Many woman, postmenopausal and with a history of vaginal delivery, suffer from pelvic organ prolapse. Therapeutic options are found in diaphragm (ring) placement, pelvic floor physiotherapy and different types of surgery.
THE ANATOMY, functionality AND (AUTO) SEGMENTATION OF THE PELVIC FLOOR
In combination with researchers form the RaM group and the UMC Utrecht, the different structures in the pelvic floor (uterus, vagina, rectum, sphincters etc) are segmented from ultrasound images. This adds to our understandig of the anatomy of the pelvic floor, as well as the functionality (which parts contract in a healthy muscle and how happens after an avulsion?).
the effect of gravity
The diagnosis of the extent of prolapse is generally estimated with the patient in supine position, while women experience the most complaints in standing position (gravity). Research using the low-field MR tilting system gives better insight in the extent of prolapse in different positions, enables us to determine the effect of surgery and might help in reducing the current high recurrence rate.
Understanding and optimising the application of a pessary
We recently started a study to understand the therapeutic options of a pessary. Pessaries are availables in multiple shapes and sizes. After placement the pessary might drop-out immediately, after a couple of days, have a great fit and effect or cause erosion. There is only very limited information on all these topics.
Current clinical studies:
- SAM: A multicenter national study to compare two different operating techniques (Modified Manchester and Sacrospinal Fixation) by means of physical examination, questionnaires and upright and supine MR scans.
- Comparison of X- and MR defecography: Previous studies have demonstrated that these two techniques are comparable in the detection of prolapse. However, MR has the added value of soft tissue visualisation. How does imaging interact with the clinical decision making of a gynecologist. Which type of treatment would be suggest after clinical examination, X-defeco and MR-defeco? Additionally: Which (new) parameters can be obtained from MR-defecografy that can futher add to the understanding and treatment of prolapse.
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