Abstract
Introduction and hypothesis
The goal of the study was to define the time needed to obtain maximal organ descent and hiatal distension during Valsalva measured by transperineal ultrasound. Secondarily, we aimed to describe the timing of these events in relationship to each other.
Methods
We undertook a retrospective review of the stored ultrasound volume datasets of 50 patients with pelvic organ prolapse. Data on organ descent and hiatal distension were obtained in 10 volumes from rest to maximal Valsalva.
Results
On average, a Valsalva maneuver lasted 9.4 s (range 5 to 18). It took patients on average about six volumes (approximately 5–6 s) to reach 80% of maximum organ descent. The time to maximum organ descent was 8.9 s and the time to maximum distension of the levator hiatus was 8.2 s, p = 0.031.
Conclusions
In order to obtain adequate assessment of pelvic organ prolapse, a Valsalva maneuver should last at least 6 s. Hiatal distension seems to precede pelvic organ descent.
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Conflicts of interest
Dr. Orejuela and Dr. Shek do not have any conflict of interest to report. HP Dietz has in the past acted as consultant for American Medical Systems (AMS) and Continence Control Systems. He currently is consulting for Materna. He has received lecture fees from AMS, General Electric, and Astellas and has benefited from equipment loans by GE, Toshiba, and Brüel & Kjær.
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Orejuela, F.J., Shek, K.L. & Dietz, H.P. The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J 23, 175–178 (2012). https://doi.org/10.1007/s00192-011-1533-x
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DOI: https://doi.org/10.1007/s00192-011-1533-x