Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?

Andrew, Bronwyn; Shek, Ka Lai; Chantarasorn, Varisara; Dietz, Hans Peter

doi:10.1111/ajo.12026

Cited by 44 publications

(38 citation statements)

References 29 publications

(44 reference statements)

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“…Moreover, we did not include perineometry as another objective grading tool. We included patients after pelvic floor surgeries, although such interventions can affect bladder neck mobility and hiatal dimensions [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound

Albrich

Steetskamp

Knoechel

et al. 2015

Arch Gynecol Obstet

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Section: Discussionmentioning

confidence: 99%

Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound

Albrich

Steetskamp

Knoechel

et al. 2015

Arch Gynecol Obstet

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“…While this is irrelevant for avulsion (as avulsion is due to childbirth and unlikely to change over time), it may be of importance for hiatal ballooning, that is, excessive distensibility of the levator hiatus. In own prospective work, we recently were able to show a strong association between pre-and postoperative hiatal dimensions without any confounding effect of successful prolapse surgery, 30 but it seems likely that ballooning may be an effect as well as cause of prolapse, at least in some individuals. Hence, the association observed by us will have to be tested in larger prospective series.…”

Section: Commentmentioning

confidence: 97%

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

Rodrigo

Wong

Shek

et al. 2014

Aust NZ J Obst Gynaeco

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Aims: Female pelvic organ prolapse is a common condition. Prolapse recurrence following surgical treatment is a significant clinical issue. The aim of this study was to determine risk factors for recurrence, attempting to improve clinical practice by allowing better patient selection prior to surgery. Methods: This was a retrospective study utilising patient records and ultrasound volume imaging data sets obtained in four clinical audits following anterior colporrhaphy AE mesh. Prolapse recurrence was diagnosed clinically and by ultrasound; findings were analysed against potential predictors. Results: Symptomatic prolapse recurrence was demonstrated in 86 (26%), on clinical examination in 141 (42%) and on ultrasound in 113/334 women (34%). None of the tested predictors were predictive of recurrent symptoms, likely due to a lack of power. However, both levator avulsion and hiatal area on Valsalva were shown to be highly significant predictors of objective prolapse recurrence on clinical examination and ultrasound. Conclusions: Prolapse recurrence following surgery is a common complaint. The state of the patient's pelvic floor muscle seems to be the strongest determinant.

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“…Three factors are known to be associated with anterior vaginal wall prolapse: Apical descent [10, 11], levator ani muscle damage [12–15] and an enlarged levator hiatus [16] that is related to levator damage. What has been lacking is a biomechanically plausible conceptual model of how these factors interact to cause prolapse.…”

Section: Introductionmentioning

confidence: 99%

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

et al. 2014

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Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation. Methods Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined. Results A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R2=0.91, P<0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R2=0.85, P<0.001). Conclusion A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.

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Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect?

Abstract: Surgery for female pelvic organ prolapse is associated with a small but significant reduction in hiatal area, but abnormal hiatal distensibility persists in most cases. This suggests that excessive hiatal distensibility is more likely the cause rather than the effect of prolapse.

Cited by 44 publications

References 29 publications

Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound

Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound

The use of 3‐dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

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