PELVIC FLOOR MUSCLE DYSFUNCTION AT 3D/4D TRANSPERINEAL ULTRASOUND IN PATIENTS WITH DEEP INFILTRATING ENDOMETRIOSIS: A PILOT STUDY

OBJECTIVE: Pelvic floor muscle (PFM) dysfunction seems to play an important role in the pathophysiology of pain in women with with pelvic pain syndromes, including deep infiltrating endometriosis (DIE). The aim of the study was to evaluate static and dynamic morphometry of PFM in women affected by DIE, in comparison to asymptomatic control women, using three-dimensional (3D) and four-dimensional (4D) transperineal ultrasound. METHODS: A pilot, prospective study was conducted between March 2015 and November 2015, at our tertiary center. We enrolled 50 nulliparous patients with DIE (study group) and 35 nulliparous asymptomatic healthy women (control group). 3D/4D transperineal ultrasound examinations were performed in both groups. In particular, levator hiatal area (LHA), anteroposterior and left-right diameters were evaluated at rest, at maximum pelvic floor contraction and on maximal Valsalva manoeuvre. Persistent levator ani muscle (LAM) coactivation during Valsalva manoeuvre was also investigated. RESULTS: Compared to control group, patients with DIE showed a smaller LHA at rest (p = 0.03) and during Valsalva manoeuvre (p < 0.01). Moreover, in the study group smaller changes in LHA narrowing during PFM contraction and in LHA enlargement during Valsalva manoeuvre were reported (p < 0.001 and p < 0.01, respectively). In comparison with controls women with DIE presented a higher frequency of LAM coactivation during Valsalva manoeuvre, although this did not reach statistical significance (p = 0.05). CONCLUSIONS: 3D and 4D transperineal ultrasound could represent an objective and non-invasive method to detect PFM dysfunction in women with DIE.