American Journal of Obstetrics and Gynecology
ResearchUrogynecologyLevator avulsion using a tomographic ultrasound and magnetic resonance–based model
Section snippets
Materials and Methods
In this prospective study, 3-dimensional pelvic floor ultrasound scanning and an MRI-based 3-dimensional model were used to assess the abnormal morphologic condition of the pubovisceral muscle in women who had significant pelvic organ prolapse. It was conducted between December 2008 and February 2010 at the Fuzhou General Hospital, Fuzhou, Fujian Province, China. Over the course of 1 year, 69 women who were to undergo surgery for prolapse repair were assessed with the use of pelvic floor
Results
Because of corrupt datasets, we were unable to obtain data from 3 women, which left data from 66 women to be assessed. The mean age of the patients was 63 years (range, 41–86 years); median vaginal parity was 3.3 (range, 0–9); 65 women had given birth vaginally. Complaints at presentation were stress incontinence (31%), urge incontinence (29%), symptoms of voiding dysfunction (such as hesitancy, a poor stream, and straining to void; 59%), and prolapse symptoms (93%). The general demographic
Comment
This study compared levator defects imaged by 3-dimensional pelvic floor ultrasonography and an MRI-based model in an attempt to validate the former method as a means of assessing levator avulsion. It confirms that the 2 methods used for the diagnosis of levator avulsion correlate well with each other. There was good agreement between observers for the diagnosis of avulsion defects by TUI, which is consistent with previous studies.27 Our data on LUGs and LSGs also confirm previous study by
Acknowledgements
We are indebted to the National Cancer Imaging Archive (NCIA) in the United States for offering 3-dimensional slicer software (www.slicer.org), which is a multiplatform, free, and open source software package. We thank Professor Hans Peter Dietz for giving us instruction on tomography ultrasound imaging by e-mail.
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2023, European Journal of Obstetrics and Gynecology and Reproductive BiologyLevator ani muscle avulsion in patients with pelvic floor dysfunction – Does it help in understanding pelvic organ prolapse?
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Avulsion is the disconnection of the muscle from its insertion in the inferior pubic ramus and lateral pelvic wall. It is considered partial LAM avulsion when the levator-urethra gap >25 mm occurs in at least one of the slice and complete when the levator-urethra gap >25 mm occurs in three consecutive slices [18] (Fig. 1). The study was approved by the institutional ethics committee for research on human subjects (CRE −366/21).
Impact of pushing timing on occult injury of levator ani: secondary analysis of a randomized trial
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :The gap threshold of 2.5 cm that was used a priori to define LAM injury was directly based on retrospective assessments of parous patients referred for symptoms of pelvic floor disorders and diagnoses of injury made via the previously mentioned sonographic assessments.8,22 In the current study, it was decided to compare LUG measurements using lower thresholds (2.25 cm) established in nonpregnant nulliparous community participants and other studies of parous participants or symptomatic patients.14,16,23,24 Although the lower threshold yielded higher overall injury rates, it did not alter the conclusion that neither immediate nor delayed pushing conferred an advantage on LAM injury seen by ultrasound.
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Supported by Grant no. 2010Y0046 from the Fujian Provincial Key Projects Foundation of China and by Grant no. 2010Y2005 from Fujian Science and Technology Foundation of China.
Cite this article as: Zhuang RR, Song YF, Chen ZQ, et al. Levator avulsion using a tomographic ultrasound and magnetic resonance–based model. Am J Obstet Gynecol 2011;205:232.e1-8.