Ghazaleh Rostaminia

• MD, MSc
• Professor (Assistant) at NorthShore University HealthSystem, University of Chicago

Magnetic resonance defecography imaging techniques have been used widely to study pelvic floor function and diagnose pelvic organ prolapse (POP). The aim of this study was to investigate the diagnostic accuracy of the H-line to detect bladder descent compared with the current landmark, the pubococcygeal line (PCL). In this retrospective cohort stud...

Remodeling of the sacrum and coccyx to accommodate pregnancy and delivery has been hypothesized but not directly quantified. This study aimed to quantify the remodeling of the sacrum and coccyx by comparing midsagittal lengths, angles, curvature, and shape between nulliparous, pregnant, and parous women using both 2 and 3 dimensional measures. Nine...

Introduction and hypothesis: Endovaginal ultrasound has long been hypothesized to have a significant effect on locations of what it visualizes. However, little work has directly quantified its effect. This study aimed to quantify it. Methods: This cross-sectional study consisted of 20 healthy asymptomatic volunteers who underwent both endovagina...

Importance: In the past, urethral shape, mobility, and urodynamics have been used to retrospectively demonstrate correlations with stress urinary incontinence. Our previous work has shown a relationship between urethral function and shape in symptomatic women. Objective: This study aimed to characterize the effect of pelvic floor squeeze and str...

Specific levator ani muscle imaging measures change with pregnancy and vaginal parity, though entire pelvic floor muscle complex (PFMC) shape variation related to pregnancy-induced and postpartum remodeling has never been quantified. We used statistical shape modeling to compute the 3D variation in PFMC morphology of reproductive-aged nulliparous,...

Introduction and hypothesis: Measurements of levator bowl volume using advanced imaging, may be predictive of pelvic floor muscle function. The aim of this study was to compare the volume of the levator bowl using both magnetic resonance imaging (MRI) and endovaginal ultrasound (EVU) of healthy asymptomatic women. Methods: All participants under...

Introduction and hypothesis: Pelvic organ prolapse (POP) is often diagnosed during an in-office examination, which looks for motion of the vaginal wall while performing a strain maneuver. It is believed that the pelvic organs in adequately supported women are relatively stationary. This study was aimed at investigating the physiological displaceme...

Introduction and hypothesis: Fecal incontinence (FI) has two primary subtypes: urgency fecal incontinence (UFI) and passive fecal leakage (PFL). The pathophysiology underlying the subtypes is incompletely understood. Objectives: To compare the bowel habits, physical examinations and pelvic floor anatomical defects in patients with UFI-dominant F...

We used dynamic pelvic floor ultrasound to investigate the relationship between obstructed defecation symptom (ODS) severity and the degree of rectal hypermobility/folding. In this retrospective study, women who presented with ODS from October 2017 to January 2019 and underwent an interview, pelvic examination, and pelvic floor ultrasound were recr...

Introduction and hypothesisUrethral closure mechanism dysfunction in female stress urinary incontinence (SUI) is poorly understood. We aimed to quantify these mechanisms through changes in urethral shape and position during squeeze (voluntary closure) and Valsalva (passive closure) via endovaginal ultrasound in women with varying SUI severity.Metho...

Introduction and hypothesisIn Part 1, we observed urethral mechanics during Valsalva that oppose current continence theories. In this study, we utilize a finite element model to elucidate the role of supportive tissues on the urethra during Valsalva. By determining the sensitivity of urethral motion and deformations to variations in tissue stiffnes...

The complex levator ani anatomy is perhaps best visualized with three-dimensional endovaginal ultrasonography. In this chapter we will investigate imaging of different levator ani subdivisions and their relationship to the levator plate movement and function. We will also address the occurrence of levator ani muscle injury during childbirth and inv...

Objective The shape of the sacrum-coccyx was defined and compared in nulliparous, pregnant, and parous women to provide insight into anatomical adaptations that afford vaginal delivery. Design A retrospective study comparing midsagittal anatomical measurements based on MRI of the sacrum and coccyx from 63 subjects. Setting Magee-Womens Research Ins...

Introduction and hypothesisThe current study was aimed at investigating the safety, efficiency, and durability of transvaginal sacrospinous ligament suture rectopexy in women with obstructed defecation symptoms (ODS) and significant rectal hypermobility/folding.Methods This was a prospective case series study performed during December 2018 to July...

