Ballooning of the levator hiatus

Dietz, Hans Peter; Shek, C.; Leon, Juan De; Steensma, Anneke B.

doi:10.1002/uog.5355

Cited by 276 publications

(289 citation statements)

References 18 publications

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“…[9][10][11][12] Furthermore, there is some evidence that the size of the genital hiatus, or the hiatus of the levator ani muscle, may also be a predictor independently of avulsion, as patients with excessive hiatal distensibility of over 25 cm 2 on maximal valsalva seem to be at an increased risk of support failure. 13 Such imaging studies are supported by data from a clinical study showing that diminished levator ani contraction strength and a widened genital hiatus were associated with increased anatomical prolapse recurrence.…”

Section: Introductionmentioning

confidence: 85%

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

Rodrigo

Wong

Shek

et al. 2014

Aust NZ J Obst Gynaeco

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Aims: Female pelvic organ prolapse is a common condition. Prolapse recurrence following surgical treatment is a significant clinical issue. The aim of this study was to determine risk factors for recurrence, attempting to improve clinical practice by allowing better patient selection prior to surgery. Methods: This was a retrospective study utilising patient records and ultrasound volume imaging data sets obtained in four clinical audits following anterior colporrhaphy AE mesh. Prolapse recurrence was diagnosed clinically and by ultrasound; findings were analysed against potential predictors. Results: Symptomatic prolapse recurrence was demonstrated in 86 (26%), on clinical examination in 141 (42%) and on ultrasound in 113/334 women (34%). None of the tested predictors were predictive of recurrent symptoms, likely due to a lack of power. However, both levator avulsion and hiatal area on Valsalva were shown to be highly significant predictors of objective prolapse recurrence on clinical examination and ultrasound. Conclusions: Prolapse recurrence following surgery is a common complaint. The state of the patient's pelvic floor muscle seems to be the strongest determinant.

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Section: Introductionmentioning

confidence: 85%

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

Rodrigo

Wong

Shek

et al. 2014

Aust NZ J Obst Gynaeco

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“…Cut-off points for the association with symptoms and signs of POP have been suggested. 20 However, anatomical understanding of the pelvic floor and its complex spatial arrangement may not be possible in its entirety by using TPUS. This can be explained by low frequency of TPUS probes (4-8 MHZ) whereas EVUS with its high frequency (9-16 MHZ) has a superior resolution aiding identification of LAM fibres.…”

Section: Techniquementioning

confidence: 99%

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Lone¹,

Sultan²,

Stankiewicz³

et al. 2016

BJR

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Objective: To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Methods: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using twodimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360°rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. Results: 158 females had PFUS assessment. Good-toexcellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Conclusion: Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. Advances in knowledge: We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

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“…We now know that the levator ani is commonly damaged in childbirth [5,6], that the use of forceps is the main risk factor [7], and that such tears and overdistension lead to excessive distensibility of the levator hiatus, the largest potential site for herniation in the human body [8]. This damage is associated with symptoms and signs of female pelvic organ prolapse [8,9], with rectal intussusception [10] and with prolapse recurrence after pelvic reconstructive surgery [11][12][13].…”

Section: Piloni Et Al Make An Important Contribution With ''Mrdefecomentioning

confidence: 99%

Imaging in patients with obstructed defecation

Dietz

Cartmill

2013

Tech Coloproctol

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Ballooning of the levator hiatus

Abstract: ABSTRACT

Cited by 276 publications

References 18 publications

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy

Imaging in patients with obstructed defecation

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