RU2523632C1 - Early diagnostic technique for pelvic floor relaxation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: graduated vaginal probe is introduced into a uterine cavity through an opening in a plate which is arranged with its opening opposite a vaginal orifice; the plate is pressed to vulvar lips, and a vaginal length is measured. The vaginal probe is presented in the form of a flexible plastic tube with a thick wall at a working end. The working end of the vaginal probe is introduced up to a posterior vaginal vault; the vaginal length Li is measured by the graduation of the vaginal probe at the level of the plate opening; the patient is suggested to strain; the post-strain vaginal length Ls is measured again; a degree of the pelvic floor relaxation X is determined by formula: X=(L₁-L₂)×100%/L₁, wherein L₁ is the vaginal length (mm); L₂ is the post-strain vaginal length (mm); X is the degree of the pelvic floor relaxation (%); if X is 51-100%, the absence of the pelvic prolapse is diagnosed; if X is 31-50%, degree I pelvic floor relaxation is stated; if X is 11-30%, degree II pelvic floor relaxation is diagnosed; if X is 0-10%, degree III pelvic floor relaxation is diagnosed.

EFFECT: method enables providing higher diagnostic accuracy ensured by more accurate vaginal measurements by means of the vaginal probe.

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Description

The invention relates to medicine and can be used for early diagnosis of pelvic floor muscle failure in gynecology.

Currently, pelvic floor muscle failure is the most urgent problem in modern gynecological practice. The frequency of prolapse and prolapse of the internal genital organs is 1.7-28%. (Krasnopolsky V.I., Popov A.A. Vaginal extraperitoneal colpopexy (Prolift method) - a new look at the surgery for prolapse and prolapse of the internal genital organs. // Obstetrics and gynecology. 2007. - No. 2. - P. 51-55. )

Menopausal women face this problem most often (~ 40%) than women of reproductive age.

A gynecological examination often reveals the failure of the muscles of the pelvic floor of varying severity, but, as a rule, already II-III art. If timely measures for early diagnosis and prevention are not taken, the disease progresses further. A woman feels discomfort in intimacy, urogenital disorders, intestinal dysfunctions appear, which leads to a deterioration in the quality of life, decreased working capacity, the appearance of psychoemotional disorders and an increase in the complexity class and the cost of treatment. (Pushkar D.Yu. Pelvic disorders in women / Pushkar D.Yu., Gumin L.M. M .: Med-Press Inform, 2006. - 254 p.)

The solution to the problem of diagnosing pelvic floor muscle failure in the early stages, stratification of the prolapse class, especially in women of working age, is an extremely important component of preventive treatment. In this connection, new approaches and diagnostic methods for patients of the climacteric period are the most significant not only from a medical, but also from a social point of view.

There is no single standardized approach to the diagnosis and treatment of pelvic floor muscle insolvency, which complicates the general directed approach to this problem. Thus, early diagnosis of pelvic floor muscle failure remains relevant and requires further study of effective and atraumatic methods of diagnosis and correction.

A number of methods have been proposed for diagnosing pelvic floor muscle failure (Oxford scale, POP-Q test, sphingomanometry, cough test, Q-tip test, etc.). (Adamyan L.V. Tests and tests of functional diagnostics in the examination of gynecological patients with urinary incontinence Text. / L.V. Adamyan, I.F. Khodova, M.A. Gazimiev // In the book: Laparoscopy and hysteroscopy in gynecology and Obstetrics. - M., 2002. - S.352-356., Nager C.W. Incontinence pessaries: size, POP-Q measures and successful fitting Text. / CW Nager, HE Richter, I. Nygaard // Int Urogynecol. J. Pelvic Floor Dysfunct. - 2009. - Vol.20. - No. 9. - P.1023-1031).

However, such diagnostic procedures are not the most optimal and less predictable.

