Measurement of pelvic floor muscular strength with the Colpexin pull test: a comparative study

Foley Balloon Pull Test of Pelvic Floor Muscle Strength

IMPORTANCE

Methods for pelvic floor muscle (PFM) strength testing are limited by their subjective nature, prohibitive cost, training burden, or lack of validation.

OBJECTIVES

The objectives of this study are to validate a new, inexpensive, and accessible method for PFM strength testing using a 30-mL Foley balloon inserted into the vagina, the Foley Balloon Pull Test (FPT), and to demonstrate external validity by comparing the subjective Oxford Muscle Grading Scale (OMGS) scores to measurements obtained with the FPT. Secondary objectives include demonstrating repeatability and internal validity of the FPT.

STUDY DESIGN

Participants underwent PFM strength testing with the OMGS on a 0 to 5 scale. A gauge was attached to the Foley balloon to measure the force required to remove the balloon from the vagina. Three measures at rest and 3 measures during maximal muscle contraction were recorded. Cross-sectional data were analyzed.

RESULTS

One hundred one participants were included; there were no adverse events. The ratio of contraction FPT measurements to at-rest measurements revealed moderate linear and rank order correlation with the OMGS ( R2 = 0.54, P < 0.001, and R2 = 0.58, P < 0.001). The reliability of repeated measurements was highly correlated, with intraclass correlation coefficients >0.95. An FPT ratio of 1.75 discriminated between weak (0-2) and strong (3-5) OMGS scores with an area under the curve of 0.86.

CONCLUSION

The FPT is an internally reliable, simple, and externally valid method of PFM strength testing.

Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

INTRODUCTION AND HYPOTHESIS

Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term.

METHODS

This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015. Patients were divided into "absent," "weak" and "good" preoperative PFM strength (aPFM, wPFM and gPFM, respectively) based on a modified Oxford scale. Failure rates were determined by a composite of subjective and objective anatomic outcomes. Subjects who underwent re-operations or procedures for recurrent prolapse of the anterior compartment were considered failures. A p value < 0.05 was considered statistically significant.

RESULTS

Two hundred ninety-nine patients were included. The aPFM (n = 36), wPFM (n = 115) and gPFM (n = 148) groups had similar descriptive statistics, except subjects in the aPFM and wPFM groups were significantly older than the gPFM group (p = 0.008). All groups underwent similar reconstructive surgeries. Average length of follow-up of 143.9 weeks (41 to 717 weeks) was similar among the three groups (p = 0.472). For the primary outcome of composite failure, aPFM had significantly more anterior vaginal wall recurrences than both the wPFM and gPFM groups, 13.89% vs. 3.48% and 4.05%, respectively (p = 0.033).

CONCLUSIONS

Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.

Effect of Colpexin Sphere on pelvic floor muscle strength and quality of life in women with pelvic organ prolapse stage I/II: a randomized controlled trial

INTRODUCTION AND HYPOTHESIS

Colpexin Sphere was effective for advanced pelvic organ prolapse. The aim of this study was to assess the effect of Colpexin Sphere in women with pelvic organ prolapse (POP) stage I or II on pelvic floor muscle strength, quality of life, and POP stage.

METHODS

Women were randomly divided into Colpexin Sphere with pelvic floor muscle exercise group and exercise only group for a 16-week period. They had Colpexin pull test and digital test every 4 weeks. Quality of life and POP stage were re-evaluated at the end of treatment.

RESULTS

Ninety-one women were recruited and 85 completed. Colpexin Sphere plus pelvic floor exercise improved pelvic floor muscle strength. There was no significant difference between both groups. Vaginal symptom score decreased in both groups while the stages of prolapse did not change.

CONCLUSIONS

Colpexin Sphere plus pelvic floor exercise and exercise alone improved pelvic floor muscle strength.