II.

Although anatomic results are similar, ASC is associated with a higher rate of complications compared with MISC.

Objective To determine the muscles comprising the minimal levator hiatus.Design Cross-sectional study.Setting The University of Oklahoma Health Sciences Center, USA.Population Eight female fresh frozen pelves and 80 nulliparous women.Methods Three-dimensional endovaginal ultrasound was performed in eight fresh frozen female pelves. The structures of the levator hiatus were tagged with needles and the cadavers were dissected to identify the tagged structures. A group of 80 nullipara underwent 3D endovaginal ultrasound, and the minimal levator hiatus area, puborectalis area, and anorectal angle were assessed, and normal values were obtained.Main outcome measures Anatomic borders of minimal levator hiatus and normality in pelvic floor measurements.Results The pubococcygeus forms the inner lateral border and anterior attachment of the minimal levator hiatus to the pubic bone. The puboanalis fibres are immediately lateral to pubococcygeus attachments. There are variable contributions of the puborectalis fibres lateral to the puboanalis attachment. The posterior border of the minimal levator hiatus is formed by the levator plate. Eighty community-dwelling nulliparous women underwent 3D endovaginal ultrasound. The median age was 47 years (range 22-70 years). The mean of minimal levator hiatus and puborectalis hiatus areas were 13.4 cm 2 (±1.89 cm 2 SD) and 14.8 cm 2 (±2.16 cm 2 SD). The mean anorectal and levator plate descent angles were 156°(±10.04°SD) and 15.9°(±8.28°SD).Conclusion Anterior and lateral borders of the minimal levator hiatus are formed mostly by pubococcygeus. The puborectalis, pubococcygeus, and iliococcygeus form the bulk of the levator plate.

Three-dimensional EVUS can be used to visualize structures of the anterior and posterior compartments in nullipara.

Greater reduction in point Aa and abdominal surgical route are risk factors for new onset postoperative SUI after SCP.

Worsening LAD score is associated with levator plate descensus and with decreasing levator plate descent angle. We can use levator plate descent angle along with the minimal levator hiatus and anorectal angle as objective measurements to assess levator ani muscle deficiency.

In this population of community-dwelling nulliparous women, age was associated with worsening sexual function and slightly increased odds of reporting symptoms of pelvic floor disorders.

Visualization of periurethral structures by 3D EVUS in the midsagittal plane is not associated with SUI status.