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Levator ani muscle volume and architecture in normal vs. muscle damage patients using 3D endovaginal ultrasound: a pilot study

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Abstract

Introduction and hypothesis

This study aimed to compare the difference in levator ani muscle (LAM) volumes between 'normal' and those with sonographically visualized LAM defects. We hypothesized that the 'muscle damage' group would have a significantly lower muscle volume.

Methods

The study included patients who had undergone a 3D endovaginal ultrasound. The normal (NM) and damage (DM) muscle groups’ architectural changes were evaluated based on anterior-posterior (AP), left-right (LR) diameter, and minimal levator hiatus (MLH) area. The puboanalis-puboperinealis (PA), puborectalis (PR), and pubococcygeus-iliococcygeus (PC) were manually segmented using 2.5 vs. 1.0 mm to find the optimal sequence and to compare the volumes between NM and DM groups. POPQs were compared between the NM and DM groups.

Results

The 1.0-mm segmentation volumes created superior volume analysis. Comparing NM to the DM group showed no significant difference in LAM volume. Respectively, the mean total LAM volumes were 17.27 cm3 (SD = 3.97) and 17.04 cm3 (SD = 4.32), p = 0.79. The mean MLH measurements for both groups respectively were 10.06 cm2 (SD = 2.93) and 12.18 cm2 (SD = 2.93), indicating a significant difference (p = 0.01). POPQ analysis demonstrated statistically significant differences at Ba and Bp parameters suggesting that the DM group had worse prolapse (p = 0.05, 0.01, respectively).

Conclusions

While LAM volumes are similar, there is a significant difference in the physical architecture of the LAM and the POPQ parameters in muscle-damaged patients compared to the normal group.

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Acknowledgments

The authors do not have any conflicts of interest and received no assistance writing this manuscript. The research project was the Master project for Ms. Zara and was supported by the George Mason University Department of Bioengineering and INOVA Department of Obstetrics and Gynecology.

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Author notes

  1. Zara Asif and Roni Tomashev contributed equally to this work.

Authors and Affiliations

  1. Department of Bioengineering, George Mason University, Fairfax, VA, USA

    Zara Asif, Qi Wei & S. Abbas Shobeiri

  2. Department of Obstetrics & Gynecology, INOVA Women’s Hospital, 3300 Gallows Road, Second-floor South tower, Falls Church, VA, 22042-3307, USA

    Roni Tomashev, Veronica Peterkin, Jonia Alshiek, Baumfeld Yael & S. Abbas Shobeiri

Authors
  1. Zara Asif
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  2. Roni Tomashev
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  3. Veronica Peterkin
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  4. Qi Wei
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  5. Jonia Alshiek
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  6. Baumfeld Yael
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Contributions

Z Asif: Data collection, Data analysis, Manuscript writing

R Tomashev: Manuscript writing

V Peterkin: Data analysis, Manuscript writing

J Alshiek: Data collection, Data analysis

Q Wei: Manuscript writing

Y Baumfeld: Data analysis

SA Shobeiri: Project development, Data analysis, Manuscript writing

Corresponding author

Correspondence to S. Abbas Shobeiri.

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This work was presented during the IUGA 46th Annual Meeting.

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Asif, Z., Tomashev, R., Peterkin, V. et al. Levator ani muscle volume and architecture in normal vs. muscle damage patients using 3D endovaginal ultrasound: a pilot study. Int Urogynecol J 34, 581–587 (2023). https://doi.org/10.1007/s00192-022-05366-4

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