Skip to main content
Erschienen in: International Urogynecology Journal 7/2013

01.07.2013 | Original Article

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

verfasst von: I. Volloyhaug, V. Wong, K. L. Shek, H. P. Dietz

Erschienen in: International Urogynecology Journal | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Singh K, Reid WM, Berger LA (2002) Magnetic resonance imaging of normal levator ani anatomy and function. Obstet Gynecol 99:433–438CrossRefPubMed Singh K, Reid WM, Berger LA (2002) Magnetic resonance imaging of normal levator ani anatomy and function. Obstet Gynecol 99:433–438CrossRefPubMed
2.
Zurück zum Zitat Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712CrossRefPubMed Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712CrossRefPubMed
3.
Zurück zum Zitat DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53CrossRefPubMed DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53CrossRefPubMed
4.
Zurück zum Zitat Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103:31–40CrossRefPubMed Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103:31–40CrossRefPubMed
5.
Zurück zum Zitat Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113:225–230CrossRefPubMed Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113:225–230CrossRefPubMed
6.
Zurück zum Zitat Shek KL, Dietz HP (2009) The effect of childbirth on hiatal dimensions. Obstet Gynecol 113:1272–1278PubMed Shek KL, Dietz HP (2009) The effect of childbirth on hiatal dimensions. Obstet Gynecol 113:1272–1278PubMed
7.
Zurück zum Zitat DeLancey JO, Morgan DM, Fenner DE et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302CrossRefPubMed DeLancey JO, Morgan DM, Fenner DE et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302CrossRefPubMed
8.
Zurück zum Zitat Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115:979–984CrossRefPubMed Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115:979–984CrossRefPubMed
9.
Zurück zum Zitat Weemhoff M, Vergeldt TF, Notten K, Serroyen J, Kampschoer PH, Roumen FJ (2012) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23:65–71CrossRefPubMed Weemhoff M, Vergeldt TF, Notten K, Serroyen J, Kampschoer PH, Roumen FJ (2012) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23:65–71CrossRefPubMed
10.
Zurück zum Zitat Dietz HP, Chantarasorn V, Shek KL (2010) Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 36:76–80CrossRefPubMed Dietz HP, Chantarasorn V, Shek KL (2010) Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 36:76–80CrossRefPubMed
11.
Zurück zum Zitat Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506CrossRefPubMed Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506CrossRefPubMed
12.
Zurück zum Zitat Wong V, Shek KL, Goh J, Rane A, Dietz H (2011) Should mesh be used for cystocele repair? Long-term outcomes of a case–control series. Int Urogynecol J 22(Suppl 1):S91 Wong V, Shek KL, Goh J, Rane A, Dietz H (2011) Should mesh be used for cystocele repair? Long-term outcomes of a case–control series. Int Urogynecol J 22(Suppl 1):S91
13.
Zurück zum Zitat Dietz H, Shek K, Moegni F (2012) Diagnosis of levator avulsion injury: a comparison of three methods. Ultrasound Obstet Gynecol. doi:10.1002/uog.11190 Dietz H, Shek K, Moegni F (2012) Diagnosis of levator avulsion injury: a comparison of three methods. Ultrasound Obstet Gynecol. doi:10.​1002/​uog.​11190
14.
Zurück zum Zitat Kearney R, Miller JM, Delancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25:50–54CrossRefPubMed Kearney R, Miller JM, Delancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25:50–54CrossRefPubMed
15.
Zurück zum Zitat Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMed Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMed
16.
Zurück zum Zitat Khunda A, Shek KL (2012) Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 206:246.e1–246.e4CrossRef Khunda A, Shek KL (2012) Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 206:246.e1–246.e4CrossRef
17.
Zurück zum Zitat Abdool Z, Shek K, Dietz H (2009) The effect of levator avulsion on hiatal dimension and function. Am J Obstet Gynecol 201:89.e1–89.e5CrossRef Abdool Z, Shek K, Dietz H (2009) The effect of levator avulsion on hiatal dimension and function. Am J Obstet Gynecol 201:89.e1–89.e5CrossRef
18.
Zurück zum Zitat Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part 1: two-dimensional aspects. Ultrasound Obstet Gynecol 23:80–92CrossRefPubMed Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part 1: two-dimensional aspects. Ultrasound Obstet Gynecol 23:80–92CrossRefPubMed
19.
Zurück zum Zitat Dietz HP, Bernardo MJ, Kirby A, Shek KL (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22:699–704CrossRefPubMed Dietz HP, Bernardo MJ, Kirby A, Shek KL (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22:699–704CrossRefPubMed
20.
Zurück zum Zitat Dietz HP, Wong V, Shek KL (2011) A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol 51:540–543CrossRefPubMed Dietz HP, Wong V, Shek KL (2011) A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol 51:540–543CrossRefPubMed
21.
Zurück zum Zitat Dietz H, Shek C, De Leon J, Steensma AB (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31:676–680CrossRefPubMed Dietz H, Shek C, De Leon J, Steensma AB (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31:676–680CrossRefPubMed
22.
Zurück zum Zitat Dietz HP, Franco AV, Shek KL, Kirby A (2012) Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand 91:211–214CrossRefPubMed Dietz HP, Franco AV, Shek KL, Kirby A (2012) Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand 91:211–214CrossRefPubMed
Metadaten
Titel
Does levator avulsion cause distension of the genital hiatus and perineal body?
verfasst von
I. Volloyhaug
V. Wong
K. L. Shek
H. P. Dietz
Publikationsdatum
01.07.2013
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 7/2013
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-012-1993-7

Weitere Artikel der Ausgabe 7/2013

International Urogynecology Journal 7/2013 Zur Ausgabe

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Harninkontinenz: Netz-Op. erfordert über lange Zeit intensive Nachsorge

30.04.2024 Harninkontinenz Nachrichten

Frauen mit Belastungsinkontinenz oder Organprolaps sind nach einer Netz-Operation keineswegs beschwerdefrei. Vielmehr scheint die Krankheitslast weiterhin hoch zu sein, sogar höher als von harninkontinenten Frauen, die sich nicht haben operieren lassen.

Welche Übungen helfen gegen Diastase recti abdominis?

30.04.2024 Schwangerenvorsorge Nachrichten

Die Autorinnen und Autoren einer aktuellen Studie aus Griechenland sind sich einig, dass Bewegungstherapie, einschließlich Übungen zur Stärkung der Bauchmuskulatur und zur Stabilisierung des Rumpfes, eine Diastase recti abdominis postpartum wirksam reduzieren kann. Doch vieles ist noch nicht eindeutig belegt.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.