Prevalence of pubovisceral muscle avulsion in a general gynecology cohort: A computed tomography (CT) study

Abstract

The prevalence of pubovisceral muscle avulsion using CT scanning in a general gynecology cohort is 6.4%. Thinning of the pubovisceral muscle occurs with parity and protracted labor and is more prominent on the left portion of the muscle.

3 T MRI-based measurements for the integrity of the female pelvic floor in 25 healthy nulliparous women

“…Our results of the levator symphysis gap with 19.8 mm for the right side and 21.3 mm for the left side were well comparable to the results by Derpapas et al, reporting 21.2 mm for the right side and 22.5 mm for the left side ( P = 0.17, P = 0.29) . However, the mean values in our study were higher compared to Singh et al using a 3D‐MRI‐model, reporting 17.4 mm for the right side and 18.0 mm for the left side ( P = 0.03, P < 0.05) …”

“…On the one hand, Zhuang et al defined the measurement on a 3D model as the distance from the middle of the inferior symphysis to the nearest aspect of the pubovisceral muscles on each side . On the other hand, Singh et al and Derpapas et al measured each side of the levator symphysis gap as the distance from the anterior aspect of the levator ani muscle to the closest point of the pubic symphysis on transversal plane . In our study, we measured the width from the anterior‐lateral part of the puborectal muscle to the most lateral part of the pubic symphysis still visible on the same transversal slice, similar to Derpapas et al on axial CT scans, as there was no muscle avulsion …”

“…Injuries of the levator ani muscle are considered a common cause of pelvic floor dysfunction, increasing with age, obesity, and especially after vaginal childbirth and were evaluated in recent studies using ultrasound or cross‐sectional imaging modalities . Therefore, the detection of these injuries, especially avulsion of the puborectalis muscle, has been of growing interest for urogynecologists.…”

“…As descriptions of the measurement technique for the levator symphysis gap in the literature are inconsistent, we measured both sides to determine the distance from the anterior‐lateral part of the puborectal muscle to the most lateral part of the pubic symphysis (Fig. ) …”

Do ultrasound findings of levator ani “avulsion” correlate with anatomical findings: A multicenter cadaveric study

“…Other studies have found the risk of urinary incontinence decreased, a highly counterintuitive finding . The prevalence of “avulsion” varies significantly, ranging from 6% to 50%, depending on the imaging technique used …”