OP31.03: Pelvic floor morphometry at three‐ and four‐dimensional transperineal ultrasound in women with ovarian endometriosis or deep infiltrating endometriosis

Deep infiltrating endometriosis (DIE) seems to be associated with pelvic floor muscle (PFM) hypertonic disorder, while no data are reported for women with ovarian endometriosis. The aim of our study was to evaluate the PFM morphometry of women affected by DIE compared to women with ovarian endometriosis, using 3- and 4-dimensional (3D and 4D) transperineal ultrasound. A prospective study was conducted between January 2016 to December 2016 on women with clinical and sonographic diagnosis of DIE (DIE group) or ovarian endometriosis (OVA group) scheduled for laparoscopic surgery. We excluded patients with current or previous pregnancies, previous surgery for endometriosis, vulvodynia, congenital or acquired abnormalities of pelvic floor anatomy. 3D and 4D transperineal ultrasound for evaluation of PFM morphometry was performed at rest, during PFM contraction and during Valsalva manoeuvre by the same operator, assessing the levator hiatus area (LHA) as previously described. All volumes were offline analysed with a dedicated software by an investigator blinded to the clinical data. Ninety-three patients were enrolled in the study: 54 in the DIE group and 39 in the OVA group. Diagnosis of endometriosis was confirmed by histological examination in all patients. Compared to OVA group, women with DIE showed a smaller LHA at rest (DIE group 10.90±2.63 cm2 vs OVA group 12.02±2.30 cm2, p=0.04). Furthermore, in women with DIE smaller changes in LHA narrowing during PFM contraction (DIE group 1.56±1.67 cm2 vs OVA group 2.84±1.33 cm2, p<0.001) and in LHA enlargement during Valsalva manoeuvre (DIE group 1.01±1.84 cm2 vs OVA group 1.99±2.06 cm2, p=0.02) were reported in comparison with women in the OVA group. The higher PFM tone associated with DIE in comparison with women with ovarian endometriosis might suggest a more severe PFM dysfunction, which can be easily detected with 3D and 4D transperineal ultrasound.