Aims and objectives
The levator ani muscle (LAM) is a broad muscular sheet of variable thickness attached to the internal surface of the bony pelvis.
There is significant controversy about the sub-divisions of the muscle,
however,
it is broadly accepted that it is subdivided into parts according to their attachments,
namely the iliococcygeus,
pubococcygeus,
and ischiococcygeus.
The pubococcygeus is further subdivided into separate parts according to the viscera they are related to e.g pubourethralis,
pubovaginalis and puborectalis1-6.
The components of the LAM differ from most other skeletal muscles...
Methods and materials
We performed a cross-sectional study on 135 women four years after their first delivery,
who were previously recruited as part of a prospective longitudinal study.
Symptoms were assessed with the validated International Consultation on Incontinence Questionnaires.
Pelvic floor muscle strength (PFMS) was assessed with the Modified Oxford Score (MOS) and pelvic organ prolapse with the validated ICS-POP-Q.
All patients underwent 3D/4D Transperineal US (with the use ofconvex probe 4-8.5 MHz,
Voluson,
GE),
(Fig.) high frequency 3D Endovaginal US (with the use ofrotational 360° automatic acquisition...
Results
Mean age was 34.8 (SD 5.5) years,
BMI 26.5 (SD 6.0) and parity 1.5 (SD 0.6).
Time after first delivery was 3.8 (0.4 SD) years.
Time between US and MRI was 21 (SD 49) days.
On MRI 23 (17%) had a minor and 3 (2%) a major LAM avulsion.
Both TPUS and EVUS showed a poor sensitivity (26-39%) for minor LAM avulsion and an excellent sensitivity (100%) for major LAM avulsion (Table 1).
Specificity was excellent (93-97%) for both US techniques for minor and major...
Conclusion
This is the first prospective study to investigate the accuracy of three imaging techniques for LAM avulsion in the same patient.
Ultrasound is a good diagnostic tool for the assessment of major LAM avulsion (high sensitivity),
but poor for detecting minor avulsions (low sensitivity).
LAM avulsion seen on EVUS correlates better with expected symptoms than MRI and TPUS.
It therefore appears that EVUS is better in diagnosing symptomatic LAM avulsion and could substitute MRI as a reference standard.
Using EVUS instead of MRI enables widespread...
Personal information
Isabelle van Gruting- research fellow- Urogynaecology and Pelvic Floor Reconstruction Unit,
Croydon University Hospital,
London,UK
Aleksandra Stankiewicz,
MD,PhD- Consultant Radiologist,
Radiology Department,
Croydon University Hospital,
London,
UK
Abdul H.
Sultan,
MD,FRCOG- Consultant Gynaecologist,
Urogynaecology and Pelvic Floor Reconstruction Unit,
Croydon University Hospital,
London,UK
Ranee Thakar,
MD,
FRCOG- Consultant Urogynaecologist,
Urogynaecology and Pelvic Floor Reconstruction Unit,
Croydon University Hospital,
London,UK
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