Introduction and hypothesis: The objective was to determine age-related changes in measurements of urethral sphincter complex components in asymptomatic nulliparous women. Methods: Eighty nulliparous women ≥18 years underwent 3D ultrasound of the anterior pelvic compartment in a cross-sectional study. Measurements of the urethral sphincter compo...

Obstructed defecation (OD) is common and may be related to compromised pelvic floor integrity. Magnetic resonance (MR) defecography and statistical shape modeling were used to define pelvic floor shape variations, hypothesizing that State (rest vs peak evacuation) and Group (control vs case) would significantly influence shape. 16 women underwent M...

Background and Objective Strong evidence suggests that pelvic soft tissues soften during pregnancy to facilitate vaginal delivery while protecting against maternal birth injury. We hypothesized that these adaptations likely result in changes to the shape of the pelvic floor. Thus, this study aimed to compare midsagittal pelvic floor shapes from MRI...

Introduction and hypothesis The current study was aimed at addressing two questions: first, is any conventional vaginal prolapse repair effective in curing obstructed defecation symptoms, and second, is there evidence to suggest that a sacrocolpopexy will increase the risk of worsening or new-onset obstructed defecation symptoms? Methods This is a...

Introduction and hypothesis Although the main function of the suspensory ligaments of the vaginal apex is to prevent its descent toward the vaginal introitus, there remains limited information regarding its normal physiological motion. This study was aimed at quantifying the motion of the non-prolapsed vaginal apex during strain and defecation mane...

Aims To investigate patient characteristics associated with overactive bladder (OAB) symptom improvement after 1 year of monthly percutaneous tibial nerve stimulation (PTNS) therapy. Methods This was a retrospective chart review of women who underwent PTNS for refractory OAB symptoms between January 2011 and December 2017 in our tertiary center. P...

Introduction and hypothesis Obstructed defecation symptoms (ODS) are common in women; however, the key underlying anatomic factors remain poorly understood. We investigated rectal mobility and support defects in women with and without ODS using pelvic floor ultrasound and MR defecography. Methods This prospective case-control study categorized sub...

In pelvic reconstructive surgery, the school of thought that fascial defects are a primary etiology for development of pelvic organ prolapse has led to increased graft utilization to augment fascial strength in an attempt to promote repair longevity and permanence. Grafts serve to strengthen attenuated tissue and enhance healing in areas with compr...

Introduction and hypothesis Multiple publications have demonstrated the efficacy of percutaneous tibial nerve stimulation (PTNS) for overactive bladder syndrome (OAB). However, patient characteristics associated with successful treatment have not been well established. The aim of this study was to identify prognostic factors for successful PTNS tre...

Objectives: The objective of this study was to evaluate perineal body stiffness intrapartum using shear wave elastography ultrasound and to study its association with maternal and labor characteristics. Methods: This was a prospective observational study. Pregnant women with term pregnancy who had been admitted for labor management were recruite...

Objective: The anatomic and physiologic pathophysiology of obstructive defecatory symptoms is complex and poorly understood. As a consequence, there is no one surgical method that can achieve overall superiority. We aimed to investigate rectal architectural change in women with obstructive defecatory symptoms using three-dimensional pelvic floor u...

Biomechanical modeling and simulation of the pelvic floor structures have caught much attention in the past decade. Many computational approaches were developed with the goal of advancing our understanding the mechanism of the pelvic floor pathologies and improving treatment clinically. In this chapter, we review some of the existing work on buildi...

The purpose of this chapter is to describe the 3D endovaginal ultrasonography utility in the assessment of pelvic floor cysts and masses. In order to visualize the structures that are located in or lateral to the vaginal canal, 3D endovaginal ultrasound technique is described. This special technique has the advantage of evaluating the anatomical re...

The complex levator ani anatomy is perhaps best visualized with three-dimensional endovaginal ultrasonography. In this chapter we will address the occurrence of levator ani muscle injury during childbirth, and investigate the role of pelvic ultrasound to identify and quantify the amount of birth-related levator ani muscle trauma.

Early postoperative pain management after single-port robotic hysterectomy versus multi-port robotic hysterectomy Objectives: To investigate the difference in amount of early postoperative opioid used for pain management after single -port robotic hysterectomy versus multi-port robotic hysterectomy Methods: This is a retrospective cross-sectiona...

Objectives: This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women. Methods: This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent...

