Bilateral avulsion of the puborectal muscle: magnetic resonance imaging‐based three‐dimensional reconstruction and comparison with a model of a healthy nulliparous woman

Otčenášek, M; Krofta, Ladislav; Báča, Václav; Grill, Robert; Kucera, E; Herman, H.; Vasicka, Ian; Drahonovsky, Jan; Feyereisl, Jaroslav

doi:10.1002/uog.4030

Cited by 46 publications

(24 citation statements)

References 15 publications

(16 reference statements)

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“…For bilateral avulsion, this relationship is even stronger, with a sevenfold increase in the risk of uterine prolapse. This is not surprising, given the degree of architectural compromise implied by such trauma [50]. Those findings are consistent with results recently obtained by magnetic resonance imaging [51].…”

Section: Pregnancy and Childbirthsupporting

confidence: 81%

The aetiology of prolapse

Dietz

2008

Int Urogynecol J

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Female pelvic organ prolapse is a common condition that is said to be multifactorial in aetiology. While a number of risk factors such as vaginal childbirth, obesity and ageing are commonly accepted, it is not clear as to how these risk factors affect the development of prolapse-that is, which pathophysiologic mechanisms are responsible for disease manifestation. Measures used in epidemiological studies, such as presentation for surgical treatment, are generally confounded by other conditions, and evidence is lacking for some of the most frequently quoted aetiological factors. In this paper, I will try to summarise the available evidence in order to separate hearsay and hypothesis from available research findings and to suggest a way forward for diagnosis and treatment.

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Section: Pregnancy and Childbirthsupporting

confidence: 81%

The aetiology of prolapse

Dietz

2008

Int Urogynecol J

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“…The commonest form of trauma, avulsion injury, has a major effect on the integrity and function of the pelvic floor [6,18], especially if there is bilateral trauma [19]. It is Fig.…”

Section: Discussionmentioning

confidence: 99%

Validity and reproducibility of the digital detection of levator trauma

2008

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Levator ani muscle trauma is a common consequence of vaginal childbirth and detectable on digital vaginal palpation. To ascertain validity and reproducibility of this test, we saw 110 women for an interview, prolapse staging, digital vaginal palpation by two blinded examiners and four-dimensional translabial ultrasound. The mean age was 55.5 years (range 17-85) and the median parity was 2 (range 0-8). Three patients could not be assessed, leaving 107 datasets representing 214 assessments of a right or left puborectalis muscle. Levator defects were found in 21 women (20%) with nine bilateral defects. There was agreement between assessors in 173/214 (81%), k=0.411, signifying moderate agreement. Agreement with an independent blinded review of tomographic ultrasound data was k=0.495. Even after substantial training, the agreement between assessors using digital palpation for the diagnosis of levator trauma remains only moderate. There seems to be a substantial learning curve. Palpatory detection of major levator trauma is less repeatable than identification by ultrasound.

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“…It is to be expected that the disconnection of a muscle from its insertion, even if partial, should have an effect on contraction strength, not least the capacity to lift, which is an important component of the modified Oxford scale. From ultrasound and magnetic resonance imaging, it appears that levator avulsion results in dorsocranial retraction of the avulsed muscle [6], reducing the capacity of the muscle to narrow the levator hiatus.…”

Section: Introductionmentioning

confidence: 99%

Levator avulsion and grading of pelvic floor muscle strength

2007

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In a retrospective study investigating the relationship between levator avulsion and clinical grading of levator ani muscle strength, we analyzed the 3D/4D translabial ultrasound and digital assessment data of 1,112 women seen in a tertiary Urogynecological clinic. Levator avulsion was diagnosed whenever the examiner was unable to palpate the insertion of the pubovisceral muscle on the inferior pubic ramus and/or whenever a discontinuity between bone and muscle was detected on ultrasound. For clinical grading of levator muscle strength, we used the modified Oxford grading. Avulsion defects were found in 252 women (23%), and this was associated with a highly significant reduction in the overall Oxford grading (2.07 vs 2.81, P < 0.001). The prevalence of avulsion increased depending on the side differences in the modified Oxford grading: from 16% when there was no difference to 76% when the side difference was 1.5 or higher (P < 0.001). Avulsion of the puborectalis muscle seems to have a marked effect on pelvic floor muscle strength, which may help in diagnosing trauma.

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Bilateral avulsion of the puborectal muscle: magnetic resonance imaging‐based three‐dimensional reconstruction and comparison with a model of a healthy nulliparous woman

Abstract: Objectives

Cited by 46 publications

References 15 publications

The aetiology of prolapse

The aetiology of prolapse

Validity and reproducibility of the digital detection of levator trauma

Levator avulsion and grading of pelvic floor muscle strength

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