There is a method of diagnosing pelvic floor muscle failure using a Q-tip test, which consists in measuring the angle of elevation of a cotton ear bud with vaginal muscle tension inserted into the urethra (Caputo RM, Benson JT The Q-tip test and urethrovesical junction mobility. Obstet Gynecol 1993 Dec ; 82 (6): 892-6. Karram MM, Bhatia NN The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. - Obstet Gynecol, 1998, Jun; 71 (6 Pt 1): 807 -eleven.)

The method has the following disadvantages: ear stick is not sterile, not graduated; the method requires dexterity from the doctor and an additional tool - a protractor, which causes some difficulties in accurate measurements and additional costs; the process of introducing a cotton bud causes discomfort and pain in a woman, because it often has a larger volume of cotton at the end than the urethral opening; from exposure to a foreign body in the urethra, irritation of the mucous membrane often occurs; when removing a cotton swab, part of the cotton wool may remain, which can lead to an infectious process; the method is not informative enough, because depending on the depth of the inserted ear stick, there will be a different level of the angle of inclination.

The closest in technical essence to the diagnostic method we propose include the uterine probe with divisions, designed to study the cervical canal and measure the length of the uterine cavity (Co-hen) (http.7 / www.wikiznanie.ru / ru-wz / index.php /% D0% 9C% D0% B0% D1% 82% D0% BE% D1% 87% D0% BD% D1% 8B% D0% B9_% D0% B7% D0% BE% D0% BD% D0% B4, http://commons.wikimedia.org/wiki/File:Uterine_probe_with_graduations,_curved_01.jpg?uselang=en).

However, the probe is designed to study the uterine cavity. This instrument has a number of disadvantages: the probe is thin, thereby the angle of its introduction into the posterior vaginal vault can change dramatically; there is a high risk of perforation of the walls of the vagina; product of a false move in the vagina.

The objective of the invention is to develop an effective and affordable method for early diagnosis of insolvency of the pelvic floor muscles in the early stages of its development and a device for its implementation, improving the accuracy of measurements.

The problem is achieved by the method of early diagnosis of pelvic floor muscle failure, including the introduction of a vaginal probe into the uterine cavity with a scale and measurement of the length of the vagina.

The vaginal probe is made in the form of a flexible plastic tube with thickened walls at the working end. The vaginal probe is inserted through the hole in the plate, which is installed by positioning the hole in the plate opposite the entrance to the vagina and pressed against the labia. The working end of the probe is introduced to the posterior vaginal fornix, and vaginal length L ₁ is measured on the scale of the vaginal probe at the level of the plate opening. Ask the patient to strain, again measure the length of the vagina L ₂ after straining, the degree of insolvency of the muscles of the pelvic floor X is determined by the formula:

X = (L ₁ -L ₂ ) × 100% / L ₁ ,

Where:

L ₁ - the length of the vagina (mm);

L ₂ - the length of the vagina after straining (mm);

X - the degree of insolvency of the muscles of the pelvic floor (%).

When X, equal to 51-100%, diagnose the absence of prolapse of the pelvic organs, when X, equal to 31-50%, diagnose the failure of the muscles of the pelvic floor I degree, when X, equal to 11-30%, diagnose the failure of the muscles of the pelvic floor II degree, with X equal to 0-10%, diagnose a failure of the muscles of the pelvic floor III degree.

Novelty inventions

- The vaginal probe is made in the form of a flexible plastic tube with thickened walls at the working end. The material of the tube allows it to easily bend and repeat the shape of the vagina. Thickening of the walls at the working end prevents perforation and injury of the walls of the vagina.

- The vaginal probe is inserted through the hole in the plate, which is installed by positioning the hole in the plate opposite the entrance to the vagina and pressed against the labia. The working end of the vaginal probe is inserted up to the posterior vaginal fornix, the length of the vagina L ₁ is measured on the scale of the vaginal probe at the level of the plate opening. The hole in the plate serves as a boundary during measurements, since the hole is located directly next to the scale of the vaginal probe, which improves the accuracy of measurements of the length of the vagina. The presence of the plate allows you to enter the probe at the same angle.

