Pelvis

ImportanceSupervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed.ObjectiveTo compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device.Design, setting, and participantsThis multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023.InterventionAll participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT).Main outcome and measuresThe primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence.ResultsA total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627).Conclusion and relevanceIn this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI.Trial registrationClinicalTrials.gov Identifier: NCT05115864.

The pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and 'ready' them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby-related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed.

BackgroundIn recent years, the integration of artificial intelligence (AI) techniques into medical imaging has shown great potential to transform the diagnostic process. This review aims to provide a comprehensive overview of current state-of-the-art applications for AI in abdominal and pelvic ultrasound imaging.MethodsWe searched the PubMed, FDA, and ClinicalTrials.gov databases for applications of AI in abdominal and pelvic ultrasound imaging.ResultsA total of 128 titles were identified from the database search and were eligible for screening. After screening, 57 manuscripts were included in the final review. The main anatomical applications included multi-organ detection (n = 16, 28%), gynecology (n = 15, 26%), hepatobiliary system (n = 13, 23%), and musculoskeletal (n = 8, 14%). The main methodological applications included deep learning (n = 37, 65%), machine learning (n = 13, 23%), natural language processing (n = 5, 9%), and robots (n = 2, 4%). The majority of the studies were single-center (n = 43, 75%) and retrospective (n = 56, 98%). We identified 17 FDA approved AI ultrasound devices, with only a few being specifically used for abdominal/pelvic imaging (infertility monitoring and follicle development).ConclusionThe application of AI in abdominal/pelvic ultrasound shows promising early results for disease diagnosis, monitoring, and report refinement. However, the risk of bias remains high because very few of these applications have been prospectively validated (in multi-center studies) or have received FDA clearance.

Emphysematous conditions of the abdomen and pelvis are uncommon but are potentially lethal. A majority of these share common predisposing risk factors such as uncontrolled diabetes mellitus, immunocompromised states, chronic kidney disease, hepatic cirrhosis, malignancy, chemotherapy, and polytrauma. Computed tomography is the most utilized modality for the evaluation of emphysematous conditions in an emergency scenario. It is equally important to recognize mimics of the lethal emphysematous pathologies to avoid misdiagnosis. Gas-containing imaging mimics occur due to recent interventions, instrumentation, and fistulae. This review discusses the pertinent clinical and imaging features of emphysematous conditions of the abdomen and pelvis that can help confirm the diagnosis and guide patient management. For each of these emphysematous pathologies, we also discuss various gas-containing imaging mimics, as the management of these mimics differs from true emphysematous pathologies.