P32.02: Pelvic floor findings in patients with endometriosis scheduled for laparoscopy surgery

To evaluate pelvic floor anatomy and function in women undergoing surgery for endometriosis. Women referred for evaluation at our endometriosis center underwent a 4D transperineal pelvic floor ultrasound as part of their assessment. Volumes were acquired at rest and maximal Valsalva, and were analyzed offline for pelvic organ descent and levator characteristics, at a later time, blinded to all clinical data. A diagnosis of endometriosis which required surgery was made based on clinical criteria and findings on transvaginal ultrasound scanning. 94 volumes were available for analysis, with mean age 34 (20-47), parity 0 (0-6), BMI 23.6 (16.9–40.23); 52 (55.5%) nulliparous, 10 (12.8%) after Caesareans. Symptoms and complaints: dysmenorrhea (92.5%), dyspareunia (64.1%), urinary (28.6%), gastrointestinal (53.8%), and infertility (37.2%). Mean bladder neck descent −12.3 (−25.9–2.9) mm, mean uterus descent −34.4 (−50–10.8) mm, mean rectal descent −2 (−24.6–16.9) mm below the SP. Mean hiatal area at rest was 15.2 (11.3–21.6), on Valsalva 21.3 (10.2–53.7), and contraction 12.8 (7.9–25.4) cm2. Three (3.1%) women had avulsion defects, and thirteen (14%) had ballooning on Valsalva. A mobile uterus (positive sliding sign) at transvaginal scanning was inversely related with Valsalva hiatal area (Chi2 = −0.264, P = 0.056) and ballooning (−0.259, P < 0.05). A rectosigmoid nodule inversely correlated with rectal descent on Valsalva (−0.286, P < 0.05), and directly with an increased anorectal angle on contraction (0.283, P < 0.05). A rectovaginal nodule was associated with an increased anorectal angle at rest (0.270, P < 0.05). A smaller anorectal angle on contraction was in association with dysmenorrhea (-0.267, P < 0.05) and rectal bleeding (0.289, P < 0.05), otherwise there was no significant effect on symptomatology. Some pelvic floor characteristics seem to be affected by the presence of endometriosis nodules, mainly those of the posterior compartment.