Levator plate descent correlates with levator ani muscle deficiency

Rostaminia, Ghazaleh; White, Dena; Quiroz, Lieschen H.; Shobeiri, S. Abbas

doi:10.1002/nau.22509

Cited by 31 publications

(22 citation statements)

References 42 publications

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“…The increasing angle of LPA and ARA also indicated the growing impairment of LA. 20 We also found movement angle of the lower segment of PVW was significantly different between stage 3 to 4 and stage 0 to 2; it could be the bulging vagina wall outside uncontrolled introitus. Bulging became the way to achieve balance on another level, which could be explained by the displacement of apex vagina being close to mid-PB, looking similar to that at stage 0.…”

Section: Discussionmentioning

confidence: 57%

A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging

Qiu

Song²

2018

Female Pelvic Med Reconstr Surg

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Objective The aim of this study was to analyze quantified displacements of the posterior vaginal wall (PVW) on dynamic magnetic resonance imaging (MRI), which may generate hypotheses for the detailed mechanisms that underlie the development of posterior vaginal prolapse. Methods Pelvic dynamic MRI scans were obtained for 12 women with normal vaginal structure (stage 0) and 62 women with 4 consecutive stages (1–4) of posterior vaginal prolapse. Structural locations (apex vagina, distal vagina, and mid–perineal body [PB]) and equidistant points along the PVW (points 4–6 were considered as midvagina) were identified, and PVW length, straight distance of PVW, levator ani parameters (levator hiatus length [LHL], levator hiatus width [LHW], levator plate angle, anorectal angle, and M line [ML]), urogenital hiatus, and prolapse diameter were measured at rest and maximal Valsalva, respectively. The displacement of these measurements was obtained. Results From stage 0 to 2, the variables LHL, LHW, levator plate angle, anorectal angle, and ML increased gradually, but midvagina, distal vagina, and mid-PB were the opposite. From stage 2 to 3, apex vagina, midvagina, distal vaginal, mid-PB, LHL, LHW, and ML raised rapidly and peaked at stage 3, then declined at stage 4. In addition, the correlation coefficients between each measurement from stage 2 to 3 were statistically higher than those from stage 0 to 2. Conclusions Quantified displacements of the PVW and its supporting structure were shown on dynamic MRI, and the mechanical mechanisms were hypothesized regarding the interaction between pressure and the support force contributing to the deformation of the PVW and the supporting structures.

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Section: Discussionmentioning

confidence: 57%

A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging

Qiu

Song²

2018

Female Pelvic Med Reconstr Surg

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“…After finishing the questionnaires, all participants underwent general overview of the pelvic floor which included the levator plate lift measurement by 2D transperineal ultrasound (BK ultrasound, Analogic, Peabody, MA) using the 8802 probe (6‐3 MHz; the distance between the levator plate and the posterior caudal aspect of the pubic symphysis) (Figure ). We also used the 8838 endovaginal probe (12‐4 MHz; the distance between the levator plate and the posterior vaginal epithelium) (Figure ) at rest and during the squeeze maneuver because this methodology has been shown to be highly reliable, repeatable, and correlate well with both the pelvic floor function and the levator ani anatomy . The measurement sequence is as follows:…”

Section: Methodsmentioning

confidence: 99%

“…We also used the 8838 endovaginal probe MHz; the distance between the levator plate and the posterior vaginal epithelium) ( Figure 2) at rest and during the squeeze maneuver because this methodology has been shown to be highly reliable, repeatable, and correlate well with both the pelvic floor function and the levator ani anatomy. 13 The measurement sequence is as follows:…”

Section: Methodsmentioning

confidence: 99%

Ultrasongraphic age‐related changes of the pelvic floor muscles in nulliparous women and their association with pelvic floor symptoms: A pilot study

Alshiek

Shobeiri

Wei

et al. 2019

Neurourology and Urodynamics

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Objective To assess age‐related changes in the pelvic floor muscular hiatus and their association with symptoms of pelvic organ prolapse, urinary and fecal incontinence, and sexual function. Methods In this pilot study we performed 3D endovaginal ultrasonography in two age groups of nulliparous women: 18 to 40 years and 52 to 85 years. Anterior‐posterior (AP) diameter, left‐right (LR) diameter, and the Minimal Levator Hiatus area were measured. The AP/LR ratio was calculated to compare the shape of the pelvic floor muscles between participants (oval vs circular). Other measurements included length of the urethra, and levator plate lift. Participants were assessed for (1) distress symptoms of pelvic floor prolapse, urinary, and fecal symptoms by the Pelvic Floor Distress Inventory‐20, (2) quality of life via the pelvic floor impact inventory‐7, and (3) sexual function by the female sexual function inventory (FSFI‐19). Results A total of 12 women into the younger group and 10 to the older group were recruited. Older women had higher AP/LR ratio and longer distance levator plate lift while performing the squeeze maneuver ( P = 0.017 and 0.038, respectively). Older women had worse urinary and pelvic organ prolapse symptoms ( P = 0.002 and 0.004, respectively). Fewer women in the older group were sexually active (60% vs 92%) and their quality of sexual life was lower based on their FSFI‐19 results. Conclusion Levator ani muscle hiatus changes to a more oval form in older nulliparous postmenopausal women and this change in shape is associated with increased pelvic floor symptoms.

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“…As recent research has gravitated towards patient-oriented, outcome-based designs, objective assessment of PFMT with instruments such as a perineometer may be unnecessary. It has been shown that severe levator ani deficiency (LAD) increases the odds of POP sevenfold 6 7. It would be interesting to know if LAD status would predict intervention responders and non-responders.…”

Section: Commentarymentioning

confidence: 99%

Individualised pelvic floor muscle training is an effective conservative treatment in women with pelvic organ prolapse

Shobeiri

Santiago

2014

Evid Based Med

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Levator plate descent correlates with levator ani muscle deficiency

Abstract: Worsening LAD score is associated with levator plate descensus and with decreasing levator plate descent angle. We can use levator plate descent angle along with the minimal levator hiatus and anorectal angle as objective measurements to assess levator ani muscle deficiency.

Cited by 31 publications

References 42 publications

A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging

A Hypothesis Generating the Mechanical Systems Underlying Posterior Vaginal Prolapse Based on Observed Displacements by Dynamic Magnetic Resonance Imaging

Ultrasongraphic age‐related changes of the pelvic floor muscles in nulliparous women and their association with pelvic floor symptoms: A pilot study

Individualised pelvic floor muscle training is an effective conservative treatment in women with pelvic organ prolapse

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