- Ask the patient to strain, again measure the length of the vagina L ₂ after straining, the degree of insolvency of the muscles of the pelvic floor X is determined by the original formula.

- With X equal to 51-100%, diagnose the absence of prolapse of the pelvic organs, with X equal to 31-50%, diagnose the failure of the muscles of the pelvic floor I degree, with X equal to 11-30%, diagnose the failure of the muscles of the pelvic floor II degree , with X equal to 0-10%, diagnose the failure of the muscles of the pelvic floor III degree. Determining the degree of prolapse of the pelvic organs is associated with finding the degree of failure of the pelvic floor muscles. This allows you to determine the need and methods of prevention and treatment of this pathology.

The set of essential features allows you to get a new technical result:

- the proposed method allows to increase the accuracy of diagnostics due to more accurate measurements;

- the used device for measurements is less traumatic.

The invention is illustrated by the drawings in figures 1 to 4.

Our proposed method for early diagnosis of pelvic floor muscle failure is as follows. A plate 1 having dimensions of 4 cm × 8 cm × 1 mm with a hole 2 with a diameter of 7 mm (FIG. 1) is installed by positioning a hole 2 opposite the entrance to the vagina. The plate 1 may be rectangular or have rounded corners. The plate can be made of plastic. In the posterior vaginal fornix through the hole 2 of the plate 1, a vaginal probe 3 is inserted in the form of a flexible plastic tube with a diameter of 5 mm with thickened walls at the working end 4 and divisions 5 (Figure 2). Thickening of the walls at the working end of the plastic tube is obtained by heating the working end to 50 ° C for 15 seconds, at the same time they press on the end and crush the walls a little. A woman is on a gynecological chair in a relaxed position. Plate 1 is pressed with fingers to the labia 6 of the woman (Figure 3) and after insertion of the vaginal probe 3 all the way into the posterior vaginal fornix (Figure 4), the length of the vagina L ₁ is determined on the vaginal probe 3 by a scale of 5 at the level of the border of the opening 2 of the plate 1 Then they ask the woman to push. At the same time, at the peak of straining, the vaginal probe is pushed out of the vagina. Then again determine the length of the vagina L ₂ after straining. From the data obtained, the degree of insolvency of the pelvic floor muscles X is determined using the following formula:

X = (L ₁ -L ₂ ) × 100% / L ₁ ,

Where:

L ₁ - the length of the vagina (mm);

L ₂ - the length of the vagina after straining (mm);

X - the degree of insolvency of the muscles of the pelvic floor (%).

When X, equal to 51-100%, diagnose the absence of prolapse of the pelvic organs, when X, equal to 31-50%, diagnose the failure of the muscles of the pelvic floor I degree, when X, equal to 11-30%, diagnose the failure of the muscles of the pelvic floor II degree, with X equal to 0-10%, diagnose a failure of the muscles of the pelvic floor III degree.

A pilot test was conducted on 100 women with pelvic floor muscle failure of varying degrees, and on women without pelvic floor muscle failure. The percentage of genital prolapse is then calculated. From the data obtained, it was revealed what degree of insolvency of the pelvic floor muscles will correspond to the ratio of the contracted vagina to the relaxed in a percentage ratio.

Example 1

Patient N., 40 years old, applied for an admission to the antenatal clinic on November 18, 2012 with complaints of discomfort during intercourse, a feeling of pressure in the lower abdomen, pain in the sacrum. A woman lies on a gynecological chair. A vaginal probe is inserted through an opening in the plate to the posterior vaginal fornix. The plate is pressed with fingers to the labia, placing a hole in the plate opposite the entrance to the vagina. The patient is in a relaxed position. At the level of the opening of the plate, the length of the vagina was visually recorded. It was L ₁ = 60 mm. Then they asked the woman to push. At the peak of straining, the vaginal probe exited the vagina to the level of L ₂ = 31 mm. From the data obtained, the degree of insolvency of the pelvic floor muscles was determined using the formula (60 mm - 31 mm) × 100% / 60 mm = 48.3%. According to our classification, 48.3% corresponds to I degree of pelvic floor muscle insolvency. The patient did not feel discomfort from the ongoing diagnostic procedure. A woman is recommended a course of therapeutic measures in order to restore the muscles of the pelvic floor.

