abstract

The objective of this project is to compare the changes in pelvic floor muscle (PFM) morphology following the two most-commonly used physiotherapy treatments for urinary incontinence in older women (group treatment and individual treatment). A cohort of 360 older women (60 and over) with urinary incontinence will participate in the study. US measurements will be taken prior to and after a 12 weeks of PFM rehabilitation intervention, delivered either in groups of 8 women or individually, using a 3D/4D transperinal with the Voluson E8 expert system with a 2-6-MHz curved array volume transducer (RM6C, GEMedical Systems, Zipf, Austria). Images will be taken under 4 conditions: rest, maximal voluntary contraction, cough, and a Valsalva maneuver. Datasets will be processed offline using the 4D View computer program for 3/4D tomography imaging. Ultrasound parameters will be taken from both the axial and sagittal images for all four conditions. For the axial images, three parameters will be taken: (1) the levator hiatus antero-posterior distance, (2) the levator hiatus left-right transverse distance, and (3) the levator hiatus area. Each parameter will be measured in the "plane of minimal dimensions". Six parameters will be taken in the sagittal images using the infero-posterior margin of the symphysis pubis as the reference point: (1) the bladder-neck X position, (2) the bladder-neck Y position (similar to MRI uretro-vesical junction height), (3) the anorectal angle, and (4) the PFM height according to previously described methods. During a maximal voluntary contraction, images will be taken of (5) the cranio-ventral (displacement lift) of the bladder-neck. Finally, during a cough and Valsalva (6) the dorso-caudal displacement (descent) of the bladder-neck will be calculated. Apart the quantitative parameters, we will provide qualitative assessment of the pelvic floor - presence or absence of major levator ani trauma (avulsion) using criteria described by HP. Dietz (2010). Statistical Analysis will be used to compare PFM morphological changes following each treatment group. This research is novel and very important, as it will inform clinicians and researchers on the impact of each physiotherapy intervention on PFM morphology. Such a study has never been conducted and will be of major importance in appreciating the impact of each intervention on the PFM morphology and ultimately, in choosing one intervention over the other. (AU)