OC263: Are anal sphincter injuries related to elevator abnormalities?

Abstract

Valsalva. Subjective scores for pelvic floor muscle contraction were given on dynamic 3D and 4D using the standardized ICS terminology for assessment of pelvic muscle contraction (non-functioning, weak, normal or strong). Offline analysis of the datasets was undertaken using the software GE Kretz 4D View. Measurements were taken at the level of minimal hiatal dimensions using the inferior margin of the symphysis pubis as reference point on 2D and 3D datasets. On 2D ultrasound the diameter of the minimal anteroposterior (AP) hiatus, vertical displacement of the bladder neck and levator angle were measured. 3D datasets were used for obtaining AP and left-right diameter as well as area of the hiatus. Results: Complete datasets were available for 349 women. The proportional difference (value A rest-value A contraction/value A rest) between the above parameters was calculated. There were significant correlations (P < 0.001) in all parameters between women with no, weak, normal or strong contractions except for vertical bladder neck displacement. The proportional 2D AP difference between rest and contraction measured in the 2D volume seemed to be the strongest predictor, followed by 3D AP diameter and hiatal area. Conclusions: Proportional differences of the AP measurement between rest and contraction in 2D volumes is the easiest method for quantification of pelvic floor muscle contraction. Surprisingly, vertical bladder neck displacement did not seem to be significant between women with no, weak, normal or strong pelvic floor contractions. OC263 Are anal sphincter injuries related to elevator abnormalities?A. B. Steensma, K. J. Schweitzer, C. W. Burger, W. R. Schouten Erasmus Medical Center, NetherlandsObjectives: Extensive damage of the pelvic floor due to childbirth can lead to anatomical abnormalities such as levator defects and or anal sphincter injuries. This study was designed to investigate their incidence and prevalence in patients complaining of pelvic organ prolapse and or fecal incontinence with transperineal ultrasound. Methods: Some 164 patients were included in a prospective observational study. Transperineal ultrasound was performed in the supine position after voiding acquiring 3D/4D volumes at rest, contraction and on Valsalva using a GE Kretz Voluson 730 Expert system. For imaging of the anal sphincter complex a 3D microconvex transducer (RNA 5-9-MHz) was used. Offline analysis was performed with 4D View software with the investigator blinded to the clinical data. For quantification of the levator defects tomographic ultrasound imaging (TUI) was used. At the level of minimal hiatal dimension a set of eight slices with an interval of 2.5 mm was examined, and defects were scored from 0 to 8 for each side. The proportional difference (value rest − value contraction/value rest) for contraction was calculated for evaluation of pelvic floor function. Results: Forty-eight patients were diagnosed with an anal sphincter injury (29%), which involved the internal sphincter, external sphincter or both. A total ...

Validity and reproducibility of the digital detection of levator trauma

“…Levator defects are associated with maternal age at first delivery [4,5] and vaginal operative delivery [4,5,15]. Not surprisingly, in view of the overlap in risk factors, there also seems to be an association with anal sphincter tears [4,16] and faecal incontinence [17].…”

Modelling the likelihood of levator avulsion in a urogynaecological population

“…Avulsion of the puborectalis muscle from the pelvic sidewall is a common consequence of vaginal childbirth, 1–6 and associated with abnormal muscle biometry and function as well as female pelvic organ prolapse 7–11 . Avulsion increases the area of the levator hiatus, 7,12 the largest potential hernial portal in the abdominal envelope.…”

Traumatismes du levator ani après l’accouchement, de l’étirement à l’avulsion : revue de la littérature

“…Il semblerait que les compartiments antérieur et médian soient les plus concernés (9,13,14). Sur le versant urinaire, il n'est pas retrouvé d'association entre incontinence urinaire et présence de lésions musculaires du levator ani que ce soit dans la période du post-partum ou plus tard dans la vie de la femme (14,15,(17)(18)(19). Sur le versant ano-rectal, les atteintes du muscle pubo-rectal sont associées à des symptômes d'urgence aux selles (27,28).…”