3D Translabial Ultrasound for Pessary Size Estimation

Evaluation of 3D Translabial Ultrasound Imaging for Pessary Size Estimation

This is a feasibility study looking at the use of 3D ultrasound with vaginal manometry at various distension volumes to predict the best available pessary for successful fit.

Patients who are currently using a pessary for management of pelvic organ prolapse and who are able to remove/replace the pessary themselves will be approached for recruitment. The pessary will be removed two days prior to 3D translabial ultrasound. The vagina will be distended with a pressurized compliant bag with concurrent pressure and volume measurements. Translabial ultrasound will be used to measure structural parameters within the vagina at varying pressures/volumes. The volume, pressure and structural parameters measured will be compared to dimensions of the patient's own pessary to develop mathematical models to predict the best available pessary choice for the patient.

Inclusion Criteria:

• are current pessary users (> 6 months) who have no pessary related complication, including discomfort, vaginal bleeding, and pessary extrusion
• are able to provide informed consent
• can perform self-care, i.e. removing and inserting the pessary themselves
• are willing to remove their pessary two days before the ultrasound examination date

Exclusion Criteria:

• inability to give informed consent
• inability to communicate with the person performing the consent and the sonographer performing ultrasound scanning
• history of pelvic radiation or surgery (excluding hysterectomy)
• using pessaries other than ring, incontinence dish, donut, Shaatz
• inability to perform the Valsalva maneuver or pelvic floor contraction
• restricted mobility that prevents them from ambulating to assess the comfort level of the pessary during the initial pessary fitting visit
• lack of sensation at the pelvic floor
• being pregnant at the time of the examination