Static and dynamic MRI features of the levator ani and correlation with severity of genital prolapse

Ansquer, Yan; Fernandez, P.; Chapron, Charles; Frey, Catherine A.; Bennis, Malika; Roy, Carine; Salomon, Laurence; Mandelbrot, Laurent; Carbonne, Bruno

doi:10.1080/00016340600984837

Cited by 21 publications

(20 citation statements)

References 19 publications

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“…17 Similarly, Ansquer et al found that anterior and apical compartment prolapse was correlated with increasing hiatus size and levator plate angle; in the posterior compartment, however, anterior rectal bulging with straining was inversely correlated with hiatus size at rest. 18 In these studies and ours, a general process of caudal displacement of the perineal structures and hiatal enlargement in women with prolapse occurs that seems to be independent of whether the anterior or posterior wall prolapse dominates. Clinically, our finding becomes relevant as it suggests that rectoceles and enteroceles are not necessarily just the result of focal, or site-specific, defects in connective tissue or “fascia”, but rather a more overall weakening and deformation of the pelvic floor connective tissues and levator support.…”

Section: Commentsupporting

confidence: 65%

Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse

Lewicky-Gaupp

Yousuf

Larson

et al. 2010

American Journal of Obstetrics and Gynecology

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Objective Compare pelvic structure location on MRI during maximal Valsalva among women with posterior prolapse and those with normal support. Methods and Materials Cases (n=37) had posterior vaginal wall (PVW) prolapse > +1cm. All underwent mid-sagittal, dynamic MRI. Structure locations (distal vagina, apex, perineal body, external anal sphincter) were determined. PVW length, levator and urogenital hiatus diameters, and prolapse diameter were measured. Results Cases had more caudal structures (p<0.001) and larger hiatus diameters (p<0.005); the posterior wall was longer, while the straight-line distance between the apex and distal vagina was shorter. In enteroceles, the apex was more ventrally displaced compared to rectoceles (p=0.003). Unlike apical descent (r=-0.3, p=0.1), PVW length and point Bp were correlated with MRI prolapse size (r=0.5, p=0.002; r=0.7, P<0.001, respectively). Conclusion At maximal Valsalva on MRI, structures are more caudal in women with posterior prolapse. The posterior vaginal wall is longer; this length strongly correlates with prolapse size.

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Section: Commentsupporting

confidence: 65%

Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse

Lewicky-Gaupp

Yousuf

Larson

et al. 2010

American Journal of Obstetrics and Gynecology

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“…It is known that larger levator hiatus measurements and more caudal levator plate angles on MRI are associated with pelvic organ prolapse. 21,22 However, studies looking at hiatal measurement changes with aging in women without prolapse are sparse. In our study, fecal incontinence was not associated with changes in hiatus or levator plate measurements.…”

Section: Commentmentioning

confidence: 99%

Fecal incontinence in older women: are levator ani defects a factor?

Lewicky-Gaupp

Brincat

Yousuf

et al. 2010

American Journal of Obstetrics and Gynecology

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Objective To compare pelvic floor structure and function between older women with and without fecal incontinence (FI) and young continent women. Study Design Young (YC, n=9) and older (OC, n=9) continent women were compared to older women with FI (OI, n=8). Patients underwent a POP-Q, measurement of levator ani (LA) force at rest (FLAR) and with maximum contraction (FLAC), and MRI. Displacement of structures and LA defects were determined on dynamic MRI. Results LA defects were more common in the OI v. the YC (75% v. 11%, p=0.01) and OC groups (22%, p=0.14); women with FI were more likely to have LA defects than women without (OR 14.0, 95% CI: 1.8-106.5). OI women generated 27.0% and 30.1% less FLAC v. the OC group (p=0.13) and YC groups (p=0.04). During Kegel, OI absolute structural displacements were smaller than in the OC group (p=0.01). Conclusions OI women commonly have LA defects, and cannot augment pelvic floor strength.

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“…Procedures to ameliorate pelvic function may fail if the pelvic floor muscles have poor tone. The size of levator hiatus in patients with pelvic organ prolapse is related to the severity of prolapse, that is, the wider the levator hiatus was, the more severe the prolapse was [11][12][13] . At present, pelvic organ prolapse quantification (POP-Q) system has been recognized as the objective and validated assessment of prolapse in clinic [14] .…”

Section: Discussionmentioning

confidence: 99%

Assessment of levator hiatus by 3D ultrasound volume contrast imaging in normal nulliparas

Ying¹,

Hu²,

Li³

2009

J. Shanghai Jiaotong Univ. (Sci.)

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The ability of 3D ultrasound volume contrast imaging in C-plane (VCI-C) in the assessment of female levator hiatus was analyzed in eighty normal nulliparas. Interoperator variability in levator hiatus measurements was analyzed. The comparison of the axial image of magnetic resonance imaging (MRI) and C-plane image of volume contrast imaging (VCI) in thirty normal nulliparas was also done. It shows that VCI-C can clearly demonstrate the structure and accurately quantitates the size of the levator hiatus. It is reliable, convenient and without contraindication in assessment of female levator hiatus. The technology opens up entirely new modality for assessing female pelvic floor.

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Static and dynamic MRI features of the levator ani and correlation with severity of genital prolapse

Abstract: In a population of women with genital prolapse, MRI evaluation of the levator ani was associated with MRI evaluation of the severity of genital prolapse.

Cited by 21 publications

References 19 publications

Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse

Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse

Fecal incontinence in older women: are levator ani defects a factor?

Assessment of levator hiatus by 3D ultrasound volume contrast imaging in normal nulliparas

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