Association between pelvic organ prolapse types and levator‐urethra gap as measured by 3D transperineal ultrasound

Kozma, Bence; Larson, Kindra; Cunningham, Tina D.; Abuhamad, Alfred; Póka, Ròbert; Takács, Péter

doi:10.1002/jum.14644

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…As the most important muscle of the pelvic floor, the LAM is critical for pelvic organ support, leading to POP when defective. Previous studies have found that LAM avulsion bears an association with symptoms of POP and severe prolapse 34,35 and impacts outcomes after prolapse surgery. 36 At 6 weeks after primary prolapse surgery, participants with avulsed (vs intact) LAMs demonstrated worse anterior vaginal support.…”

Section: Discussionmentioning

confidence: 99%

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

Wang

et al. 2022

Menopause

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Objective: To investigate translabial ultrasound (TLUS) parameters that may predict failed pessary fittings in women with symptomatic pelvic organ prolapse (POP).Methods: All participants in this retrospective study presented to the Pelvic Floor Disease Diagnosis and Treatment Center (Liaoning Province, China) between May 2018 and December 2020 seeking treatment for symptomatic POP. Each had chosen vaginal pessary as first-line treatment, undergoing TLUS in advance of placement. Participants were grouped by outcomes of pessary fittings as successful or failed. Group-wise demographic and clinical characteristics, including TLUS parameters, were then subjected to uni-and multi-variate logistic regression.Results: A total of 373 women qualified for analysis, 255 (68.4%) achieved success, and were fitted with acceptable pessaries. Predictors of failed fittings included younger age (61.54 AE 10.25 y vs 64.72 AE 10.30 y; P ¼ 0.006), premenopausal status (14.4% vs 5.9%; P ¼ 0.006), sizeable hiatal circumference (20.36 AE 2.33 cm vs 19.70 AE 2.50 cm; P ¼ 0.02) and hiatal area (HA) (29.67 AE 7.14 cm 2 vs 27.27 AE 6.99 cm 2 ; P ¼ 0.003), levator ani muscle (LAM) avulsion (odds ratio [OR] ¼ 3.23, 95% confidence interval [CI] ¼ 1.62-6.46; P ¼ 0.001), enterocele (OR ¼ 2.51, 95% CI ¼ 1.11-5.68; P ¼ 0.03), and the inferiormost aspect of cervix situated below symphysis pubis (OR ¼ 0.52, 95% CI ¼ 0.29-0.95; P ¼ 0.03). In multivariate logistic regression, younger age (OR ¼ 0.98, 95% CI ¼ 0.95-1.00; P ¼ 0.04), sizeable HA on Valsalva (OR ¼ 1.04, 95% CI ¼ 1.01-1.08; P ¼ 0.02), LAM avulsion (OR ¼ 2.87, 95% CI ¼ 1.32-6.25; P ¼ 0.008), and enterocele (OR ¼ 2.70, 95% CI ¼ 1.12-6.50; P ¼ 0.03) emerged as independent predictors of failed pessary fittings.Conclusions: Younger age, LAM avulsion, enterocele, and sizeable HA on Valsalva proved independently predictive of failed pessary fittings in women with symptomatic POP.

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Section: Discussionmentioning

confidence: 99%

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

Wang

et al. 2022

Menopause

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“…The levator‐urethra gap (LUG) is the distance between the urethral lumen center and the levator insertion site on the inferior pubic rami. Previous studies evaluating LUG measurements have shown different cutoff values for the LUG 1,10,12‐17 . A cutoff of 2.5 cm has been reported in Australian women, 13 while in Chinese women, the cutoff was 2.365 cm 10 .…”

Section: Introductionmentioning

confidence: 95%

“…Previous studies evaluating LUG measurements have shown different cutoff values for the LUG. 1,10,[12][13][14][15][16][17] A cutoff of 2.5 cm has been reported in Australian women, 13 while in Chinese women, the cutoff was 2.365 cm. 10 It seems that ethnic variation occurs which may question the validity of this cutoff for widespread use.…”

Section: Introductionmentioning

confidence: 96%

The optimal cutoff value for levator‐urethra gap measurements using tomographic ultrasound imaging in avulsion diagnosis is population specific

