The prevalence of major abnormalities of the levator ani in urogynaecological patients

Abstract

Objectives While morphological abnormalities of the pubovisceral muscle have been described on magnetic resonance imaging (MRI), their relevance remains unclear. This study was designed to define prevalence and clinical significance of such abnormalities in urogynaecological patients. Design Prospective observational study. Setting Tertiary urogynaecological clinic. Population Three hundred and thirty‐eight consecutive women referred for urodynamic assessment. Methods Participants underwent a clinical assessment, multichannel urodynamics and imaging with 3D translabial ultrasound. Blinded offline analysis was performed with the software 4D View (GE Kretztechnik, Zipf, Austria). Main outcome measures Major morphological abnormalities of the pubovisceral muscle. Results Defects of the pubovisceral muscle were found in 15.4% of parous women. They were exclusively anteromedial (uni‐ or bilateral), only occurred among women who had delivered vaginally and were associated with anterior and central compartment prolapse (all P < 0.001). There was no association with symptoms of bladder dysfunction or urodynamic findings. Conclusions Major morphological abnormalities of the pubovisceral muscle are common in parous urogynaecological patients. They are associated with prolapse of the anterior and central compartment, but not with symptoms of bladder dysfunction or urodynamic findings.

Levator ani muscle avulsion during childbirth: a risk prediction model

“…LAM avulsion can be diagnosed reliably using TUI on TPUS at maximum pelvic floor muscle contraction as excellent agreement was found between two raters [Cohen's j 0.83 (95% confidence interval [95% CI] 0.59-1.0)]. 21 …”

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

“…It is clearly related to vaginal childbirth [3,4], with Forceps delivery, length of second stage and foetal size as likely risk factors [5,6]. Such trauma is associated with abnormal muscle biometry and function as well as female pelvic organ prolapse [1,2,[7][8][9]. Avulsion increases the area of the levator hiatus [5,7], the largest potential hernial portal in the abdominal envelope.…”

Evaluation of pelvic floor muscle anatomy and function in women: modern techniques

“…Trójwymiarowe i czterowymiarowe badanie USG pozwala na bardzo szczegółową ocenę mięśni dźwigaczy odbytu i wymiarów rozworu moczowo--płciowego [8,9,13]. Ustalono wiarygodną metodę oceny morfologii dna miednicy i diagnozy urazu poporodowego mięśni dźwigaczy odbytu [14][15][16][17][18], a ostatnio także różnicową ocenę wypadania narządu rodnego [19,13]. Ultrasonografie te były używane do oceny wyników demonstrujących zmiany w grubości mięśni dna miednicy, długości mięśni w pozycji spoczynkowej pęcherza moczowego oraz podczas próby Valsalvy oraz średnicy rozworu moczowo-płciowego jako odpowiedź na zastosowanie ćwiczeń PFM [17] i są bardzo obiecujące jako techniki oceniające efekt programów fizjoterapii w przyszłości.…”