Pelvic floor muscle assessment by digital palpation and translabial ultrasound of women with cervical or endometrial can
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ORIGINAL ARTICLE
Pelvic floor muscle assessment by digital palpation and translabial ultrasound of women with cervical or endometrial cancer after pelvic radiotherapy: a cross-sectional study Thais de Morais Siqueira 1 & Sophie Derchain 1 & Natalia Martinho 1,2 & Rodrigo Menezes Jales 1 & Cassia Raquel Teatin Juliato 1 & Luiz Gustavo Oliveira Brito 1 Received: 17 September 2020 / Accepted: 28 October 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis We hypothesized that anatomical changes in the pelvic floor muscles (PFM) could be detected using four-dimensional translabial ultrasound (4D TLUS) in patients with cervical (CC) or endometrial cancer (EC) who underwent pelvic radiotherapy (RT) as digital palpation may present sensitivity limitations. Methods This was a cross-sectional study that included 64 women (26 with CC and 38 with EC). PFM function was assessed by digital palpation, grading muscle strength according to the Modified Oxford Scale and by 4D TLUS. Ultrasonographic variables were: levator plate angle, hiatal area, puborectalis muscle thickness, puborectalis strain and levator ani muscle integrity. These variables were also correlated with clinical and sociodemographic data from all these patients. A 5% significance level was adopted. Results When assessed by digital palpation, no significant difference was found in PFM strength between women with CC and those with EC (p = 0.747). However, when assessed by 4D TLUS, women with CC presented greater thickening of the left (p = 0.039) and right (p = 0.014) lower portion of the puborectalis muscle during PFM contraction compared to those with EC. After pooling the groups, higher cancer staging (p = 0.028) was associated with smaller narrowing in the symphysis-levator distance, and shorter RT finishing duration (< 60 months) was associated with higher thickening in the left (p = 0.029) and right (p = 0.013) upper portion of the puborectalis muscle during PFM contraction as well as a shorter menopause duration (p = 0.007 and p = 0.002, respectively). Conclusions Anatomical changes in the puborectalis muscle during PFM contraction were detected by 4D TLUS within gynecological cancer patients after pelvic RT. Keywords Pelvic floor . Digital palpation . Translabial ultrasound . Cervical cancer . Endometrial cancer . Pelvic radiotherapy . Pelvic floor muscle
Introduction Cervical cancer (CC) is the fourth most common cancer among women in the world. Endometrial cancer (EC) is also
prevalent worldwide and more common in developed countries [1]. When detected in early stages, CC can be treated with radical hysterectomy with or without pelvic lymphadenectomy. However, postoperative radiotherapy with or without
* Luiz Gustavo Oliveira Brito [email protected] Thais de Morais Siqueira [email protected]
Cassia Raquel Teatin Juliato [email protected] 1
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas-UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas,
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