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Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences

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Abstract

Introduction and hypothesis

This study was aimed at comparing pelvic floor parameters between the standing and supine positions using upright computed tomography (CT) and evaluating the effects of sex and age in normal healthy volunteers.

Methods

In total, 139 volunteers (70 men, mean 46.7 years; 69 women, mean 47.3 years) underwent both upright CT in the standing position and conventional CT in the supine position. The distances from the bladder neck to the pubococcygeal line (PCL) and anorectal junction (ARJ), defined as the posterior aspect of the puborectalis muscle, to PCL were measured. The length, width, and area of the levator hiatus (LH) were measured on oblique axial images.

Results

The bladder neck (men, 22.2 ± 4.9 mm vs 28.3 ± 5.3 mm; women, 9.0 ± 5.1 mm vs 19.0 ± 4.0 mm) and ARJ (men, −18.8 ± 5.5 mm vs −12.1 ± 5.1 mm; women, −20.0 ± 4.7 mm vs −11.2 ± 4.3 mm) were significantly lower in the standing position than in the supine position (all p < 0.0001). The LH area (men, 1,990 ± 380 mm2 vs 1,697 ± 329 mm2; women, 2,284 ± 344 mm2 vs 1,811 ± 261 mm2) was significantly larger in the standing position (both p < 0.0001). Differences in all parameters between the standing and supine positions were larger in women than in men. ARJ in women showed a significant tendency to descend with age only in the standing position (r = −0.29, p = 0.017).

Conclusions

The bladder neck and ARJ descend and the LH area enlarges in the standing position. Pelvic floor mobility is greater in women than in men. Descent of the ARJ in the standing position is associated with aging in women.

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References

  1. Bitti GT, Argiolas GM, Ballicu N, Caddeo E, Cecconi M, Demurtas G, et al. Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities. Radiographics. 2014;34:429–48. https://doi.org/10.1148/rg.342125050.

    Article  Google Scholar 

  2. Garcia del Salto L, de Miguel CJ, Aguilera del Hoyo LF, Gutierrez Velasco L, Fraga Rivas P, Manzano Paradela M, et al. MR imaging-based assessment of the female pelvic floor. Radiographics. 2014;34:1417–39. https://doi.org/10.1148/rg.345140137.

    Article  Google Scholar 

  3. Ribas Y, Hotouras A, Chan CL, Clave P. Imaging of pelvic floor disorders: are we underestimating gravity? Dis Colon Rectum. 2014;57:1242–4. https://doi.org/10.1097/DCR.0000000000000201.

    Article  CAS  Google Scholar 

  4. Kelvin FM, Maglinte DD, Hale DS, Benson JT. Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol. 2000;174:81–8. https://doi.org/10.2214/ajr.174.1.1740081.

    Article  CAS  Google Scholar 

  5. Jinzaki M, Yamada Y, Nagura T, Nakahara T, Yokoyama Y, Narita K, et al. Development of upright computed tomography with area detector for whole-body scans: phantom study, efficacy on workflow, effect of gravity on human body, and potential clinical impact. Investig Radiol. 2020;55:73–83. https://doi.org/10.1097/RLI.0000000000000603.

    Article  Google Scholar 

  6. MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107:1460–70.

    CAS  Google Scholar 

  7. Yamada Y, Yamada M, Yokoyama Y, Tanabe A, Matsuoka S, Niijima Y, et al. Differences in lung and lobe volumes between supine and standing positions scanned with conventional and newly developed 320-detector-row upright CT: intra-individual comparison. Respiration. 2020. https://doi.org/10.1159/000507265.

    Article  Google Scholar 

  8. Yamada Y, Jinzaki M, Hosokawa T, Tanami Y, Sugiura H, Abe T, et al. Dose reduction in chest CT: comparison of the adaptive iterative dose reduction 3D, adaptive iterative dose reduction, and filtered back projection reconstruction techniques. Eur J Radiol. 2012;81:4185–95. https://doi.org/10.1016/j.ejrad.2012.07.013.

    Article  Google Scholar 

  9. El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, et al. Magnetic resonance imaging of pelvic floor dysfunction—joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. Eur Radiol. 2017;27:2067–85. https://doi.org/10.1007/s00330-016-4471-7.

    Article  Google Scholar 

  10. Goh V, Halligan S, Kaplan G, Healy JC, Bartram CI. Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol. 2000;174:661–6. https://doi.org/10.2214/ajr.174.3.1740661.

    Article  CAS  Google Scholar 

  11. Barbaric ZL, Marumoto AK, Raz S. Magnetic resonance imaging of the perineum and pelvic floor. Top Magn Reson Imaging. 2001;12:83–92.

    CAS  Google Scholar 

  12. Nardos R, Thurmond A, Holland A, Gregory WT. Pelvic floor levator hiatus measurements: MRI versus ultrasound. Female Pelvic Med Reconstr Surg. 2014;20:216–21. https://doi.org/10.1097/SPV.0000000000000079.

    Article  Google Scholar 

  13. Gregory WT, Nardos R, Worstell T, Thurmond A. Measuring the levator hiatus with axial MRI sequences: adjusting the angle of acquisition. Neurourol Urodyn. 2011;30:113–6. https://doi.org/10.1002/nau.20957.

