INTRODUCTION AND HYPOTHESIS: Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. METHODS: We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle. RESULTS: Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma ('partial avulsion') were not associated with symptoms or signs of pelvic floor dysfunction. CONCLUSIONS: Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.
INTRODUCTION AND HYPOTHESIS: Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. METHODS: We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle. RESULTS: Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma ('partial avulsion') were not associated with symptoms or signs of pelvic floor dysfunction. CONCLUSIONS: Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.
Authors: Kim W M van Delft; Abdul H Sultan; Ranee Thakar; S Abbas Shobeiri; Kirsten B Kluivers Journal: Int Urogynecol J Date: 2014-05-24 Impact factor: 2.894
Authors: Stéphanie Thibault-Gagnon; Sara Yusuf; Suzanne Langer; Vivien Wong; Ka Lai Shek; Andrew Martin; Hans Peter Dietz Journal: Int Urogynecol J Date: 2014-05-23 Impact factor: 2.894
Authors: Li Tan; Ka Lai Shek; Ixora Kamisan Atan; Rodrigo Guzman Rojas; Hans Peter Dietz Journal: Int Urogynecol J Date: 2015-06-14 Impact factor: 2.894