Example 2

Patient S., 37 years old, applied for an admission to the antenatal clinic on 10/11/2012 with complaints of vaginal discharge, pain during intercourse, pain in the sacrum, sensation of a foreign body in the vagina, and urination impairment. A woman is placed on a gynecological chair. A vaginal probe is inserted through an opening in the plate to the posterior vaginal fornix. The plate is pressed with fingers to the labia, placing a hole in the plate opposite the entrance to the vagina. The patient is in a relaxed position. At the level of the opening of the plate, the length of the vagina was visually recorded. It amounted to L ₁ = 58 mm. Then they asked the woman to push. At the peak of straining, the vaginal probe exited the vagina to the level of L ₂ = 48 mm. From the data obtained, the degree of insolvency of the pelvic floor muscles was determined using the formula (58 mm - 48 mm) × 100% / 58 mm = 17.2%. According to our classification, 17.2% corresponds to the II degree of insolvency of the pelvic floor muscles. The patient did not feel discomfort from the ongoing diagnostic procedure. A woman is recommended a course of therapeutic measures.

Example 3

Patient A., 48 years old, applied for an admission to the antenatal clinic on November 18, 2012 complaining of sensations of the presence of a foreign body in the vagina, which interferes with walking, pain during intercourse, a feeling of pressure in the lower abdomen, pain in the sacrum and lower back, discharge drops of urine when coughing. A woman lies on a gynecological chair. A vaginal probe is inserted through an opening in the plate to the posterior vaginal fornix. The plate is pressed with fingers to the labia, placing a hole in the plate opposite the entrance to the vagina. The patient is in a relaxed position. At the level of the opening of the plate, the length of the vagina was visually recorded. It amounted to L ₁ = 21 mm. Then they asked the woman to push. At the peak of straining, the vaginal probe came out of the vagina to the level of L ₂ = 20 mm. From the data obtained, the degree of insolvency of the pelvic floor muscles was determined using the formula (21 mm - 20 mm) × 100% / 21 mm = 4.7%. According to our classification, 4.7% corresponds to the III degree of insolvency of the pelvic floor muscles. The patient did not feel discomfort from the ongoing diagnostic procedure. A woman is recommended a course of therapeutic measures in order to restore the muscles of the pelvic floor.

Thus, this method for diagnosing pelvic floor muscle failure is the most affordable, effective, accurate, less traumatic and easy to use.

Claims (1)

A method for early diagnosis of pelvic floor muscle failure, including introducing a vaginal probe into the uterine cavity with a scale and measuring the length of the vagina, characterized in that the vaginal probe is made in the form of a flexible plastic tube with thickened walls at the working end, the vaginal probe is inserted through an opening in the plate, which set by placing a hole in the plate opposite the entrance to the vagina, and pressed to the labia, the working end of the vaginal probe is inserted to the posterior fornix of the vagina, the length of the vagina is measured the vagina L ₁ on a scale of the vaginal probe at the level of the plate opening, ask the patient to strain, again measure the length of the vagina L ₂ after tension, the degree of insolvency of the muscles of the pelvic floor X is determined by the formula:
X = (L ₁ -L ₂ ) × 100% / L ₁ ,
Where:
L ₁ - the length of the vagina (mm);
L ₂ - the length of the vagina after straining (mm);
X - the degree of insolvency of the muscles of the pelvic floor (%),
and with X equal to 51-100%, diagnose the absence of prolapse of the pelvic organs, with X equal to 31-50%, diagnose the failure of the muscles of the pelvic floor I degree, with X equal to 11-30%, diagnose the failure of the muscles of the pelvic floor II , with X equal to 0-10%, diagnose the failure of the muscles of the pelvic floor III degree.

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