    Article  Google Scholar 

  14. Kepenekci I, Keskinkilic B, Akinsu F, Cakir P, Elhan AH, Erkek AB, et al. Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity. Dis Colon Rectum. 2011;54:85–94. https://doi.org/10.1007/DCR.0b013e3181fd2356.

    Article  Google Scholar 

  15. Barber MD, Lambers A, Visco AG, Bump RC. Effect of patient position on clinical evaluation of pelvic organ prolapse. Obstet Gynecol. 2000;96:18–22. https://doi.org/10.1016/s0029-7844(00)00859-0.

    Article  CAS  Google Scholar 

  16. Swift SE, Herring M. Comparison of pelvic organ prolapse in the dorsal lithotomy compared with the standing position. Obstet Gynecol. 1998;91:961–4. https://doi.org/10.1016/s0029-7844(98)00111-2.

    Article  CAS  Google Scholar 

  17. Braverman M, Kamisan Atan I, Turel F, Friedman T, Dietz HP. Does patient posture affect the ultrasound evaluation of pelvic organ prolapse? J Ultrasound Med. 2019;38:233–8. https://doi.org/10.1002/jum.14688.

    Article  Google Scholar 

  18. Maglinte DD, Hale DS, Sandrasegaran K. Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: which is the "functional" examination for anorectal and pelvic floor dysfunction? Abdom Imaging. 2013;38:952–73. https://doi.org/10.1007/s00261-012-9870-x.

    Article  Google Scholar 

  19. Iacobellis F, Brillantino A, Renzi A, Monaco L, Serra N, Feragalli B, et al. MR imaging in diagnosis of pelvic floor descent: supine versus sitting position. Gastroenterol Res Pract. 2016;2016:6594152. https://doi.org/10.1155/2016/6594152.

    Article  Google Scholar 

  20. Friedman B, Stothers L, Lazare D, Macnab A. Positional pelvic organ prolapse (POP) evaluation using open, weight-bearing magnetic resonance imaging (MRI). Can Urol Assoc J. 2015;9:197–200. https://doi.org/10.5489/cuaj.2767.

    Article  Google Scholar 

  21. Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J. 2018;12:E453–60. https://doi.org/10.5489/cuaj.5186.

    Article  Google Scholar 

  22. Grob ATM, Olde Heuvel J, Futterer JJ, Massop D, Veenstra van Nieuwenhoven AL, Simonis FFJ, et al. Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings. Int Urogynecol J. 2019;30:1939–44. https://doi.org/10.1007/s00192-018-03862-0.

    Article  Google Scholar 

  23. Mouritsen L, Bach P. Ultrasonic evaluation of bladder neck position and mobility: the influence of urethral catheter, bladder volume, and body position. Neurourol Urodyn. 1994;13:637–46.

    CAS  Google Scholar 

  24. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25:580–5. https://doi.org/10.1002/uog.1899.

    Article  CAS  Google Scholar 

  25. Woodfield CA, Krishnamoorthy S, Hampton BS, Brody JM. Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol. 2010;194:1640–9. https://doi.org/10.2214/AJR.09.3670.

    Article  Google Scholar 

  26. Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am. 2009;36:403–415, v. https://doi.org/10.1016/j.ucl.2009.07.003.

    Article  Google Scholar 

  27. Lee SE, Chung JS, Han BK, Moon KH, Hwang SI, Lee HJ, et al. Relationship of prostate-specific antigen and prostate volume in Korean men with biopsy-proven benign prostatic hyperplasia. Urology. 2008;71:395–8. https://doi.org/10.1016/j.urology.2007.10.019.

    Article  Google Scholar 

  28. Howard D, Delancey JO, Tunn R, Ashton-Miller JA. Racial differences in the structure and function of the stress urinary continence mechanism. Obstet Gynecol. 2000;95:713–7.

    CAS  Google Scholar 

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Funding

This study was supported by the Japan Society for the Promotion of Science (JSPS KAKENHI: Grant Number JP17H04266), Uehara Memorial Foundation, and Canon Medical Systems (Otawara, Japan) for Masahiro Jinzaki.

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Authors and Affiliations

  1. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Keiichi Narita, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Takehiro Nakahara & Masahiro Jinzaki

Authors
  1. Keiichi Narita
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  2. Yoshitake Yamada
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  3. Minoru Yamada
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  4. Yoichi Yokoyama
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  5. Takehiro Nakahara
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  6. Masahiro Jinzaki
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Contributions

K. Narita: data collection, data analysis, manuscript writing; Y. Yamada: protocol development, data collection, manuscript editing; M. Yamada: protocol development, data collection, manuscript editing; Y. Yokoyama: data collection, data analysis, manuscript editing; T. Nakahara: data collection, manuscript editing; M. Jinzaki: project development, manuscript editing.

Corresponding authors

Correspondence to Yoshitake Yamada or Masahiro Jinzaki.

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Conflicts of interest

Masahiro Jinzaki received a grant from Canon Medical Systems, which loaned the upright CT device to Keio University. The funder was not involved in the design of the study; collection, analysis, and interpretation of the data; or writing of the manuscript. The other authors declare that they have no conflicts of interest.

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Narita, K., Yamada, Y., Yamada, M. et al. Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences. Int Urogynecol J 31, 2387–2393 (2020). https://doi.org/10.1007/s00192-020-04335-z

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  • DOI: https://doi.org/10.1007/s00192-020-04335-z

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