Greenbaum

Klein

Alcalay

et al. 2020

Neurourology and Urodynamics

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Aims The levator‐urethra gap (LUG), the distance between the urethral lumen center and levator insertion on the inferior pubic rami, can be used for diagnosing levator avulsion, with a previously suggested cutoff of LUG ≥2.5 cm. The aim of this study is to determine an optimal cutoff value for LUG measurements in a high‐risk patient population. Methods Women followed prospectively after sustaining obstetric anal sphincter injury underwent an interview pelvic examination questionnaires and four‐dimensional‐transperineal ultrasound examination. Levator avulsion was diagnosed on contraction using tomographic ultrasound imaging. Ultrasound datasets were analyzed offline at a later time blinded to previous data. LUG was measured on each side of the three central slices, yielding six measurements and the highest available value was obtained on each side. Different cutoffs were evaluated using receiver‐operating characteristics (ROC) curve analysis and Youden's test. The cutoff was validated against symptoms and signs, and sonographic findings using logistic regression analysis. Results A total of 618 complete datasets were available for analysis, median age 29 years, median body mass index of 23.4 kg/m2, parity 1, and 26.4% instrumental deliveries. Youden's test and ROC curve analysis gave the best area under the curve of 0.869 for a cutoff of 2.305 (95% confidence interval, 0.839‐0.9). Women diagnosed with avulsion based on this cutoff were more symptomatic, whereas using larger cutoffs missed more avulsion defects. Conclusion LUG measurement is useful but should be individualized to the population studied, in our case, in a high‐risk population, 2.305 cm was the optimal cutoff. Using larger cutoffs may be more specific but is likely to miss more cases.

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“…A kismedencei süllyedéses kórképek kialakulásában a medencefenéki izomzat sérüléseinek vagy strukturális változá sainak kulcsszerepük van. A hüvelyi szülés során bekövetkező traumás elváltozások ultrahangalapú vizsgálatában vezető szerepet játszik a háromdimenziós tomografikus képalkotás [32], azonban Masslo és mtsai munkájából kitűnik, hogy az eddig alkalmazott módszereken felül az UHE a sérülések mellett képes más, funkcióvesztéssel járó állapotok feltárására is, mint a hegképződés vagy a hipokontraktilitás [33]. Xie és mtsai közlése alapján a kismedencei süllyedéses kórképek kialakulásának rizikófaktora lehet a m. levator ani elaszticitásának csökkenése, majd később ugyanezen szerzők bizonyították, hogy az izom elaszticitása mérhetően javul kismedencei torna végzésével [34,35].…”

Section: Ultrahang-elasztográfia a Nőgyógyászatbanunclassified

Ultrahang-elasztográfia alkalmazásának lehetőségei a szülészet-nőgyógyászatban

Kozma

Pákozdy

Lampé

et al. 2021

Self Cite

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Összefoglaló. Az ultrahang-elasztográfia az elmúlt évek során egyre növekvő figyelmet kapott a lágyszövetek elaszticitásának vizsgálatában. A módszer használatát az teszi szükségessé, hogy egyes, a mechanikai tulajdonságaikban különböző szövetek hasonló echogenitásúak lehetnek, valamint hogy egy adott szövet megváltozott struktúrája vagy mechanikai tulajdonsága nem minden esetben jár együtt a szövet hagyományos ultrahangképének megváltozásával. Az elmúlt évtizedben a deformációs és a nyírási ultrahang-elasztográfia vált széles körben elérhetővé. Ezen új képalkotási technika egyre nagyobb szerepet tölt be a szülészeti-nőgyógyászati ultrahang-diagnosztikában is. A nőgyógyászatban szerephez juthat az endometriosis és az adenomyosis kimutatásában, valamint a benignus és a malignus cervicalis és ovarialis képletek elkülönítésében. A nőgyógyászathoz hasonlóan a szülészetben is jelentős változást hozhat az ultrahang-elasztográfia: alkalmas lehet a szülésindukció sikerességének, a koraszülés bekövetkezésének és a praeeclampsia kialakulásának előrejelzésére. Orv Hetil. 2021; 162(18): 690–695. Summary. Ultrasound elastography has received significant attention for the assessment and measurement of soft tissue elastic properties in recent years. The advantage of ultrasound elastography lies in the fact that two different tissues can share similar echogenicities but may have other mechanical properties or, on the contrary, mechanical abnormalities of a designated tissue do not necessarily go hand in hand with an altered appearance on a conventional ultrasound image. In the last decade, strain and shear-wave elasticity imaging methods have become the most widely available among commercial ultrasound equipments. The importance of this new method expands rapidly also in the field of obstetrics and gynecology. Ultrasound elastography has a promising role in the diagnosis of endometriosis and adenomyosis and helps to differentiate benign and malignant cervical and ovarian lesions. The use in the prediction of the outcome of labor induction and preterm birth, and in the evaluation of preeclampsia are emerging. Orv Hetil. 2021; 162(18): 690–695.

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Association between pelvic organ prolapse types and levator‐urethra gap as measured by 3D transperineal ultrasound

Abstract: Bilateral levator ani avulsion as diagnosed by LUG measurements of 25 mm or greater at rest is associated with multicompartment, severe prolapse.

Cited by 12 publications

References 21 publications

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

Translabial ultrasound indices of failed pessary fittings in women with symptomatic pelvic organ prolapse

The optimal cutoff value for levator‐urethra gap measurements using tomographic ultrasound imaging in avulsion diagnosis is population specific

Ultrahang-elasztográfia alkalmazásának lehetőségei a szülészet-nőgyógyászatban

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