OBJECTIVE: The purpose of this study was to determine the effect of levator defects on perineal position and movement irrespective of prolapse status. STUDY DESIGN: Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse. Perineal structure locations were measured against standard axes on magnetic resonance scans at rest, maximum contraction (Kegel), and maximum Valsalva maneuver. Differences in location were calculated and compared. RESULTS: In women with levator defects, independently of prolapse status: (1) At rest, the perineal body was 1.3 cm, and the anal sphincter was 1.0 cm more caudal (P ≤ .01); at maximum contraction, the perineal body and the anal sphincter were both 1.2 cm more caudal (P ≤ .01); with maximum Valsalva maneuver, the perineal body was 1.3 cm more caudal, and the anal sphincter was 1.2 cm more caudal (P ≤ .01). (2) At rest, the levator hiatus was 0.8 cm larger, and the urogenital hiatus was 1.0 cm larger (P ≤ .01). (3) At rest, the bladder was 0.07 cm more posterior (P ≤ .02); with maximum contraction, it was 1.9 cm lower (P ≤ .02). (4) With maximum Valsalva maneuver, the bladder was 1.5 cm lower and displaced further caudally (P ≤ .03). CONCLUSION: When we controlled for prolapse, the women with levator defects had a more caudal location of their perineal structures and larger hiatuses at rest, maximum contraction, and maximum Valsalva maneuver.
OBJECTIVE: The purpose of this study was to determine the effect of levator defects on perineal position and movement irrespective of prolapse status. STUDY DESIGN: Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse. Perineal structure locations were measured against standard axes on magnetic resonance scans at rest, maximum contraction (Kegel), and maximum Valsalva maneuver. Differences in location were calculated and compared. RESULTS: In women with levator defects, independently of prolapse status: (1) At rest, the perineal body was 1.3 cm, and the anal sphincter was 1.0 cm more caudal (P ≤ .01); at maximum contraction, the perineal body and the anal sphincter were both 1.2 cm more caudal (P ≤ .01); with maximum Valsalva maneuver, the perineal body was 1.3 cm more caudal, and the anal sphincter was 1.2 cm more caudal (P ≤ .01). (2) At rest, the levator hiatus was 0.8 cm larger, and the urogenital hiatus was 1.0 cm larger (P ≤ .01). (3) At rest, the bladder was 0.07 cm more posterior (P ≤ .02); with maximum contraction, it was 1.9 cm lower (P ≤ .02). (4) With maximum Valsalva maneuver, the bladder was 1.5 cm lower and displaced further caudally (P ≤ .03). CONCLUSION: When we controlled for prolapse, the women with levator defects had a more caudal location of their perineal structures and larger hiatuses at rest, maximum contraction, and maximum Valsalva maneuver.
Authors: Christopher J Klingele; Adil E Bharucha; J G Fletcher; John B Gebhart; Stephen G Riederer; Alan R Zinsmeister Journal: Obstet Gynecol Date: 2005-08 Impact factor: 7.661
Authors: Yvonne Hsu; Aimee Summers; Hero K Hussain; Kenneth E Guire; John O L Delancey Journal: Am J Obstet Gynecol Date: 2006-03-31 Impact factor: 8.661
Authors: Daniel M Morgan; Wolfgang Umek; Tamara Stein; Yvonne Hsu; Kenneth Guire; John O L DeLancey Journal: Int Urogynecol J Pelvic Floor Dysfunct Date: 2006-10-17
Authors: Elisa R Trowbridge; Nancy H Fultz; Divya A Patel; John O L DeLancey; Dee E Fenner Journal: Am J Obstet Gynecol Date: 2008-05 Impact factor: 8.661
Authors: John O L DeLancey; Daniel M Morgan; Dee E Fenner; Rohna Kearney; Kenneth Guire; Janis M Miller; Hero Hussain; Wolfgang Umek; Yvonne Hsu; James A Ashton-Miller Journal: Obstet Gynecol Date: 2007-02 Impact factor: 7.661
Authors: Yvonne Hsu; Luyun Chen; Aimee Summers; James A Ashton-Miller; John O L DeLancey; James O L DeLancey Journal: Int Urogynecol J Pelvic Floor Dysfunct Date: 2007-06-20
Authors: Ingrid Nygaard; Matthew D Barber; Kathryn L Burgio; Kimberly Kenton; Susan Meikle; Joseph Schaffer; Cathie Spino; William E Whitehead; Jennifer Wu; Debra J Brody Journal: JAMA Date: 2008-09-17 Impact factor: 56.272
Authors: Anne G Sammarco; Lahari Nandikanti; Emily K Kobernik; Bing Xie; Alexandra Jankowski; Carolyn W Swenson; John O L DeLancey Journal: Am J Obstet Gynecol Date: 2017-07-11 Impact factor: 8.661
Authors: Cornelia Betschart; Jinyong Kim; Janis M Miller; James A Ashton-Miller; John O L DeLancey Journal: Int Urogynecol J Date: 2014-05-15 Impact factor: 2.894
Authors: Mary Rieger; Pamela Duran; Mark Cook; Simon Schenk; Manali Shah; Marni Jacobs; Karen Christman; Deborah M Kado; Marianna Alperin Journal: Ann Biomed Eng Date: 2021-03-08 Impact factor: 3.934