We studied the pelvic floor dysfunction symptoms in pregnancy and early postpartum and its association with parity and gestational age. Women who had been referred to low risk obstetric clinic for prenatal and early postpartum care, between January 2005 and August 2006 were recruited to the study. Women were invited to complete an anonymous, self-r...

The purpose of this chapter is to describe the 3D ultrasonography’s utility in the assessment of pelvic floor trauma associated with vaginal delivery. These pathologies are associated with urinary incontinence and cystocele. 3D ultrasonography has been overlooked in favor of MR imaging. However, this technique can be a powerful tool in the hands of...

Objectives: The aim of this study was to establish the predictive role of obstetric variables for obstetric outcomes and birth related levator ani muscle (LAM) trauma. Methods: In this prospective study, women underwent 3-dimensional pelvic floor ultrasound at their first appointment at 36 weeks and also 3 months postpartum. The measurements inc...

Objective: To investigate the association between the minimal levator hiatus (MLH) area at rest with its surrounding soft-tissue and bony structures in nulliparous asymptomatic women with a normal levator ani muscle. Methods: A subanalysis was undertaken of a prospective study of the appearance of the levator ani in asymptomatic nulliparous wome...

Introduction and hypothesis: To compare magnetic resonance imaging (MRI) to 3D endovaginal ultrasound (EVUS) in the evaluation of major levator ani defects in women with pelvic floor disorders. Methods: A total of 21 subjects with pelvic floor with complaints of pelvic floor disorders were included in this study. EVUS imaging of the levator ani...

Introduction and hypothesis: Age is a factor associated with symptomatic pelvic organ prolapse (POP) among women with significant levator ani deficiency. Methods: This cross-sectional study included patients who were referred for varied pelvic floor disorders, had 3D endovaginal ultrasound as part of their evaluation, and were diagnosed with sig...

To compare digital palpation with levator plate lift measured by endovaginal and transperineal dynamic sonography. Dynamic transperineal and endovaginal sonographic examinations were performed as part of multicompartmental pelvic floor functional assessment. Patients were instructed to perform Kegel contractions while a probe captured a video clip...

Innovation in the treatment of stress urinary incontinence (SUI) in the last twenty years has changed practice patterns. The aim of our study was to compare surgeons’ preference for surgical treatment for SUI between two surveys collected from American Urogynecologic Society’s (AUGS) administered fifteen years apart. This was a cross-sectional stud...

Female pelvic floor dysfunction (PFD) includes conditions such as urinary incontinence, pelvic organ prolapse or fecal incontinence. One in every ten women will, at some point of their lives, suffer a form of pelvic floor dysfunction (PFD) so severe that it will require surgery, with one- third of these undergoing repeated surgical procedures. PFD...

Substantial changes in surgical practice for the management of urinary incontinence in EnglandWashington J, Hirji S, Sahai A. Changing the face of urinary incontinence surgery in England: a perspective from the Hospital Episode Statistics database. BJU Int. 2014; 114(2):268-277. doi: 10.1111/bju.12650This retrospective cross-sectional study aimed a...

AimThe objective of this study was to investigate the clinical and ultrasonographic findings of women who had three-dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications.Methods This was a retrospective study of patients that had EVUS due to mesh complications at a tertiary care center. The clinical charts were...

The purpose of this chapter is to describe the 3D endovaginal ultrasonography utility in the assessment of pelvic floor cysts and masses. In order to visualize the structures that are located in or lateral to the vaginal canal, 3D endovaginal ultrasound technique is described. This special technique has the advantage of evaluating the anatomical re...

Introduction and hypothesis: We aimed to evaluate the association between obstructive defecatory symptoms in women with levator ani deficiency (LAD), worsened minimum levator hiatus measurements, widened anorectal angle (ARA), and increased levator-plate descent angle (LPDA). Methods: Using a cross-sectional study design, patients who had underg...

Introduction and hypothesis: The aim of our study was to assess the performance of levator ani muscle deficiency (LAD) evaluated by 3D endovaginal ultrasound (EVUS) to detect pelvic floor muscle function as assessed by digital examination. Methods: This cross-sectional study was conducted among 77 patients referred to our urogynecology clinic fo...

Abstract: The aim of study was to evaluate the inter-observer reliability in assessing anterior and posterior pelvic floor compartments in nulliparous women using 3-dimensional endovaginal ultrasound, and to evaluate the association of age with the visualization or measurement of these structures. 3D EVUS images were obtained in community-dwelling...

