Abstract
Introduction and hypothesis
Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion.
Methods
We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle.
Results
Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P < 0.001). Lesser degrees of trauma (‘partial avulsion’) were not associated with symptoms or signs of pelvic floor dysfunction.
Conclusions
Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.
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Abbreviations
- 3-D:
-
Three-dimensional
- ICS POP-Q:
-
International Continence Society Prolapse Quantification
- PFMC:
-
Pelvic floor muscle contraction
- ROI:
-
Region of Interest
- TUI:
-
Tomographic ultrasound imaging
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Conflicts of interest
Dr. Dietz has acted as a consultant for American Medical Systems (Minnetonka, MN), Continence Control Systems (Sydney) and Materna Inc. (San Francisco, CA), accepted speaker’s fees from General Electric Medical Ultrasound (Sydney, Australia), American Medical Systems, and Astellas (Tokyo, Japan), and has benefitted from equipment loans provided by General Electric, Bruel and Kjaer (Gentofte, Denmark), and Toshiba (North Ryde, Australia). Drs. Ka Lai Shek, Maria Jose Bernardo and Adrienne Kirby have no conflict of interest to disclose.
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Dietz, H.P., Bernardo, M.J., Kirby, A. et al. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22, 699–704 (2011). https://doi.org/10.1007/s00192-010-1329-4
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DOI: https://doi.org/10.1007/s00192-010-1329-4