The Association between Levator-Urethra Gap Measurements and Symptoms and Signs of Female Pelvic Organ Prolapse

Ixora Kamisan @ Atan, Ka Lai Shek, Glefy Inacio Furtado, Jessica Caudwell-Hall, Hans Peter Dietz

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives Levator avulsion is associated with pelvic organ prolapse in women. It is diagnosed clinically by a widened gap on palpation between the insertion of the puborectalis muscle on the inferior pubic ramus and the urethra. This gap can also be assessed on imaging. This study aimed to determine the association between sonographically determined levator-urethral gap (LUG) measurements and symptoms and signs of prolapse. Methods This is a retrospective study on 450 women seen in a tertiary urogynecological center for symptoms of pelvic floor dysfunction between January 2013 and February 2014. All had a standardized interview, International Continence Society Pelvic Organ Prolapse Quantification assessment and 4-dimensional translabial ultrasound. Post-imaging analysis of archived ultrasound volumes for LUG measurement was undertaken on tomographic slices at the plane of minimal hiatal dimensions and within 5-mm cranial to this plane, bilaterally at an interslice interval of 2.5 mm, blinded against all clinical data. A LUG of 25 mm or greater was considered abnormal. Results Mean LUG and maximum LUG in individuals were 22.5 mm (SD, 4.6) and 26.4 mm (SD, 6.0), respectively, with at least 1 abnormal LUG in 51% (n = 222). An abnormal LUG in all 3 slices involving the plane of minimal hiatal dimensions and within 5 mm cranial to this plane on at least 1 side was fulfilled in 24% (n = 103). The LUG measurements were strongly associated with bother, symptoms and signs of prolapse (P < 0.001 to 0.002). This remained significant on multivariate analysis controlling for potential confounding factors. Conclusions Sonographically determined LUG is strongly associated with symptoms, symptom bother, and pelvic organ prolapse on clinical examination and imaging.

Original languageEnglish
Pages (from-to)442-446
Number of pages5
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume22
Issue number6
DOIs
Publication statusPublished - 1 Nov 2016

Fingerprint

Pelvic Organ Prolapse
Urethra
Signs and Symptoms
Prolapse
Pelvic Floor
Palpation
Multivariate Analysis
Retrospective Studies
Interviews
Muscles

Keywords

  • levator avulsion
  • levator-urethra gap
  • pelvic organ prolapse

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynaecology
  • Urology

Cite this

The Association between Levator-Urethra Gap Measurements and Symptoms and Signs of Female Pelvic Organ Prolapse. / Kamisan @ Atan, Ixora; Shek, Ka Lai; Furtado, Glefy Inacio; Caudwell-Hall, Jessica; Dietz, Hans Peter.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 22, No. 6, 01.11.2016, p. 442-446.

Research output: Contribution to journalArticle

Kamisan @ Atan, Ixora ; Shek, Ka Lai ; Furtado, Glefy Inacio ; Caudwell-Hall, Jessica ; Dietz, Hans Peter. / The Association between Levator-Urethra Gap Measurements and Symptoms and Signs of Female Pelvic Organ Prolapse. In: Female Pelvic Medicine and Reconstructive Surgery. 2016 ; Vol. 22, No. 6. pp. 442-446.
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