Background and Objectives: The increasing use and acceptance of robotic platforms calls for the need to train not only established surgeons but also residents and fellow trainees within the context of the traditional residency and fellowship program. Our study aimed to clarify the current status of robotic training in gynecologic fellowship program...

The aim of our study was to determine the accuracy of a new three-dimensional (3D) endoluminal ultrasound probe in assessing the levator ani muscle and anal sphincter complex. A total of 85 patients who had undergone concurrent 3D endovaginal (EVUS) and 3D endoanal (EAUS) ultrasound with both the standard BK 2052 probe and the new high-definition B...

Tester 1 vs tester 2 0.891 0.825 0.874 0.930 0.889 0.887 Tester 1 vs tester 3 0.882 0.839 0.831 0.891 0.903 0.881 Tester 1 vs tester 4 0.714 0.712 0.638 0.740 0.821 0.797 Tester 2 vs tester 3 0.857 0.857 0.885 0.873 0.890 0.862 Tester 2 vs tester 4 0.670 0.715 0.678 0.752 0.803 0.816 Tester 3 vs tester 4 0.708 0.705 0.639 0.674 0.791 0.865

Three-dimensional endovaginal ultrasound has been used for evaluation of levator ani muscle deficiency. The aim of this study was to assess interrater agreement/reliability of 3D endovaginal ultrasound for scoring levator ani deficiency (LAD). This was a cross-sectional study. Women referred to our urogynecology clinic for different pelvic floor dy...

The aim of our study was to determine the association between the severity of anal incontinence and levator ani deficiency, anal sphincter defects, anorectal angle, and colonic motility abnormalities. This was a retrospective study. Subjects were categorized into three groups: normal, minor anal incontinence, and major anal incontinence according t...

METHODS Our study had IRB approval at our institution and informed consents were signed by patients. Freehand 3D TPUS and 3D EVUS volumes obtained from 30 patients who were referred to our Urogynecology clinic with various pelvic floor complaints between January–June 2011 were reviewed. Our inclusion criteria were completed charts and good quality...

Objectives: Assess the accuracy of freehand 3D Transperineal ultrasound (TPUS) compared to 3D endovaginal ultrasound (EVUS) for obtaining pelvic floor measurements. Methods: We compared 30 freehand 3D transperineal ultrasounds and 360 degrees endovaginal ultrasounds of patients referred to our clinic with different urogynecologic symptoms during Ja...

Measurements such as the minimal levator hiatus dimension, levator plate angle, iliococcygeal angle, and anorectal angle have been used for assessing the impact of levator damage on static and dynamic imaging features. The primary aim of this study was to investigate the association between levator ani muscle deficiency (LAD) and the position of th...

Objectives: The aim of this study was to construct an anatomically correct phantom for visualization of anal sphincter complex structures. Methods: To ake an endoanal ultrasound phantom, we experimented with a variety of commercially available materials to simulate hyperechoic, hypoechoic, and isoechoic tissue consistency. We created external an...

The purpose of this pictorial essay is to describe the utility of 3-dimensional endovaginal and endoanal sonography in the assessment of vulvovaginal cysts and masses. It is accepted that compared with transabdominal pelvic sonography, transvaginal end-fire sonography provides improved resolution for visualization of female reproductive organs with...

: To estimate whether levator ani deficiency severity is a predictor of clinically significant pelvic organ prolapse (POP) and to determine whether there is a levator ani deficiency threshold above which POP occurs. : Two-hundred twenty three-dimensional ultrasound scans performed on urogynecologic clinic patients were reviewed, and each levator an...

Introduction and hypothesis: Our aim was to determine the association between visualizing periurethral structures in the midsagittal plane with 3D endovaginal ultrasonography (EVUS) and stress urinary incontinence (SUI) status. Methods: In a cross-sectional study, we measured urethral length and scored for presence or absence of the following in...

Objective: To determine the muscles comprising the minimal levator hiatus. Design: Cross-sectional study. Setting: The University of Oklahoma Health Sciences Center, USA. Population: Eight female fresh frozen pelves and 80 nulliparouswomen. Methods: Three-dimensional endovaginal ultrasound was performed in eight fresh frozen female pelves....

To evaluate the referral pattern to a tertiary care center for vaginal mesh complications following surgeries for pelvic organ support defect. This was a retrospective review of women presenting to our clinic for complications of vaginal mesh. One hundred thirty three patients were included in the study. The median age was 58.4 years, median parity...