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Levator avulsion and grading of pelvic floor muscle strength

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Abstract

In a retrospective study investigating the relationship between levator avulsion and clinical grading of levator ani muscle strength, we analyzed the 3D/4D translabial ultrasound and digital assessment data of 1,112 women seen in a tertiary Urogynecological clinic. Levator avulsion was diagnosed whenever the examiner was unable to palpate the insertion of the pubovisceral muscle on the inferior pubic ramus and/or whenever a discontinuity between bone and muscle was detected on ultrasound. For clinical grading of levator muscle strength, we used the modified Oxford grading. Avulsion defects were found in 252 women (23%), and this was associated with a highly significant reduction in the overall Oxford grading (2.07 vs 2.81, P < 0.001). The prevalence of avulsion increased depending on the side differences in the modified Oxford grading: from 16% when there was no difference to 76% when the side difference was 1.5 or higher (P < 0.001). Avulsion of the puborectalis muscle seems to have a marked effect on pelvic floor muscle strength, which may help in diagnosing trauma.

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Acknowledgements

This study was supported in part by the Betty Byrne Henderson Foundation, University of Queensland, Brisbane, Queensland, Australia.

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Authors and Affiliations

  1. Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, NSW, 2750, Australia

    H. P. Dietz & C. Shek

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  1. H. P. Dietz
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  2. C. Shek
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Correspondence to H. P. Dietz.

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Dietz, H.P., Shek, C. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J 19, 633–636 (2008). https://doi.org/10.1007/s00192-007-0491-9

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  • DOI: https://doi.org/10.1007/s00192-007-0491-9

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