Vladimir EgorovCEO of Advanced Tactile Imaging, Trenton, United States
Title: Biomechanical Integrity of the Female Pelvic Floor
Introduction: The true etiology of pelvic diseased conditions such as organ prolapse, urinary incontinence, vaginal tissue atrophy and variations observed among individuals are not entirely understood. These disorders are thought to share common pathogeneses, tissue elasticity changes, weakening of the connective support tissues, and pelvic muscle dysfunction. Logically, proposing a biomechanical assessment and characterization of the female pelvic floor could give rise to important information in clinical practice.
Objective: To develop and validate a new integral parameter – the Biomechanical Integrity score (BI-score) - for the characterization of the female pelvic floor.
Methods: A total of 253 subjects with normal and pelvic organ prolapse (POP) conditions were included in the data analysis from multi-site observational, case-controlled studies; 125 subjects had normal pelvic floor conditions, and 128 subjects had POP stage II+. A Vaginal Tactile Imager (VTI) was used to acquire and calculate automatically 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t-test, boxplot, and correlation) to identify the VTI parameters sensitive to the pelvic conditions and to establish the BI-score components.
Results: Out of 52 parameters, 26 were identified as statistically sensitive to the POP development. These 26 parameters were subdivided into five groups, each of them characterizing (1) tissue elasticity, (2) pelvic support, (3) pelvic muscle contraction, (4) involuntary muscle relaxation, and (5) pelvic muscle mobility, respectively. Every parameter was transformed to its standard deviation units against the patient age similar to T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups (1)-(5) and the BI-score in standard deviation units. The p-value for the BI-score has p = 4.3*10-31 for POP versus normal conditions. The POP diagnostic accuracy of the BI-score was found as 89.7% versus POP-Q data. A reference BI-score curve against age for normal pelvic floor conditions was defined (see Figure 1).
Conclusions: The proposed BI-score and its five components allow a comprehensive biomechanical characterization of the female pelvic floor. Objectively measurable transformations of the pelvic tissues, support structures, and functions under different diseased conditions may be studied with the BI-score in future research and practical applications.
Dr. Egorov is a scientist and entrepreneur with primary area of focus in the women’s healthcare. He is a CEO of Advanced Tactile Imaging, Inc. The company develops transvaginal biomechanical mapping as an imaging and diagnostic tool to characterize the wide spectrum of pelvic diseased conditions such as pelvic organ prolapse, incontinence, chronic pelvic pain, pathologies which include endometriosis, adenomyosis and uterine fibroids, cervical and ovarian cancer, and conditions leading to spontaneous preterm delivery and predicting maternal birth trauma. He is a recipient of multiple research grants from National Institutes of Health; conducted 13 clinical studies in the USA. He introduced a new integral parameter, Biomechanical Integrity score (BI-score), for characterization of the female pelvic floor. Objectively measurable transformations of pelvic tissues, support structures, and functions under different diseased conditions may be quantified with the BI-score relatively normal conditions. He has 82 research publications, 29 patents and delivered numerous talks on national and international scientific meetings. He received his Master of Science in Biophysics at the Moscow Institute of Physics and Technology, and his PhD at the Institute of Basic Biological Problems, Russia.