Shortcomings of our current measurement systems, such as the POPQ system, include a dependency on the patient's ability to perform a Zipf-Thal-Salva maneuver. Without an adequate generation of intra-abdominal pressures, areas of prolapse can be grossly underestimated and even missed. There's an inability to quantify asymmetrical defects and an inability to differentiate between the nature of prolapsed tissue. For example, the degree of tissue distension versus a predominant detachment defect with an intact vaginal wall. In addition to the difficulties in fully classifying structural defects, we also encounter significant limitations in the evaluation of functional muscle contributions to pelvic floor disorders. Our current classification system relies on a simple and limited evaluation of pelvic floor muscles, with an inability to characterize potential passive and active muscle contributions to a patient's condition. Physicians often compensate with non-standard terminology to further describe their clinical examinations. The differences in our clinical judgment is often based on characteristics appreciated on exam from an intuitive judgment of biomechanical properties, based on how the tissue moves with palpation, or what we observe with strain. Properties that, to date, have not been readily quantified, and makes it quite difficult to compare outcomes or understand what factors are important for optimized repairs. Objective. To introduce pelvic tissue evaluation with a vaginal tactile imaging probe, which allows high-definition pressure mapping to quantify behavior of the female pelvic floor muscles with voluntary and involuntary use. We designed a new vaginal tactile imaging probe to image the entire vagina, the underlying support structures, and the pelvic floor muscle contractions in real time. The probe sensor has 96 sensor arrays along either side, and it measures approximately 11 centimeters in length, a motion tracking sensor, a temperature controller, and two microchips that communicate with the main computer. We implemented the software support for high-definition pressure mapping during valsalva maneuver, pelvic floor muscle contractions, and involuntary relaxation. The patients were studied with the vaginal tactile imaging probe in lathotomy position. We enrolled the first 24 subjects of 150 planned into an observational case-controlled study. Mean patient age was 56.9 years, with a range of 26 to 72. Pelvic floor conditions were from normal to stage 3 pelvic organ prolapse, and medium parity was 2, with a range of 0 to 8. They were asked to complete an assessment of comfort and pain levels for the tactile imaging. Results. All 24 patients were successfully examined and data were recorded using the vaginal tactile imager. The preliminary data analysis reveals the following findings. Under valsalva maneuver, we observed pressure patterns that were not uniform along the anterior and posterior compartments, which are substantially different than under pelvic floor muscle contraction. It seems that high-pressure zones correspond to softer tissues with a low support capability. These high-pressure zones measuring 30 to 50 millimeters of mercury appear to have been created by penetration of surrounding loads through an internal strain, or easily flexed. That means that this test allows detection of biomechanically weak structures and their locations. We observed significant amplitude difference or ratio, involuntary muscle contractions for anterior versus posterior, and left versus right side, which may allow recognizing of muscle avulsion and further characterization of their functional conditions. It seems possible to recreate their dynamics in three dimensions. During the involuntary muscle relaxation, the patient was asked to maintain a sustained pelvic muscle contraction. By quantifying the pressure decline versus time at a region of interest or for specific muscles, it seemed possible to characterize functional conditions of multiple pelvic dynamic structures. A typical examination with vaginal tactile imaging probe takes two to three minutes. Fifty percent of patients classified tactile imaging comfort level as more comfortable than a manual palpation examination, 33 percent as the same, and 17 percent as less comfortable. Conclusions. Our findings demonstrate that high-definition pressure mapping during valsalva maneuver, pelvic floor muscle contraction, and involuntary relaxation may be used for quantitative characterization of pelvic organ prolapse. Functional imaging of the pelvic floor muscles may offer a needed insight into the biomechanics of the pelvic floor to help understand the relative contribution of pelvic floor muscles into pelvic organ prolapse development and its effective treatments. This research is being supported by the National Institutes of Health, National Institute of Aging. Thank you for watching our presentation.

measurement systems

pelvic floor disorders

vaginal tactile imaging

pressure mapping

pelvic structures