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Does levator avulsion cause distension of the genital hiatus and perineal body?

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Abstract

Introduction and hypothesis

Levator avulsion is associated with prolapse and prolapse recurrence after reconstructive surgery. We set out to determine whether clinical measurement of the genital hiatus and the perineal body (gh + pb) on maximum Valsalva can predict levator avulsion.

Methods

A total of 295 women attending a tertiary referral service underwent 4D translabial ultrasound imaging and clinical examination using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification system (POP-Q). Analysis of ultrasound data sets for levator avulsion was performed using tomographic ultrasound imaging. The predictive performance of gh + pb for avulsion was tested using receiver-operating characteristic curves.

Results

Optimal sensitivity [70 %, 95 % confidence interval (CI) 59–79 %] and specificity (70 %, 95 % CI 66–72 %) were achieved with a cut-off of 8.5 cm for gh + pb.

Conclusions

A gh + pb measurement ≥ 8.5 cm may help to identify women with levator avulsion who are at increased risk of prolapse recurrence.

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Abbreviations

MRI:

Magnetic resonance imaging

4D:

Four-dimensional

ICS POP-Q:

International Continence Society Pelvic Organ Prolapse Quantification system

PFMC:

Pelvic floor muscle contraction

TUI:

Tomographic ultrasound imaging

LUG:

Levator urethra gap

ROC:

Receiver-operating characteristic curve

OR:

Odds ratio

RR:

Relative risk

ICC:

Intraclass correlation coefficient

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Conflicts of interest

Dr. Volloyhaug has accepted speaker’s fees from Astellas and received travel and congress expenses from Pfizer, travel and course expenses from Johnson and Johnson. Dr. Dietz has, within the last 2 calendar years, acted as a consultant for American Medical Systems (Minnetonka, MN, USA) and Materna Medical Inc. (San Francisco, CA, USA) and has received an educational grant from GE Medical.

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Authors and Affiliations

  1. Department of Gynaecology and Obstetrics, Trondheim University Hospital, PO Box 3250 Sluppen, 7006, Trondheim, Norway

    I. Volloyhaug

  2. Sydney Medical School Nepean, Penrith, NSW, Australia

    V. Wong, K. L. Shek & H. P. Dietz

Authors
  1. I. Volloyhaug
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  2. V. Wong
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  3. K. L. Shek
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  4. H. P. Dietz
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Correspondence to I. Volloyhaug.

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Volloyhaug, I., Wong, V., Shek, K.L. et al. Does levator avulsion cause distension of the genital hiatus and perineal body?. Int Urogynecol J 24, 1161–1165 (2013). https://doi.org/10.1007/s00192-012-1993-7

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  • DOI: https://doi.org/10.1007/s00192-012-1993-7

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